Physiology teaching methodology – Perspective of undergraduate medical students

Background: Proper understanding of concepts of physiology forms basis of good clinical practice. To make the lectures in physiology more interesting and understanding, one has to review the teaching methods at regular intervals. Aims and Objectives: This study is designed to get feedback regarding teaching methods in physiology from MBBS students of Government Medical College, Kozhikode, to make teaching more effective. Materials and Methods: Two hundred randomly selected students who successfully completed 1st-year MBBS are included in the study group. The standard questionnaire is shared to study group through Google forms and adequate time is given to record their responses. Descriptive statistics are used. Frequency is expressed in percentage. Results: Most of students prefer interactive teaching methodologies such as group discussion as their preferred mode of learning rather than conventional didactic lectures in whole batch. Students also like to have integration with other subjects and early clinical exposure to understand the concepts precisely. Conclusion: Teaching in small groups with proper integration and alignment with other subjects will make maximum results rather than the traditional teacher centered medical education. Periodic review of teaching methods is very much essential to make the subject more interesting.

PERCEPTION OF FIRST YEAR MBBS STUDENTS TOWARDS ECE (EARLY CLINICAL EXPOSURE) IN PHYSIOLOGY.

Introduction : Early Clinical Exposure is a teaching learning method which enables student to learn basic sciences effectively and retain the information which bene?ts patient and promotes better patient care. Hundred students selected after applying inclusion exclusion criteria divided into 2 groups A and B taught Methodology : basal ganglia and thyroid physiology in conventional method and other in ECE integrated method respectively and after interchanging groups, demonstrating the clinical features of parkinsonism and hypothyroidism for ECE group. A pretest and post-test were conducted preceding and following lecture in both settings. The results obtained were interpreted using Results : excel. The mean of pre-test marks for Traditional teaching and ECE integrated teaching are 5.62±2.42 and 4.58±2.33 respectively and the post-test scores of Traditional and ECE teaching are 10.62±2.52 and 12.8±2.46 respectively. Discussion : Majority considered that the synchronisation of classroom learning with clinical experiences was bene?cial, and the majority believed that integrated teaching improved understanding of the practical applications of physiology. Through Conclusion : this study we conclude that ECE integrated teaching is more effective in imparting knowledge in ?rst MBBS students as the gap of imagination was bridged by live demonstration with help of patient which is re?ected in the Likert scale and in the scores. Though the ECE integration is a tough job for the teacher, it is a great learning tool for students.

Laboratory reports as a learning tool – Early clinical exposure in 1st-year MBBS physiology (Hematology)

Background: Early clinical exposure (ECE) aims to bridge the gap between pre-clinical and clinical subjects. ECE exposes students to the health-care system at an early stage of professional life, follows patient-centered approach, and increases motivation for classroom learning. Most of the studies have reported a positive attitude of students toward ECE. However, very few studies have reported the difficulties that may be faced by the students during implementation of ECE. Aim and Objectives: The aim of this was to explore the attitude of students and difficulties faced if any during implementation of ECE in 1st MBBS Physiology (Hematology) with the help of laboratory reports and clinical scenarios. Materials and Methods: One hundred and ten students participated after completion of theory and practical classes of hematology. Clinical scenarios and laboratory forms were prepared based on actual laboratory reports of patients from pathology department. Group discussions and discussion with faculty was done. Attitude of the students was noted. Results: Most of the students found this method to be interesting and better than routine methods, helped in better understanding of theory and practical concepts, and helped in better preparation for examinations and better clinical correlations. However, about half of the students agreed or were not sure about the difficulty of ECE. Conclusion: The positive attitude of the students shows that ECE provides a successful integration of basic science and clinical subjects. It also helps in understanding the relevance of a basic science subject. Concepts of the subjects are made easier and interesting by ECE. However, the difficulties faced by the students should be kept in mind and more practice sessions may be done

An Overview of Early Clinical Exposure for Undergraduate Medical Education in Japan / 医学教育

Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.

