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Background: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission’s formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders — the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME. Methods: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020. Results: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60 (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities. Conclusion: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W’s and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.
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Background: The COVID-19 pandemic affected all the educational activities including medical education and there is a substantial shift from direct classes to online platforms.In competency-based medical education (CBME), the formative assessment orchestrates a prominent role in increasing the student’s capacity of learning. This method of teaching guides the students to measure the performance over a period of time and also improves the students’ knowledge gap. Aim and Objectives: The present study was carried to evaluate the perception and attitude of students toward online assessment during the formative assessment in 1st year MBBS degree in biochemistry subject. The study also aimed to assess practical difficulty and feasibility of conducting online assessment as a part of formative assessment as per CBME curriculum. Materials and Methods: The study was conducted on 124 1st year MBBS students and the students were informed about the assessment in 15 days advance. The perception and attitude of the students toward online assessment was done using 20 items structured questionnaire administered through Google forms. The students’ response was measured using 5-point Likert scale. Results: Among the 124 students, 42 (39.6%) were aware about online assessment. About 57.5% of students preferred any type of gadgets such as desktops, laptops, and smart phones. Most of the students 84.5% obtained 50–75% for a total score of 25. Around, 51.9% of students responded that online teaching is more feasible, and 74.5% reported that there is connectivity problem during online platform. In this study, 46.2% online assessment is safe and 41.5% strongly disagree that distraction from home environment did not affect the online assessment. Conclusion: The present study concludes that the students are more interested in MCQ-based question assessment for the knowledge assessment. Further, they opined in favor of online education but with some demerits.
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Background: The new competency-based medical education curriculum envisages the need to adopt newer teaching-learning methods. There is a growing concern about the effective dissemination of knowledge to a large group of students through conventional didactic lectures. Flipped classroom teaching has evolved as an innovative method and is a systematic approach to improving the student learning experience. Aims and Objectives: The present study was undertaken (1) to compare the effectiveness of flipped classroom methods with that of the lecture as a teaching learning method in pharmacology for undergraduate medical students and (2) evaluate the students’ perception of the flipped method. Materials and Methods: This study was done in the Department of Pharmacology in a tertiary care teaching hospital in Kerala after ethics committee approval. Two groups of students enrolled using the convenient sampling method, received three flipped classes and three lectures on the topics after crossover. Feedback was collected using a validated structured questionnaire and a common evaluation after each topic was done with a pre-validated multiple choice questions questionnaire. Results: This study has examined the perceptions of students about flipped teaching method using various teaching materials on a Likert 5-point scale. The findings indicate that flipped classroom was a better teaching method. The mean scores of flipped classrooms were high and it was found to be significant (P < 0.05). Conclusion: The results of the study indicate that flipped classroom is more effective for students when compared to lectures. An implication of this is the possibility that it can be used as an adjunctive method in the new curriculum.
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Background: Assessment is an essential part of each and every education, which represents the learning of a student. If the assessments are performed regularly, it inspires active study habits and inevitably enhance learning. Aim and Objectives: Formative assessments, which are performed regularly, increase the effectiveness of the learning. Hence, we aimed to observe the effectiveness of spaced formative assessments on the performance of students in summative assessments. Materials and Methods: We selected 250 first-year medical students from the 21 to 22 batch. The students were categorized into three groups on the basis of formative assessment performance. Group I did not appear in the formative assessment, Group II scored <50% in the formative assessment, and Group III scored more than 50% in the formative assessment. Multiple comparisons of scores of summative assessments between different groups were done using ANOVA. Scores of formative assessments and summative assessment were correlated using Pearson correlation. Results: We got a statistically significant difference (P < 0.05) in mean summative assessment scores in different groups. Again, the analysis showed formative assessments had a significant (P < 0.05) relationship with summative assessment performance. Conclusion: The performance of formative assessments is predictive of summative examination scores. Academically poor medical students will be benefited from formative assessments.
