ABSTRACT
@#<jats:p>Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p<0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p<0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p<0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic</jats:p>
Subject(s)
Clinical CompetenceABSTRACT
@#<jats:p>Objectives: To determine if online team-based learning (TBL) is effective in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work up, and management among fourth year medical students Study design: A quantitative evaluative design. Population and Setting: Fourth year medical students (medical clerks) rotating in the Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines from July to December 2020. Methodology: A modified TBL workshop is adopted in teaching fourth year medical clerks about hyponatremia. The TBL session was held with a group of medical clerks weekly from July to December 2020. As a pre-workshop preparation, the medical clerks were assigned to read ahead of time the clinical practice guidelines on the diagnosis and treatment of hyponatremia developed by the European Renal Best Practice. After reading it, they were asked to answer an Individual Readiness Assessment Test (IRAT) composed of 20 case-based multiple-choice questions (MCQ). The group was thereafter divided into 4 subgroups and asked to discuss the same MCQ-based exam and present it as a Team Readiness Assessment Test (TRAT). As each subgroup presented their IRAT, the facilitator discussed the underlying concepts for each question and its application in actual cases of hyponatremia. The facilitator then summarized the learning outcomes at the end of the TBL workshop. For team application (TAPP), the students created a concept map and formulated admitting orders. The medical clerks were then surveyed on their confidence in hyponatremia diagnosis and management during pre-TBL workshop, after IRAT, after TRAT, and after discussion with the facilitator. Statistical Design: Descriptive statistics were used to summarize the study variables and included the mean, standard deviation, frequency, and percentage. Within-group comparisons of different outcomes across the different timeframes were conducted using one-way multivariate analysis of variance (one-way MANOVA). Cognizant that the study has multiple outcomes or dependent variables which were compared at four different timeframes, multivariate analysis was utilized to minimize the inflation of family-wise errors (FWE). Results: Comparative analysis indicated that the mean readiness scores of the respondents after TRAT was significantly higher (t=–91.61, p=0.001) compared to the mean readiness scores after IRAT. Comparative analysis using paired t-test indicated that the mean confidence scores of the respondents in the recognition, diagnosis, and treatment of hyponatremia were significantly higher among the respondents after the IRAT (t=–24.26, p=0.001), TRAT (t=–34.58, p=0.001), and facilitator discussion (t=–42.72, p=0.001) approaches compared to the mean pre-TBL confidence score. The mean knowledge score of the respondents on the creation of a concept map and the formulation of admission orders of patients with hyponatremia was 25.54±1.98 (95% CI 25.26-25.82). Conclusion: Findings of this study are not to be interpreted as demonstrating a causal relationship. Furthermore, the results are only hypothesis-generating at best. The study showed that online TBL has the potential to be an effective method in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work-up, and management among fourth year medical students. As a preliminary evaluation of TBL, further studies can be conducted to determine its effectiveness as a teaching modality in the medical curricula in comparison to the traditional method before being adopted as a teaching-learning activity. Key words: team-based learning, online learning, COVID-19, hyponatremia, medical education</jats:p>
Subject(s)
Education, Distance , COVID-19 , HyponatremiaABSTRACT
Background@#The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. @*Objectives@#The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks.@*Methodology@#An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. @*Results@#Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. @*Conclusion@#The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition.
Subject(s)
COVID-19 , PandemicsABSTRACT
@#<p style="text-align: justify;"><strong>Background:</strong> Self-evaluation can augment the facilitation of acquiring knowledge, skills and attitude through a reflective method. Self-assessment video (SAV) can be a very useful reflective method tool that is student-centered and self-directed.</p><p style="text-align: justify;"><strong>Objective:</strong> This study aimed to identify if SAV is an effective supplementary learning tool in improving cardiovascular examination knowledge, skills and attitude of second year medical students.</p><p style="text-align: justify;"><strong>Methodology:</strong> A quasi-experimental two-group design with pre- and post-test was used. The study population by convenience sampling involved second year medical students of the University of Santo Tomas Faculty of Medicine and Surgery. A structured direct observation checklist on cardiovascular precordial examination was used, done on two occasions in a week interval period. The said examinations were recorded in a video and evaluated and scored by two independent facilitators on these two occasions. The experimental group had the opportunity to review their videos immediately after the two examinations and accomplished self-assessment form. One-Way Repeated Measures Multivariate Analysis of Variance (One-Way RM-MANOVA), a parametric multivariate test for between- and within group comparison of multiple dependent variables was used.</p><p style="text-align: justify;"><strong>Results:</strong> It showed that there was a significant improvement in all parameters measured after the intervention (SAV in the experimental group compared to the control group).</p><p style="text-align: justify;"><strong>Conclusion:</strong> The study showed that SAV is an effective supplementary learning tool in cardiovascular examination attitude, knowledge, and skills, and can be a very useful teaching and learning self-evaluation tool.</p>
Subject(s)
Students, Medical , Self-Assessment , LearningABSTRACT
@#The best online teaching practices in the Internal Medicine Clerkship Program during the COVID-19 pandemic in the oldest university in Southeast Asia and oldest medical school in the Philippines was presented. Time constraint was a big factor during the unforeseen lockdown. There was a need to retool the faculty and provide institutional support to maximize the utilization of the existing online learning platform for the graduating medical clerks. The task to equip medical clerks with all the necessary knowledge, skills and attitude of a basic physician in such a short a time is colossal. So much so that this pandemic paved the way to adopt the best online learning and teaching practices that is expected to be a part of the blended learning even beyond the lockdown. The future of this COVID-19 pandemic is still bleak as of the moment, but as such it would defi nitely strengthen the position of online learning as an effective alternative or better still, a replacement of the traditional learning method. The COVID-19 pandemic has fostered acceptance of the online mode as an auspicious choice for the teaching and learning method in the future.