International Medical Education

Indonesia is currently revamping its medical sector—a process dubbed medical transformation. In place of this transformation, medical education has also received spotlights due to the number of medical universities and the lack of medical specialists in Indonesia. Therefore, several plans will revolutionize Indonesian medical education and its health system. This commentary will briefly comment on those transformations and their potential impact in the near and distant future. Full article

Due to the COVID-19 pandemic, educational institutions globally were forced to close, resulting in a transition to online learning. However, this transition increased screen time and made e-learners more vulnerable to biopsychosocial issues. This study aimed to assess the impact of online learning on the eyes and mental health of medical science students, including those pursuing MBBS, Nursing, Optometry, Pharmacy, and Veterinary degrees during the COVID-19 lockdown period. A cross-sectional quantitative study was conducted, collecting online data from 182 samples using a socio-demographic data sheet (SDVS), Computer Vision Symptom Scale (CVSS 17), and the Perceived Stress Scale (PSS 10). Results revealed that most students spent between 2 and 4 h and >7 h on electronic devices before and during COVID-19, respectively, with many reporting moderate mental stress and eye strain. A weak positive correlation (r = 0.204 at p < 0.05) was found between perceived stress and eye strain, with the 24–29 age group reporting higher mean scores for eye strain. Female participants in the study reported higher mean scores for both eye strain and perceived stress. Additionally, the study found significant associations between eye strain and the electronic devices used, the program of study, and perceived stress levels. The participants’ ethnicity was also found to impact eye strain levels. The study concludes that the transition to online learning during COVID-19 caused moderate to severe levels of eye strain and mental stress, indicating the need for interventions for the student community. Full article

Background: The effect of the COVID-19 pandemic has transformed medical education and is likely to have long-lasting effects on student learning, mental well-being, and eating behaviour. This study aimed to examine the learning behaviours of medical students at the American University of Integrative Sciences (AUIS), Barbados, during the COVID-19 pandemic. Methods: A cross-sectional web-based on-line survey was administered to medical students at AUIS from July to November 2021. The data collecting instrument recorded students’ demographic and learning behaviour information and eating disorders (SCOFF questionnaire). Results: The overall response rate was 55% (n = 120). In relation to learning behaviour, students agreed with the following statements: ‘deterioration in work performance and studying’ (48.4%), ‘remember subject’s contents appropriately’ (40.4%), ‘concentration on the studies’ (40.3%), ‘difficulty in performing two tasks simultaneously’ (38.7%), ‘difficulty in performing mental calculations’ (33.9%), ‘difficulty in recalling recent information’ (32.3%), and ‘difficulty in recalling old information’ (38.7%). Among the eight dimensions of learning behaviours, deterioration in work performance or studying and difficulties in recalling recent information were found to be significantly associated with the gender of the students. For the SCOFF questionnaire, approximately 24.2% screened positive for eating disorders. Screening with the SCOFF test demonstrated that females, older (>25 years), overweight + obese, Clinical Sciences + PreMed, and non-USA-based students were at more risk of eating disorders. Conclusions: The results indicate that during the COVID-19 pandemic, AUIS students have developed learning difficulties and are likely to have eating disorders. University policymakers should take appropriate measures to support a healthy learning environment and improve students’ mental well-being and eating behaviours. Full article

Reviews of the literature on leadership training in undergraduate medical education have been conducted since 2014. Previous reviews have not identified networks, defined leadership, studied the selection criteria for instructors, nor analyzed leadership as interprofessional or transprofessional education. This scoping review fills these gaps. Inclusion criteria included use of competency-based education to teach leadership in universities, and quality assessment. Indexes and grey literature in Spanish, Portuguese, and English languages were included from six databases. Hand searching and consultation were employed for selected bodies of literature. This review identified leadership interventions in nine countries which had national and international networks primarily in English-speaking and European countries. No literature was found in Spanish-speaking or Portuguese-speaking countries, nor in Africa. Teaching leadership was linked mainly with undergraduate medical education and interprofessional education. This review identified 23 leadership and leader definitions and underscored the importance of including values in leadership definitions. Instructors were selected by discipline, role, experience, and expertise. This review may be used to inform the teaching of leadership in undergraduate medical curricula by suggesting potential networks, reflecting on diverse leadership definitions and interprofessional/transprofessional education, and assisting in selection of instructors. Full article