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Background: Traditional lectures (using PowerPoint presentation or chalk and board) have become less effective, monotonous, and involve less student-teacher interaction. Introducing peer-assisted learning (PAL) may improve learning by increased student-teacher interaction, making interesting, and more effective for better student outcome, producing a competent Indian medical graduate. Aims and Objectives: The aim of the study was to introduce PAL in 1st year MBBS students, to evaluate effectiveness of PAL both from Students and Teachers perspective, and to determine feasibility of PAL in a large batch of 150 students with limited teacher availability. Materials and Methods: Place of study is Muzaffarnagar medical college, Muzaffarnagar, UP. Study was conducted on 80, 1st phase MBBS students (2020 Batch) Ethical clearance from Institutional Ethics committee was obtained. A pre-test and a post-test of ten MCQs were given. Feedback from students and faculty members was also taken. Results: As post-test scores show a significant improvement Pal can be introduced as a TL method in MBBS students. Conclusion: Feedback from both the students and teachers show that a significant percentage agree that PAL is helpful in increasing knowledge, should be included in the teaching methodology in CBME curriculum, is feasible, can be included in internal assessment, and improve critical thinking skills.
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Background: The flipped classroom is an educational model in which the standard lecture and homework elements of a course are “reversed” or “flipped.” In the current scenario, the new teaching-learning (T-L) method like flipped classroom is an essential requirement due to shifting in medical education from teacher-centric to student-centric as a consequence of the recent changes in medical education called “Competency-Based Medical Education.” The advantage of this teaching-learning method is to motivate students for self-directed learning and provides an opportunity for students to read/view course-related material at their own pace and on their own time before the actual class. Change in T-L method in medical biochemistry is extremely important since 1st Professional MBBS students considered it as tiresome and boring subject and give it least priority in all the subjects of 1st Professional MBBS course. Aim and Objectives: The main objective of this study is to introduce “Flipped Classroom” as an innovative teaching-learning method in medical biochemistry. Materials and Methods: For this study, 76 students were in-rolled and randomly divided them into two equal groups. Two topics from the medical biochemistry were selected, each group given an equal chance to learn by each method, at the end of teaching-learning the MCQ test was conducted and feedback from the student was collected. Results: In topics, the group learned the topic by flipped classroom scored more marks than the other group. The mean score of students, after the didactic lecture and flipped-classroom irrespective of the topic, were 4.43 and 5.39 marks, respectively (P < 0.001). Conclusion: The flipped-classroom method was found useful to improve the score of the 1st Professional MBBS students in medical biochemistry subject and facilitate them to understand the topic more clearly than the didactic lecture.
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Conventional medical education does not provide adequate training to undergraduates to resolve healthcare-related ethical dilemmas. This quasi-experimental study using a pre-post design was conducted to assess knowledge, attitudes and practices in healthcare ethics (HCE) and evaluate the effectiveness of the introduction of HCE in ethical behaviour among medical undergraduates at the Mahatma Gandhi Institute of Medical Sciences in Sevagram, India. All the participants thought that knowledge of HCE is important. There was an improvement in the knowledge of HCE after the intervention, as both weighted mean and percentage consensus improved. In Phase I, absolute learning gain, relative learning gain, and normalised gain “g” were significantly higher after the intervention. In Phase II, the intervention showed low and moderate effectiveness in improvements in the affective and psychomotor domain, and in the ability to handle ethical issues, respectively; but no significant improvement in communication skills. During the feedback session, it was seen that a majority of the participants thought that it is the need of the hour to introduce skill-based HCE into their curriculum from the first year. It can be concluded that it is possible to improve knowledge, and affective, psychomotor ability to handle ethical issues among undergraduate medical students with formal training
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Background: To become lifelong learners, it is essential for medical students to develop self-directed learning (SDL) skills from early medical schools. Aim and Objective: The present study was conducted to compare the outcome of traditional lecture classes (LCs) and SDL sessions among the first MBBS students in the department of physiology. Materials and Methods: This pilot study was conducted over a period of 1 year in the department of physiology among the first MBBS students to compare the outcome of traditional LCs with SDL sessions. The first 12 traditional LCs were conducted among Group A (roll no. 1–100) and the first 12 SDL sessions were conducted among Group B (roll no. 101–200). For the rest 13 traditional LCs and SDL sessions, crossover of two groups was done, that is, traditional LCs were conducted among Group B and SDL sessions were conducted among Group A. Results: Students performed significantly better in the 3rd, 7th, 10th, 11th, 12th, 13th, 15th, 18th, 19th, 21st, and 22nd SDL sessions as compared to LCs in post-test sessions. Students performed significantly better in the 4th, 6th, 8th, 16th, 23rd, 24th, and 25th LCs as compared to SDL sessions in posttests. Students performed significantly better in post-test sessions as compared to pre-test sessions. Students were highly satisfied with the program (as per evaluation done by Kirkpatrick model: Level 1). Conclusions: The students were highly satisfied with the teaching-learning program implemented by the department of physiology and their performance was better following SDL sessions as compared to traditional LCs.