Evaluating the Effectiveness of Early Clinical Exposure Program in Learning Clinical Anatomy amongMedical Undergraduates

Introduction:Early clinical exposure (ECE) is viewed as a way to provide contexts of basic science and highlight its relevance to medical picture 67(39.3%) and the commonest the parietal bone was commonly affected 85(55.6%). In closed TBI, majority had subarachnoid hemorrhage130 (84.9%). All cases of T BI had brain edema, with one coincidental finding of metastatic adenocarcinoma. A total of 42cases of TBI had brain herniation practice. It is one of the measures taken by Medical Council of India to enact its vision 2015. ECE promotes self –directed learning and analytical skills in students when they are exposed to it at an earlier phase. Subjects and Methods: This study was conducted among volunteered participants of first year medical undergraduate during their regular ECE sessions in the department of Anatomy at Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry after the approval of Instituition al Ethical Committee. The ECE program was used as a supplement to the traditional lectures. Feedback questionnaire after getting validated by the faculty were filled by the students. Results: Statistical analysis was done by Students Paired - Test. The Pre- Test score was (44.5+_16.1) and the Post - est Score was (53.1+_14.54).The Pre- value obtained was 0.0009 which was extremely significant. The results demonstrated that the ECE program will definetly influence the analytical understanding aspects along wi th getting accustomed to the hospital environment for the students. On a longer run it will have major impact on the academic as well on the attitudinal aspect of students.Conclusion: Medical students found their first experience with clinical setting va luable. Providing clinical exposure in the initial years of medical curricula and teaching the application of basic sciences knowledge in clinical practice can enhance students’ understanding of the role they will play in the future as a physician.

Effectiveness of Flipped Class Room Approach as a Teaching Methodology in Anatomy for Early Clinical Exposure Modules for First-Year Medical Students – An Interventional Study

Background: The National Medical Commission (NMC) of India has rolled out the competency based undergraduate medical curriculum in the year 2019 where there is more emphasis on integration of basic and clinical sciences, early clinical exposure (ECE) and clinical competence and skills. To achieve this it is essential to work on higher forms of cognitive work. Hence it reckons for the change in the teaching–learning methodology currently in practice. Thus we introduced a innovative teaching methodology such as flipped class room (FCR) methodology among first year medical graduates for early clinical exposure modules in anatomy. Materials and methods: This interventional study was conducted among the 1st year MBBS students of Sree Balaji Medical College & Hospital (2019–2020 academic year). The ECE modules were taught using both traditional lectures and FCR methodology. Pre and post tests were conducted for both the methodology. A comparative analysis of FCR teaching method with lecture based session was done by obtaining the scores of the students. A Structured questionnaire to assess the learner’s perception about FCR teaching methodology was obtained from the participants. The Results were analyzed using microsoft excel and SPSS software version 23. Evaluation of teaching tool was done by using Kirkpatrick model Results: Repeated measures Anova was applied and there was a significant difference within the two methodology and the interaction effect was also significant with P value 0.001. Although both methods show increase in mean from pre to post test the mean increase in flipped class method is more than the lecture. Spearman’s correlation was done which showed there is a significant relationship between both the methods with p value 0.001 correlation co-efficient r was 0.377. Overall Response to FCR method received higher rating. Conclusion: FCR methodology creates the opportunity to meet the needs of students through various instructional activities. There is a positive reinforcement and improvement in the student’s performance.

Clinical Competence and Perception of Medical Students after Early Clinical Exposure through Pre-clerckship Education at an Ethiopian Medical School: A Cross-sectional Study

BACKGROUND: Conventional medical curriculum is the mainstay in the long history of modern medical education. Innovative integrated medical curriculum attracted significant attention in improving conventional curriculum. In the integrated curriculum, basic sciences are incorporated horizontally with each other, and students are exposed early to clinical settings. This is expected to improve students' knowledge and skills in clinical medicine by the time they start their clerkship rotation. METHOD: the study aims to make a baseline assessment on the overall knowledge and skills of medical students towards clinical medicine. An institution-based cross-sectional study was conducted from March to April of 2020 using 91 third year medical students (convenience sampling). A threesection selfadministered survey instrument, short written MCQ exam, and practical (OSCE) students' examination were used for this survey. RESULT: participants tend to exhibit better knowledge on basics of history taking and physical examination with an average score of 79%. Comparatively, the score for average physical examination skill was low (56.3%). Students' perception on ECE showed, over 50% of participants believe ECE increases burden on their overall workload. Even then, the majority (92.3%) still think that ECE has positive impact on their clerkship education. Taken together, it appears more hands-on interventions is needed to further improve skills of medical students in physical examination with particular emphasis on the clinical examination of breast, thyroid, musculoskeletal, and neurologic systems