Introduction: The purpose of our report is to describe the design and implementation of the first antimicrobial stewardship certificate program (ASCP) in the United Arab Emirates (UAE). Methods: The ASCP was implemented in January 2019. A needs assessment was conducted before the implementation of the program. The program delivery utilized a blended learning format with both a live and an experiential component. Learner assessments consisted of pre- and post-course assessments, as well as structured feedback throughout the course. Course assessments and post-course evaluation results were utilized to assess the certificate program (CP) outcomes. Results: Between January 2019 to March 2020, 24 pharmacists were trained through the program. All participants passed the post-course assessment. Participants scored a median of 40 percent on the pre-course assessment at the start of the program and a median of 80 percent on the post-course assessment (p-value < 0.0001), demonstrating a significant improvement in their baseline knowledge. Overall, participants were highly satisfied with the program and felt that it would enhance their ability to take care of patients and/or result in practice change in their institution. Conclusions: The ASCP enhanced the knowledge of pharmacists in antimicrobial stewardship. The implemented model provides a sustainable blueprint for future CPs in specialty areas of practice for the Middle East region. Full article

Problem-based learning (PBL) is an active learning technique that promotes a life-long learning approach to understanding and using the principles of clinical medicine. It does so by helping learners hone their critical thinking skills in a team-based environment. It was originally developed for use in live, in-person settings. During the COVID-19 pandemic, it has had to be rapidly adapted for online delivery. In this article, we first highlight the key challenges faced by educators and learners in making this transition. We then share five lessons for effectively translating in-person PBL curricula to online and hybrid learning formats. Full article

Providing international medical educators with opportunities for faculty development has become a favorable moment for capacity building and the creation of partnerships with universities around the world. It has also become a social responsibility when such a development implies growth and improvement for the institutions involved. In 2018 and 2019, the University of Alberta Faculty of Medicine & Dentistry designed and delivered an international faculty development program (IFDP) in Edmonton, Canada, in collaboration with the faculty management from Jilin University and Wenzhou Medical University, and Shandong University. The inspiration for program driven by capacity development for three universities in China, all of whom were developing strategies to respond to new government policies for medical education. The focus of the course was based on the needs that the three institutions expressed: teaching innovation, research, and quality curriculum development. By design, the two-week, in-person program included lectures, personal tutorials, class and laboratories observations, as well as guided teaching visits to hospitals and university museums. Recommendations are offered to assist other international faculty development programs focused on capacity building for medical education. Full article

Background: Social accountability is defined as “the obligation of medical schools to direct their education, research and service activities toward addressing the priority health concerns of the community, region, and/or nation that they have a mandate to serve”. It is becoming increasingly critical in evaluating medical school performance and education quality. Medical students must have an appropriate understanding of social accountability. This study explores knowledge, attitudes and institutional readiness as perceived by medical students towards social accountability. Method: An independent online cross-sectional survey was conducted, which included 121 medical students recruited through a convenience sampling technique. The survey instruments were validated through a pilot study and the responses were analyzed using chi-squared (χ²) tests. Frequencies and percentages were computed. Results: A total of 69% of students understood SA, 61.2% believed they demonstrated SA, and 82.6% believed it has a positive impact on their attitudes and behaviors. About 52.1% believed that their school has a positive impact on the community with a curriculum that includes (52.9%) and reflects the needs of the population that they will serve (49.6%). Conclusion: Based on the findings, a significant number of students have knowledge about social accountability, have a positive attitude towards the concept, and believe that their institution demonstrates readiness. Full article