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The National Medical Council (NMC) has mandated that all post-graduate training shall be competency-based, following the principles of Competency. Based Medical Education (CBME). This aims to serve the dual purpose of standardizing ophthalmology post-graduate training and to overcome the shortcomings of the traditional curriculum by employing innovative and interactive teaching–learning and assessment techniques to produce competent ophthalmologists well equipped with clinical, surgical, and professional skills relevant to current times. CBME marks a paradigm shift from traditional curriculum methodologies and involves the introduction of several new concepts. This article aims to highlight the key principles of CBME and the various teaching–learning and assessment technique methodologies which can be employed for post-graduate training. It also highlights the various challenges that are likely to be faced in its implementation and measures to overcome them.
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Background: In pathology, students are assessed by both theory as well as practical examination, but we have more upper hand and regularity in conducting theory assessment over practical evaluation. We have put newer case-based practical examination (CBPE) module over traditional one to achieve better practical approach which consists of case scenario pertaining to hematology and urine exercise followed by its interpretation without performing procedure. Aim and Objectives: The objective of this study were to develop and implement this new method of CBPE as a formative assessment tool for undergraduate 2nd year medical students. Materials and Methods: We have included MBBS undergraduate students of 4th semester by dividing students into two groups. Each group consists of 25 students. Group 1 was exposed to CBPE of hematology and urine exercises, while Group 2 was exposed to conventional method of hematology and urine exercises. Evaluation form was given to each student at the end of session to know their perception and opinion regarding this newer form of practical examination. Results: Mean marks scored in Group 1(CBPE) were 28 and in Group 2 (conventional) were 20.32 out of 40 marks. We had used unpaired t-test to calculate significance with P value which was found to be 0.0012. Feedback was based on five-point Likert scale. Most of the faculty members and students gave positive opinion for case-based pattern. Conclusion: CBPE can be used as alternative to conventional practical examination for formative assessment with improvement in performance of students.