Research progress of early clinical exposure in medical colleges and Universities in China:A review / 中华医学教育探索杂志

This paper systematically reviews the relevant literature on early clinical exposure (ECE) in China in recent years. It analyzes the main contents of literature, summarizes the various forms of ECE that the colleges and universities provide, and analyzes its positive effect on the students' learning interest and ability, their humanistic care for patients, as well as the teacher's self-improvement. Finally, according to the actual practical situation of ECE in medical universities in China and relevant experience from foreign studies, it is proposed that China should increase the emphasis on ECE in colleges and universities, strengthen the construction of teaching staff, and establish a scientific and systematic evaluation system.

Formative assessment of the communication skills related to drug delivery systems on standardized patients through group objective structured clinical encounters in second year medical students

Background: Choosing an appropriate Drug Delivery System (DDS) influences the acceptability, adherence and better outcome of the therapy in the patients. The present study was planned to evaluate the second year MBBS students on standardized patients (SP) using Group Objective Structured Clinical Encounters (GOSCE) after content delivery by traditional power point class versus experiential teaching methodology.Methods: DDS practical class was held in two larger groups after adding two odd sub-groups (1+3) as ‘A’ (64 students) and even sub-groups (2+4) as ‘B’ (66 students). The formative GOSCE evaluation was done 2 weeks after the classes by the trained physician examiners as per the Medical Council of Canada pre-determined scoring instruments.Results: The average magnitude of change in GOSCE scoring is extremely statistical significant on t-test (P< 0.0001) in favour of experiential teaching methodology for all the skills. The statistical significant percentage of students were able to extract the treatment history in respect of eliciting problem, reasons for non-compliance, methods of intake, explain the technique and showed the courteous professional behaviours.Conclusions: The clinical cases as SP in pharmacology teaching for developing competency based communication skills and GOSCE are the appropriate methodology for evaluation of large student group for experiential DDS training.

Ece as A Novel Teaching-Learning Method in Curriculum Of Anatomy.

Introduction: Anatomy is one of the basic science disciplines in the medical undergraduate curriculum and forms the foundation for the training of future doctors. It not only involves a vast curriculum but for some students it is a complex and dry subject. To make it interesting, a lot of educators are of the opinion that knowledge of Anatomy should be acquired in a situation resembling those in which it will be applied. MCI (Medical Council of India) in its ‘VISION 2015’, has introduced a restructured curriculum and training program for undergraduate teaching with emphasis on early clinical exposure, integration of basic and clinical sciences, clinical competence and skills and new teaching learning methodologies. This according to MCI, will lead to a new generation of medical graduates of global standards. In the present setup, in the undergraduate curriculum, students are exposed to clinical subjects only during the second year. However, it has been observed that students find it difficult to recollect essential basic concepts during clinical postings. To improve this scenario, it has become necessary to introduce the students to clinical problems within the first undergraduate year itself, as advocated by the MCI. As medical education continues to advance, it is the endeavour of educators as well as MCI, to attempt to prepare students for their professional lives. ECE will help students to develop a professional identity, increase motivation to learn, ensure well integrated knowledge of the basic sciences so as to retain knowledge better and even consider career options earlier. ECE also promotes selfdirected learning and analytical skills in students. Conclusion: ECE is a useful method for a basic science like anatomy if it is taken up with the traditional teaching method. Anatomy will be better understood, retained and later practically applied, if learned in a clinically significant set-up.

