Writing Articles on Continuing Medical Education for Medical Journals

@#Sharing of knowledge through Continuing Medical Education (CME) contribute immensely to professional development of skills in clinical medical practice. Thus, the writing of CME articles should adopt an approach that addresses the needs of the readers by attempting to fill gaps in their knowledge, skills, and ethics about clinical care. As such CME articles should be comprehensive and focused on specific areas. The specific learning outcomes should be well defined. In designing and development of such articles, pedagogic principles are to be borne in mind. In this article we outline a guide to writing a CME article, incorporating both the principles of instructional design and directed selflearning. The ideal CME articles will transit through multimedia-enhanced interactive online learning, with greater use of connectivity through the internet. Synchronous and asynchronous learning is in greater need, as distance and online learning are increasingly popular. Authors of CME articles will need to eventually design CME articles to be interactive, enriched with multimedia to engage their readers. Lesson plans employing instructional design principles should aim to promote both instructions for learning and formative assessment ensuring learning have taken place, and outcomes have been achieved. This article describes on how to write effective CME articles for medical journals.

Niveles de motivación en el estudiantado de enfermería y estrategias de enseñanza / Levels of motivation in nursing students and learning strategies

Introducción: Para el estudiantado de enfermería el aprendizaje es complejo, y requiere integrar contenidos teóricos, procedimentales y actitudinales durante la etapa formativa, los cuales ejecutará posteriormente en un contexto real. El logro de estos saberes les debe garantizar a los alumnos el desempeño óptimo esperado para su nivel de formación. Objetivo: Identificar los niveles de motivación de los estudiantes de enfermería y su influencia en la concreción de sus logros, a partir de las estrategias de enseñanzas utilizadas en la asignatura Enfermería en salud familiar y comunitaria. Métodos: Se empleó una metodología mixta. La recogida de datos fue cuantitativa: se aplicó al estudiantado el cuestionario de motivación y estrategias de aprendizaje; y cualitativa: se realizó una entrevista semiestructurada a los docentes de la asignatura. Resultados: Se comprobó que un porcentaje importante del estudiantado presentaban una amplia dispersión en la valoración de la motivación intrínseca, lo cual no se observó en la motivación extrínseca. Los datos cualitativos permitieron inferir que el trabajo activo por parte de los estudiantes se encontraba poco desarrollado y las evaluaciones realizadas por los docentes eran principalmente sumativas y dirigidas a los aspectos teóricos. Conclusiones: Los altos niveles de motivación extrínseca del estudiantado de enfermería se vinculan con las estrategias tradicionales de enseñanza del profesorado y la evaluación de competencias en la fase de formación estimula la mejora continua en su desempeño profesional(AU)

Introduction: For nursing students, learning is complex and requires integrating theoretical, procedural and attitudinal contents during the training stage, which they will use further in real settings. Achievement of this knowledge must guarantee students the optimal performance expected from their training level. Objective: To identify the levels of motivation of Nursing students and their influence on such achievements, based on the teaching strategies used in the subject Nursing in Family and Community Health. Methods: A mixed methodology was used. The data collection was quantitative: the motivation and learning strategies questionnaire was applied to the students; and qualitative: a semi-structured interview was conducted with the professors of the subject. Results: A significant percentage of the students were found to have a wide dispersion regarding the assessment of intrinsic motivation, which was not observed for extrinsic motivation. The qualitative data allowed to infer that the active work on the part of the students was poorly developed and that the evaluations carried out by the professors were mainly summative and aimed at theoretical aspects. Conclusions: The high levels of extrinsic motivation among Nursing students are associated with traditional teaching strategies used by the faculty. The evaluation of competences in the training stage stimulates continuous improvement in the students' professional performance(AU)

Comparison of individual and group learning in different laboratory settings among third year Medical Technology students