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Background: During MBBS course, the students’ study about cardiovascular system (CVS) in physiology, pathology, pharmacology, preventive medicine, pediatrics, and medicine for the management and diagnosis of cardiovascular disorders. Blood pressure measurement is a common and a beneficial tool for the diagnosis of cardiovascular disorders (hypertension, hypotension, etc.) along with their treatment and management. Thus, knowing the proper technique of measuring blood pressure becomes an essential part of learning the course and management of cardiovascular disease. This study is designed to teach and train the first phase undergraduate students to measure blood pressure in a proper way so that they do not stumble on the first step of examination of CVS. Competency-based training is an outcome-based approach that involves identifying the skills acquired by Indian medical graduate. Competency-based teaching involves teaching of undergraduate students to support their achievement and assessment of the communication and technical skills and to develop their ability to interpret the results of blood pressure measurement for apt patient management. Aim and Objectives: This study aims to assess and compare the effect of competency-based teaching and traditional teaching in learning the skill of blood pressure measurement. Materials and Methods: Two hundred students were taken from Phase I undergraduate medical students which were randomly divided in two Groups A and B. Competency-based teaching of blood pressure measurement was done in Group A in by teaching method of demonstrate, observe, assist, and perform and Group B was taught by traditional demonstration. Pre-test questionnaire was given to both the groups before beginning of the practical session. The students learning of skill to measure blood pressure was assessed by directly observed procedural skills (DOPS) checklist after which student feedback was provided along with filling up of the post-test questionnaire. Furthermore, feedback from both student and teacher was collected. Results: Highly significant difference was found between pre-test and post-test of both Group A and Group B. Significant difference was found between Group A and Group B post-test scores. It was found that Group A in which competency-based teaching was done scored higher post-test scores then Group B. Furthermore, highly significant difference was seen among the scores of DOPS checklist between Group A and Group B. Conclusion: In the present research study, it was found that the students who underwent competency-based training of the skill of blood pressure measurement showed significantly higher scores in learning and performing the skill. Furthermore, on feedback provided by the students, 96% of the students strongly agree that the competency-based teaching and learning is better than traditional teaching.
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Background: First year MBBS curriculum in Biochemistry is taught by the conventional methods of teaching in which didactic lectures share almost 70% of the total content load, in which students fail to grasp the importance of biochemistry and its significant contribution in medical laboratory science. Hence, case-based learning (CBL) is being used in the medical curriculum, so that students are exposed to the real-life medical problems. Aim and Objectives: The study aimed implementation of CBL sessions in 1st year MBBS students and to analyze perception of students and faculty about the effectiveness of CBL method. Materials and Methods: A group of 150 students of Phase 1 MBBS course was selected for interventional study comprising two teaching-learning sessions on two core topics in biochemistry. Pre-test and post-test were conducted before and after the CBL session. A third test was conducted 1 month after the post-test to assess retention of knowledge gained by the students. The performance of the students was analyzed. Results: Pre-test and post-test analysis showed a very significant improvement in performance of the students after the CBL sessions. About 95% of the students and 90% of faculty reported that CBL sessions were useful to facilitate critical thinking through active learning. About 85% of students and 80% of faculty expressed that CBL helped in bridging the gap between theory and practice. Conclusion: It is evident from the present study that CBL in biochemistry can be implemented as innovative and effective teaching module to achieve the learning objectives. Case studies encourage active learning, promote critical thinking, and instill motivation in the subject.
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Introducción: En los últimos años, la formación por competencias transita hacia las actividades profesionales encomendables, enfoque que facilita su operativización y evaluación. Objetivo: Actualizar los conceptos y metodologías del enfoque de actividades profesionales encomendables. Material y Métodos: Se realizó una revisión de alcance en la que se consultaron las bases de datos: SciELO, LILACS y PubMed. Se usó el término de búsqueda: "entrustable profesional activities", tanto en español, como en inglés, desde el año 2005 al 2021. Se encontraron 1 011 artículos en total, se revisaron 290, de los cuales se seleccionaron finalmente 43, todos relacionados con aspectos conceptuales y metodológicos de las actividades profesionales encomendables. Desarrollo: Se explica el concepto de actividades profesionales encomendables, sus características, usos, descripción y diferencias con el término "competencia". Se mencionan los pasos para desarrollarlas según Taylor, y se mencionan algunos desafíos de su aplicación. Conclusiones: Las actividades profesionales encomendables constituyen un novedoso enfoque en la educación médica contemporánea, que no siempre es bien comprendido. Aplicable no solo a pregrado, sino también a posgrado, especialidades médicas-quirúrgicas, tecnologías de la salud, enfermería y otras. Se ofrece información actualizada sobre su descripción y se reflexiona sobre su aplicación e implementación en el contexto nacional y regional(AU)