Good Clinical Judgment (GCJ) is associated with clinical excellence and accolades whereas poor clinical judgment is often associated with suboptimal care and the need for remediation. Although commonly referenced in practice, a shared definition for GCJ based on primary data is lacking. We interviewed 16 clinicians and surgeons across different specialties at one Canadian academic center to understand their conceptualization of GCJ. The data analysis led to the formulation of three pillars that were viewed by participants as core ingredients of GCJ. These included (1) a strong baseline knowledge and breadth of clinical experience, (2) the demonstration of curiosity, reflection, and wisdom, and (3) an ability to attend to contextual factors and understand the “bigger picture” when providing care to patients. Although there were inconsistent opinions regarding whether GCJ is innate or learned, participants reflected on strategies to support the development or improvement in clinical judgement for trainees. Full article

Background: Delivering impactful feedback is a skill that is difficult to measure. To date there is no generalizable assessment instrument which measures the quality of medical education feedback. The purpose of the present study was to create an instrument for measuring educator feedback skills. Methods: Building on pilot work, we refined an assessment instrument and addressed content and construct validity using expert validation (qualitative and quantitative). This was followed by cognitive interviews of faculty from several clinical departments, which were transcribed and analyzed using ATLAS.ti qualitative software. A research team revised and improved the assessment instrument. Results: Expert validation and cognitive interviews resulted in the Educator Feedback Skills Assessment, a scale with 10 items and three response options for each. Conclusions: Building on the contemporary medical education literature and empiric pilot work, we created and refined an assessment instrument for measuring educator feedback skills. We also started the argument on validity and addressed content validity. Full article

The COVID-19 pandemic has been a learning curve for Higher Education Institutions (HEIs) in devising and delivering teaching online. This transition has enabled HEIs to continue teaching students, especially international students, who were restricted to travel to their countries of study. In the UK, approximately 20% of the student cohort are international students. The pandemic resulted in a drop in international student recruitment, which generated concerns about a potentially alarming economic crisis in the UK HE sector. However, COVID-19 measures have also been portrayed as a significant contributor to reducing global CO₂ emissions. Thus, the question arises: can online teaching reduce the carbon footprint of the internationalisation of education? This paper reviews online teaching as a potential solution to reduce carbon footprint and increase access to HE, whilst maintaining high student performance in HE within the remits of internationalisation. Full article

Background: Telehealth-based health coaching in a usual care setting has yet to be examined. The purpose of this study was to incorporate the inHealth Lifestyle Therapeutics, Inc.’s Telehealth Enabled Approach to Multidisciplinary Care (TEAM) method within a real-world routine clinical care setting to reduce body weight in obese participants. Materials and Methods: n = 70 participants were recruited for this intervention (Age: 58.1 ± 14.6yrs, BMI: 35.5 ± 7.8 kg/m², 32 males and 38 females). All participants self-selected participation in either the virtual health coaching (VHC) group or usual care (UC) group. VHC participants met with a medical doctor monthly and a certified health coach weekly for the first 12 weeks of the study, bi-weekly for the following 12 weeks, and monthly for the remaining 6 months. Data were analyzed using a two-sample student’s t-test to assess any changes from baseline for both VHC and UC groups. Results: A significant difference for weight-loss between VHC and UC groups (8.24 ± 9.8 vs. 0.16 ± 10.6 kg, respectively, p < 0.05) was observed. In addition, there was a significant change in the mean percentage of body weight loss (6.5 ± 0.1% vs. 0.53 ± 1.45%, respectively, p < 0.05) between groups. Conclusions: Incorporating innovative deliveries that are scalable, such as telehealth-based interventions, may help stem the tide of patient obesity related care. Furthermore, using a TEAM method in a usual care setting may be effective for inducing sustained weight loss at 12 months. Full article

This commentary describes COVID-19-related disruptions and responsive accommodations to facilitate a research project required to complete postgraduate psychiatry training in a resource-limited small island developing state. After providing context concerning the impact of the pandemic on medical education, we focus on implications for postgraduate training in psychiatry. Lessons learned from this experience have relevance for ongoing discussions concerning the role and implementation of research training in residency programs. Research skills are essential for evidence-based practice as well as academic careers. Longitudinal integration of research training and flexibility of research requirements are needed in postgraduate psychiatry to balance residents’ development of research skills with demands of clinical service. Full article