Background and Objectives@#To learn technical skills in Medical Technology schools, laboratory experiments are made individually or in groups. The nature of student participation and effect of group work in laboratory skills and attitudes of students have not been well studied. The study compared individual work, working in groups of three, and working in groups of six in terms of skills and attitudes toward learning, motivation to learn, responsibility, helpfulness, and teamwork. @*Methodology@#Experimental study was used that employed a counter-balance design among thirty-six thirdyear medical technology students who were instructed to learn laboratory skills in three settings and were rotated in six experiments. Performance examination and questionnaires were formulated by the researcher and used for gathering data. One-way ANOVA was used to determine the significant differences among practical exam scores of the three laboratory settings while Kruskal-Wallis H and Mann-Whitney U test were used to determine differences in rating scores of the attitude questionnaire. @*Results and Conclusions@#There were no significant differences in students' skills F(2, 213)=1.97, (p=.142) and in their attitude toward learning, helpfulness and teamwork among the laboratory settings. Students have higher motivation when working in groups (H(2)=14.413, p=.001) and assumed more responsibility when working alone than when working groups. When students worked individually or in groups of three, they perceived ending up doing most of the work.

Association of educational interventions with clinician learning and ventilator-associated pneumonia patient outcomes: A protocol for systematic review and meta-analysis

@#Recent studies have shown that educational interventions for ventilator-associated pneumonia (VAP) prevention may result in positive outcomes in intensive care units. However, other studies investigating this kind of intervention have produced inconsistent results. Thus this paper reports a protocol for systematic review and planned meta-analysis to investigate the association of instituted VAP educational interventions with clinician learning and patient outcomes. In this review, the authors will identify relevant citations from electronic databases, reference lists, and other sources; screen articles against predetermined eligibility criteria; appraise each study using the Cochrane Collaboration’s risk of bias assessment tools and combine acquired evidence using the meta-analytic approach. The results of this review are crucial to assist clinicians and policy-makers in making well-informed decisions regarding VAP prevention practices for mechanically ventilated patients. This review protocol followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 guidelines and was registered with PROSPERO as CRD42016051561.

Comprehensive Course-Embedded Assessment System (CCEAS) to Measure Program Learning Outcomes (PLO): Measures that Matters

Continuous efforts are made by many educational researchers and quality experts to measure Program learning outcomes (PLO) by using direct and indirect methods in medical education. To overcome the challenges and limitations in the measurement of PLO, educational researchers use different sources of data to increase the probability that the measured value represents the accurate scenario. In the recent past, education researchers showed more interest in CCEAS. It emerged from the fact that student learning is assessed all the time in the courses to move ahead in the program. Many higher education institutions (HEI) and accreditation bodies recommend the course-embedded assessment method to measure PLO. However, the HEI uses randomization method to embed the course assessments on the PLO. In all these methods, the measurement of PLO is analyzed to improve the quality of the program than focusing on improving the learners in the program. In the perspective of internal quality assurance, the measurement of PLO is not only the retrospective analysis of the learner’s exit the program; rather it should identify the “outcome gap” in the learners of all the phases in the program. Finally, the improvisation must benefit the learners entering the phase as well as the learner’s progress to the next phase. The best fitting answer will be “implementation of CCEAS to measure the PLO, and it acts as a magnifying lens to visualize the microenvironment (courses and learners) in the program and analyze the standard of learning and teaching to improve the overall performance of all the learners and program (Assurance of learning (AOL))”. However, the importance of macro-level measurement of PLO cannot be negated because it acts as a validation of what is measured and implemented at the micro-level (courses level).