ABSTRACT Introduction: In recent years, competency training has moved towards training with entrustable professional activities, an approach that facilitates its operationalization and evaluation. Objective: To update the conceptual and methodological aspects of the entrustable professional activities approach. Material and Methods: Databases such as Scielo, LILACS and PubMed were used to collect information. The search term: "entrustable professional activities" was used in both Spanish and English. The review was undertaken during the period from 2005 to 2021. A total of 1 011 articles were found; 290 were read, and 37 were selected. All selected articles were related to conceptual and methodological aspects of entrustable professional activities. Development: The concept of entrustable professional activities is defined, as well as its characteristics, uses, and differences with the term "competence". The steps to develop entrustable professional activities according to Taylor are mentioned. Some challenges for its application in the national context are also mentioned. Conclusions: The entrustable professional activities constitute a novel approach to contemporary medical education, which is not always well understood. The e ntrustable professional activities are applicable not only to undergraduate but also to postgraduate education, medical-surgical specialties, health technologies, nursing, and others. Updated information on entrustable professional activities, their description, and reflections on their application and implementation in national and regional contexts are provided(AU)
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HumansABSTRACT
During the mandate duty in primary military hospital, we conducted continuing neurological education combining with the hospitals trait and department needs. By using the concept of competency-based education, we have explored a pattern of continuing medical education suitable for primary physicians. Thematic approach was implemented for acquiring professional knowledge, formative evaluation was applied for training effect assessment, and scientific clinical thinking was emphasized for promoting the demand of lifelong learning. Under the communication and efforts of teachers and learners, we have obtained good clinical effect and positive social affection by the competency-based neurological education.
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@#Although the transformation towards adopting an Outcome-based Education (OBE) is gathering momentum globally, several medical schools are finding it hard to implement the change. Based and built on authors’ experience and cues from the literature, the tips – relating to the process of identification, description and dissemination of learning outcomes (LOs); usage of LOs to ascertain the curricular contents, the teaching/learning and assessment methods; implementing, monitoring and reviewing the curriculum – are the actions that the institutions of higher learning need to perform to transform the existing curriculum or to develop an altogether a new curriculum according to OBE approach. The development of the faculty through dialogues, discussions and training sessions should be an initial and essential step in this process. It is hoped that these tips will alley some of the fears and facilitate the adoption of OBE curriculum in new as well as in existing established institutions.
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Background: Adoption of competence-based medical education (CBME) is the need of the hour. Objectives: The objective of the study is to develop and validate appropriate assessment tools for the community medicine entrustable professional activities (EPAs) and to assess the usefulness of the validated tools in the assessment of postgraduate (PG) students. Methods: An interventional study for 14 months was done in the department of community medicine. After the sensitization of faculty members and PGs, three EPAs were selected through consensus between faculty members and appropriate assessment tools mini-clinical evaluation exercise (Mini-CEX), case-based discussion (CBD), and direct observation of procedural skills (DOPS). Rubrics of milestones were formulated for the selected tools, and the designed tools were validated. These three validated tools were used for the quarterly assessment. Results: The item-content validity index for all three assessment tools was one, while Scale Content Validity Index for Mini-CEX and CBD were 1, and for DOPS, it was 0.87. Three PG students were assessed using the validated tools thrice for the three selected EPAs. The PGs opined that assessment using rubrics made their task-specific, while faculties were quite satisfied with the assessment process as it removed subjectivity. Conclusions: The developed and selected tools of EPAs were found to have a substantial level of both face validity and content validity. The tools were also found to useful for periodic assessment in workplace settings and acceptable to both PG students and internal/external faculty members.