Immersive technology is a growing field in healthcare education—attracting educationalists to evaluate its utility. There has been a trend of increasing research in this field; however, a lack of quality assurance surrounding the literature prompted the narrative review. Web Of Science database searches were undertaken from 2002 to the beginning of 2022. The studies were divided into three mixed reality groups: virtual reality (VR), augmented reality (AR), 360 videos, and learning theory subgroups. Appraising 246 studies with the Medical Education Research Study Quality Instrument (MERSQI) indicated a gap in the validation of measures used to evaluate the technology. Although, those conducted in VR or those detailing learning theories scored higher according to MERSQI. There is an educational benefit to immersive technology in the healthcare setting. However, there needs to be caution in how the findings are interpreted for application beyond the initial study and a greater emphasis on research methods. Full article

Superstition is a belief that is not based on scientific knowledge. Traditional healers usually use superstition in their practices to manage human health problems and diseases; such practices create a conflict with the medical profession and its evidence-based practices. Medical professionals confirm that this kind of practice is unsafe as it is performed by untrained people (e.g., traditional healers) utilizing unsterilized instruments within unhygienic environments. Most of the cases eventually develop a variety of complications, which are sometimes fatal. Female genital mutilation, uvulectomy, oral mutilation (tooth bud extraction to cure “Ibyinyo”), and eyebrow incisions are examples of the many different types of superstitious practices which occur commonly in other parts of the world. We describe how these traditional practices of superstition have been and continue to be performed in various parts of the world, their complications on oral and general health, and how such practices hinder modern medical practices and highlight huge inequalities and disparities in healthcare-seeking behavior among different social groups. This paper aims to increase health literacy and awareness of these superstition-driven traditional and potentially harmful practices by promoting the importance of evidence-based medical practices. Full article

Background: The urgency for heightened levels of the Coronavirus disease of 2019 (COVID-19) awareness is due to their estimated face-to-face participation in the COVID-19 pandemic and similar pandemics. The unavailability of updated pandemic information is a significant challenge. There is no available data or previous studies undertaken to investigate the level of pandemic awareness of medical students in Trinidad, Tobago, or the wider Caribbean. Methods: A cross-sectional study of medical students, years one to five, at the University of the West Indies (UWI) St. Augustine campus, Faculty of Medical Sciences, was conducted using random sampling. Data was collected using a 20-item questionnaire structured to test awareness. Chi-square analysis was done using SPSS version 28.0.1.0 (142). Results: Of the 137 participants, 100% claimed to be aware of the COVID-19 pandemic, mainly via social media and the Ministry of Health press conferences. Though all claimed to be aware, 98.5% were aware of COVID-19 being a viral infection, whilst 87.6% were aware of the modes of transmission. Less than half of the population (45.3%) stated they were prepared to be a frontline worker exposed to and treating COVID-19 patients, while the majority (76.6%) were worried about exposure to the virus. Conclusions: The data collected in this research indicated that the level of awareness increases with higher levels of education, whereas age has no effect. Additionally, it was determined that undergraduate medical students had an average knowledge base of COVID-19 but would need training programs to increase their preparedness as future healthcare professionals. Lastly, it was discovered that the two top sources of information were social media and press conferences held by the government. Full article

In 2019, Showa University implemented a compulsory clinical English course for all 4th-year medical students that included a medical interview with an English-speaking standardized patient (ESSP), but since 2020 the interviews have been conducted online due to the novel coronavirus pandemic. These students reported difficulties with eye contact and reading body language/non-verbal cues of the ESSP. In this project report, we describe a telemedicine lecture that we included in the 2021 course and compare students’ reported difficulties during the online medical interview for two years. The 2021 cohort reported significantly less difficulties with eye contact than the 2020 cohort, and a similar trend was found for reading body language/nonverbal cues and creating rapport with the ESSP. While possible third variables, such as 2021 cohort’s greater comfort in using teleconference platforms, may limit the interpretation of these results, we conclude that Japanese medical students can clearly benefit from the inclusion of telemedicine education into the medical curriculum as online healthcare services become the “new normal” in Japan. Full article