Validation of a proposed instructional workbook in the teaching of cells, carbohydrates and proteins in college biochemistry / The Health Sciences Journal

INTRODUCTION@#An instructional workbook for students taking biochemistry in Libya was developed. The research aimed to understand the level of acceptability to selected local biochemistry faculty and their perception of the basis for recommending the proposed instructional workbook. The study also aimed to determine the effect of sex, age, length of service and educational attainment on acceptability and recommendation. @*METHODS@#The study utilized the descriptive method of research to develop and validate an instructional material for biochemistry. Faculty from a private university teaching college-level biochemistry were given a copy of the instructional material whose topics included the cell, carbohydrates and proteins. The respondents were asked to answer a questionnaire to validate the instructional material based on objectives, content, usefulness, clarity, presentation, language and style, and evaluation. @*RESULTS@#The respondents level of acceptance in terms of the learning objectives was high with a grand weighted mean of 3.55. Content, usefulness, clarity, presentation, evaluation, and language and style were rated as acceptable. Age, length of service and educational attainment had significant impact on the acceptability of the proposed instructional workbook in terms of all seven criteria, except for age which was not significant for language and style. @*CONCLUSION@#Faculty teaching biochemistry have rated as acceptable the proposed instructional workbook on cell, carbohydrates and proteins and recommend its use as a teaching tool. The proposed workbook may be considered for use as a standard tool for teaching biochemistry in Libya.

The influence of course experience and course engagement on learning outcomes / 中国实用护理杂志

Objective To explore the relationship of course experience,course engagement and learning outcomes in medical nursing.Methods Adapted Course Experience Questionnaire and Selfestablished Course Engagement Questionnaire were used to collect data of 142 nursing undergraduates of which 126 were valid.The data were analyzed by regression analysis.Results Course experience had significant impact on course engagement,t=4.621,2.477,4.538,P＜0.01 or 0.05.Course engagement had significant impact on learning outcomes,t=2.439,P＜ 0.05.Course experience had significant impact on learning outcomes,P＜ 0.05.Conclusions It is proposed that the clinical courses should provide students with good experience,increase the deep learning engagement,and reform evaluation methods to improve the students' academic achievement.

Can learning outcomes in cognitive domain be assessed effectively using multiple choice questions? A study in an undergraduate pharmacy curriculum

Background: The widespread use of multiple choice questions (MCQ) in examinations is attributed to its logistical advantage and broad coverage of content within a short duration. The end-of-semester examinations for several modules in the pharmacy programme previously employed a combination of written examination tools including MCQ, short answer questions (SAQ) or essays for assessing learning outcomes in the cognitive domain. Concerns regarding assessment fatigue and subjectivity in marking have led to a review of the assessment formats in the examinations. Various types of MCQ were consequently introduced as the only assessment tool. This study was conducted to evaluate the performance of students in the examinations as a result of the change. Methodology: Analyses were carried out on the end-ofsemester examination results of two cohorts of students for each module, one based on a combination of MCQ, SAQ or essay and the other based on MCQ alone. The class means were compared, and t-test was used to determine the difference between the performances. Results: Although the difference in the mean scores of the two groups is statistically significant in 13 of the 20 modules, the difference is less than 5% in 10 modules. Conclusion: The findings provide evidence that wellconstructed MCQ can effectively assess cognitive skills.

Salud y resultados del aprendizaje en educandos de primaria del Consejo Popular Cayo Hueso, 2009 / Health and learning outcomes in elementary learners in Cayo Hueso Community Council, Havana in 2009

Se realizó un estudio que tuvo como objetivos caracterizar la morbilidad de los educandos de primaria del Consejo Popular Cayo Hueso, del Municipio Centro Habana, en el curso escolar 2008-2009, e identificar la relación entre la morbilidad encontrada y los resultados académicos de los educandos. El estudio fue complejo combinado de tipo transversal descriptivo y analítico (caso y control). Se estudiaron los educandos de primer a sexto grados de las seis instituciones educacionales de la enseñanza primaria del mencionado Consejo Popular. Para cumplir los objetivos propuestos se les realizó a todas las madres un cuestionario con preguntas que exploraron los antecedentes patológicos personales de los educandos. Se identificaron alteraciones del estado de salud que pudieron estar relacionadas con las condiciones ambientales de los hogares o las instituciones educacionales y constituir factores de riesgo para el aprendizaje. El retardo del desarrollo psicomotor y la inatención e hiperactividad fueron las alteraciones de salud que más se asociaron con estos resultados académicos. Se hacen recomendaciones