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The purpose of the present review is to examine the new competency-based undergraduate curriculum in community medicine against the established frameworks and criteria and suggest the way forward for achieving competencies expected of the Indian Medical Graduate (IMG). The new Graduate Medical Education Regulations, 2018, is based on Harden's concept of the curriculum. Hence, we reviewed the components of new curriculum against Harden's conceptualization of various components of the curriculum, and since it claims it is competency-based, we used Tyler's Goal/Objective-Based Evaluation. The new undergraduate curriculum has shown a move toward integration of course content and defined the competencies in more measurable terms. However, it appears that the earlier information-based curriculum corresponding to book chapters (”topics”) has been modified to specify higher cognitive domains with no explicit link between the IMG level curriculum outcomes to subject level intended learning outcomes (ILOs). The mechanism to link ILOs to assessment is also not clear and so needs more clarity. The assessment system hinted at in the current document is mostly based on the existing conventional system of 50% as pass cutoff, etc., against criterion-referenced assessment applicable to competencies that need to be performed. Furthermore, there is no guidance on the creation of educational opportunities and environment for students and faculty – perhaps it is left to “Curriculum Implementation Support Programme (CISP) Workshops.” Hence, the need for preparing a roadmap/blueprint to learning experiences and assessment methods and levels and milestones to be reached at various phases of MBBS and during internship is required.
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Objective: Toassess the validity of modified Centor Score in predicting streptococcalpharyngitis, and describe the antibiotic sensitivity of streptococcal strains. Methods: A cross-sectional study of 120 children (age 1-18 y) with signs and symptoms of pharyngitis wasundertaken in the pediatric department of a tertiary care teaching hospital in Chennai fromJuly 2015 to April 2016. Modified Centor score was calculated for all children, andstreptococcal sore throat was confirmed by throat swab culture. Predictive validity of Centorscore was assessed by Receiver Operating Curve (ROC) analysis. Results: Streptococcalculture positivity was 35%. The Area Under the Curve (AUC) value for modified Centor scorewas 0.589 (95% CI 0.481 to 0.697, P=0.11) in predicting streptococcal pharyngitis. Coughhad the highest sensitivity (63.4%), but poor specificity (36.7%) for streptococcal pharyngitisconfirmed by culture. The specificity was 100% for palatine petechiae, followed by palatineexudates (97.5%) and tender anterior cervical nodes (88.6%) to diagnose streptococcalpharyngitis. The proportion of antibiotic resistance was highest for cotrimoxazole (16.7%).Conclusion: Predictive validity of modified Centor score was not satisfactory, and resistanceto cotrimoxazole, fluoroquinolones and macrolides was high among S. pyogenes strains.
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BACKGROUND: Graduate medical education is shifting from the traditional apprenticeship model to a competency-driven model. Here we describe the design and implementation of competency-based medical education (CBME) in an internal medicine residency program, and report satisfaction survey results. METHODS: We redesigned the residency curriculum as CBME to be resident-centred, systematic, focused on general internal medicine, to provide experience in various care setting, and work-based assessment. In the second year of this CBME transition, we surveyed residents' overall satisfaction using 5-point Likert scale. Feedback on their training program was also analysed. RESULTS: The overall satisfaction score was 3.24 and thirteen residents (61.9%) answered that the preceptor's practical training in an educational atmosphere and improvement through training were the merits of the training program. However, residents complained about the working condition such as work overload. CONCLUSION: With the CBME implementation, most residents expressed satisfaction with the hospital's educational environment but they suffered from overwork. Further efforts to improve the educational program and environment are warranted.
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Atmosphere , Curriculum , Education , Education, Medical , Education, Medical, Graduate , Internal Medicine , Internship and ResidencyABSTRACT
The realization that medical graduates are failing to serve the health needs of the society has compelled the medical educationists and regulatory authorities worldwide to review the medical training. A medical curriculum oriented towards developing the key competencies that enable a fresh graduate to be delivering socially responsive health care is seen as a promising step towards alleviating this problem. This calls for a departure from the traditional approach of organizing the curricular components around educational objectives, to a competency-based approach for planning the curriculum. The present article discusses the concept of competency-based medical education in Indian context, the steps in planning and implementing such a curriculum, and the key aspects of assessment for its effective implementation.