Background: The COVID-19 pandemic caused medical education to shift unprecedentedly, leading medical schools to switch to virtual platforms and modify student-patient interactions. On top of educational changes, medical students adapted to their support network, finances, and mental and physical health changes. Objective: To understand the holistic impact of COVID-19 on medical students and medical education and identify how to distribute resources during future educational disruptions in a large medical university in the United States. Methods: An anonymous online survey was distributed to medical students at Sidney Kimmel Medical College, Philadelphia, in February 2021. Participants self-reported the impact of the COVID-19 pandemic on their medical education, family life, financial burden, mental health, and physical health. Results: 168 out of 1088 students at Sidney Kimmel Medical College completed the survey, with 58% (98/168) of the respondents identifying as female. The class breakdown was as follows: 38% (63/168) first years, 18% (31/168) second years, 21% (36/168) third years, 20% (34/168) fourth years, and 2% (4/168) were considered “other” (including research year, Master’s program). A total of 28% of respondents reported developing new mental illness, with second years having the highest incidence at 39%. In total, 42% said the pandemic affected a previous mental health condition. Further, 96% of third and fourth years reported COVID-19 affected their clinical rotations. In total, 68% of first years reported their entrance to medical school was severely affected. Moreover, 13% reported losing a family member due to COVID-19, and 7% reported personal sickness due to COVID-19. Additionally, 16% reported incurring a financial burden due to the pandemic. Conclusion: COVID-19 impacted the well-being of students by affecting their mental health and financial burdens. Clinical rotations and medical school entrance were the most problematic aspects. In the future setting of major educational disruptions, this study provides a starting point for where to focus resources, mental health support, financial support, and academic flexibility. Full article

Objectives: Demonstrate the feasibility and effectiveness of using the AirSim^® Bronchi airway simulator to teach anesthesia residents how to successfully troubleshoot and manage malpositioned double-lumen endotracheal tubes used for single-lung ventilation. Design: Prospective observational study. Setting: Simulation lab in a university-based anesthesiology residency training program. Participants: CA1 (PGY2) anesthesiology residents. Interventions: Each resident was initially tasked with troubleshooting a malpositioned double-lumen tube (DLT) on an AirSim^® Bronchi (Trucorp, Craigavon, UK) airway simulator in one of the three positions and was timed on their performance. This first simulation was followed by completion of a survey that assessed the resident’s level of confidence in repositioning a malpositioned DLT. Following the initial simulation, a didactic presentation was given to the residents on the management of malpositioned DLTs using a protocol, followed by a practice session. Two months later, each resident repeated the simulation exercise. A follow-up survey was conducted after each simulation, assessing the quality of the curriculum and subsequent level of confidence in performing the same tasks using a five-point Likert scale. Measurements and Main Results: Ten residents at the University of Mississippi Medical Center completed the simulation exercises and curriculum. The average time it took to troubleshoot the malpositioned DLT during the first simulation was 139 s, with only 30% of the residents correctly identifying the specific malposition and 40% correctly repositioning the DLT after initial malposition. The repeat simulation after two months showed significant improvement in efficiency, with the average time to complete the task decreasing from 139 s to 56 s. During the second simulation exercise, all 10 residents were able to correctly identify the DLT malposition and correctly reposition the DLT to the correct position. Additionally, residents’ confidence levels in managing a malpositioned DLT improved significantly. Initially, 70% of the residents reported a lack of confidence in identifying and correcting a malpositioned DLT, but after the didactic curriculum and simulation training, 100% of the residents reported confidence in completing the task. Conclusions: The AirSim^® Bronchi (Trucorp, Craigavon, UK) simulator can be used to effectively teach and evaluate residents on correctly identifying and repositioning a malpositioned DLT. The residents’ performance and level of confidence were evaluated before and after the simulation curriculum. The results reveal that simulation-based training is an effective educational tool for improving clinical performance and confidence in identifying and appropriately managing a malpositioned DLT. Full article