A study aiming to characterize the morbidity of primary students was conducted in Cayo Hueso Community Council, Havana, in the 2008-2009 school year. Also, the relationship between the found morbidity and students´ academic results was to be identified. This was a complex cross-sectional combination of descriptive and analytical (case and control) study. The students from the first to sixth years were sample to study from six different primary education institutions from this community council. In order to meet our objectives, a questionnaire exploring the personal medical history of these students was applied to all mothers. Health disorders were identified. They could be related to the environmental conditions of their homes or their educational institutions and be risk factors for learning. Psychomotor developmental delay, inattention and hyperactivity were the health disorders most associated with these academic results. Recommendations are made

Implementation of outcome–based education at the Chiba University School of Medicine focusing on planning a sequential curriculum / 医学教育

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.<br>2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.<br>3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

Evaluation of the Clinical Clerkship Program at the University of Tokyo (part 1): Student's Self-evaluation and Evaluation by Faculty / 医学教育

A clinical clerkship program was introduced at the University of Tokyo in 2002 to help students acquire clinical knowledge, skills, and attitudes by increasing their involvement in clinical activities. We assessed the learning effectiveness of clinical clerkships at the University of Tokyo Hospital by examining evaluations of student's clinical competence by themselves and by the faculty. Methods: We evaluated each clerkship with reference to overall educational goals developed in advance. We measured students' self-evaluations and evaluatio s by the faculty before and after the clerkship. Results: At the end of the 2-month clerkship, students' self-evaluation scores (3.18) were significantly higher than before the clerkship (2.71). In particular, scores for patient care were markedly higher. Evaluation scores by the faculty were also higher during (3.64) and after (3.57) clerkships than before (3.26) clerkships. Conclusion: We will use this data to make next year's clerkship programs more effective. We should also develop more-objective strategies for evaluation and establish relevant educational goals.

Aprendizagem baseada em problemas: efeitos no aprendizado

Resumo Como motivar o aluno de Medicina e proporcionar um aprendizado significativo e produtivo no ensino pré-clínico? A estratégia de aprendizagem baseada em problemas pode ser uma das respostas para tal questão. Na Universidade de Brasília desenvolveu-se uma experiência com essa estratégia em programa de integração interdisciplinar, que passou a incorporar apresentação seriada de casos clínicos, uso de módulos de orientação para aprendizagem auto-dirigida e discussão em grupo pequeno, da base de informação e do raciocínio envolvidos na resolução de problemas. Efetuou-se uma análise de processos e produtos nessa experiência, incluindo exame de resolução de problemas e questionários de avaliação que envolveram 421 participantes. Os resultados indicam a utilidade da estratégia inovadora em função, principalmente, do desenvolvimento da capacidade de aplicação de informação e das habilidades de processo pelos alunos. A avaliação de programa sugere aumento da qualidade da experiência educativa, após incorporação da estratégia, em termos de medidas do valor e significado da vivência, da adaptação pessoal do aprendiz, e da percepção de maior eficácia da aprendizagem, na comparação com programas congêneres do ensino pré-clínico na Universidade.

Summary: How to motivate the medical student in preclinical studies and to provide a meaningful and productive learning experience? The strategy of problem-based learning may be an answer to this questions. An experience with this strategy was developed in a program of inter-disciplinary integration at the University of Brasilia. Presentation of clinical problems, use of study guides for self-learning, and small group discussion of knowledge basis and reasoning in problem-solving, were blended in the program. An analysis of processes and outcomes, including problem-solving examinations and evaluation questionnaires was done with 421 respondents. The results point out the usefulness of the strategy, mostly regarding the development of students' capacity to apply knowledge and the extension of process skills. Course appraisal suggests an increasing educational quality, after the change to problem-based learning, regarding measures of meaningfulness and value, leaner's personal adaptation, and perception of learning efficacy, in comparison with other preclinical programs at the University.