Evaluating the effect of early clinical exposure in improving medical students' cognitive aspects of the doctor-patient relationship / 中华医学教育探索杂志

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

Regarding multidisciplinary education: / 医学教育

　Healthcare professionals need to understand the operational mechanisms that drive the team-care model. Although such concepts should be integrated into the education of healthcare students, but current methods of teaching such a model of care are unsatisfactory. In 2007 the Faculty of Medicine and Health Science of Kobe University introduced an early clinical exposure program focusing on team care for first-year students. In 2008, students of the school of pharmacy joined this program. We have developed a collaborative program, the Interprofessional Work tutorial program, for the fourth year of the undergraduate curriculum. As the history of collaborative education for healthcare students is relatively short, we faculty members continuously discuss how to develop this tutorial program. Simulated multidisciplinary team conferences have been introduced into this program to increase students’ understanding of the scenario. During the course of this program, students, as well as faculty members, come to understand the roles of other professionals and to consider collaboration to be fundamental for patient-centered treatment and care. Interprofessional education is essential for human resource development and for preparing future healthcare professionals to participate in interdisciplinary team care. We must integrate the community-based aspects of health and welfare into interprofessional education for health professional students.

Educational effectiveness of early clinical exposure with reflection / 医学教育

Early clinical exposure has been implemented worldwide as an effective method of medical education. The duration of early clinical exposure is 1 year in some universities in Western countries. In Japan, however, early clinical exposure occurs most often through health and welfare services, and its duration varies. One-year early clinical exposure and reflection upon it were implemented for first-year students at Mie University School of Medicine in 2006 to motivate them and to teach them about professionalism. The effectiveness of this program was evaluated with a questionnaire, a daily log, and a portfolio.1) The questionnaire survey revealed that students considered the program extremely valuable. They had learned much about communication skills, the relationship between medicine and society, patients' families, and professionalism.2) An analysis of the daily logs clearly showed that students were unsure and hesitant at the start of the program. However, they gradually became accustomed to participating in this program and began to learn earnestly.3) Qualitative analysis of the portfolios revealed that students considered 10 items important in the practice of medicine, including communication skills, responsibility, the value of being a physician, professionalism, and the motivation to study medicine.4) In their final reports, the students described the expected behaviors of physicians they should seek to perform, by learning medical ethics or through professionalism.5) In conclusion, 1-year early clinical exposure is a more effective method than short-term or intermittent exposure for medical students because of its uniqueness and the maintenance of motivation.

The Effect and Significance of Early Clinical Exposure of Medical Students From the Viewpoint of Communication and Medical Students' Research Into the Doctor-Patient Relationship / 医学教育

Many medical schools have recently introduced clinical exposure in the early years of training. During this period of early clinical exposure, medical students observe many aspects of a hospital and its staff. Because they do not yet have any special knowledge of medicine, medical students are able to understand problems in medicine from a patient's point of view. We sent questionnaires to students of several medical schools and investigated what students learned, especially about communication. We reported on voluntary research by some medical students at Osaka University. We believe that early clinical exposure gives medical students a chance to recognize and consider many aspects of medicine.

Results of a Survey on the Present Status of Undergraduate Clinical Training and Plans for Its Improvement / 医学教育

We used questionnaires to study the present status of undergraduate clinical training at medical schools in Japan in February 1996. Completed questionnaires were returned by 81%(65) of 80 medical schools and approximately 54%(1, 328 clinical departments) of the schools. The results were as follows. Courses for early clinical exposure in the 1st or 2nd year were provided at 83% of the 65 schools; clinical clerkships in the 5th and 6th years were provided at 28%. Specific behavioral objectives for clinical training were clearly shown to students and teaching staff at 75% of schools. Clinical procedures that medical students were permitted to perform were listed and announced to students and teaching staffs at 66% of schools. Patients were informed and gave consent for clinical training of students at 77% of schools. Essential knowledge and skills of students were assessed before the start of clinical training at 40% of schools, and summative assessment was made at the end of the training at 72%. Training of clinical teaching staff for faculty development was conducted at 51% of schools. Eightynine percent of schools reported a shortage of clinical teaching staff. Similar results were obtained in the survey of clinical departments of university hospitals: most departments complained of a shortage of teaching staff, of students not being active, and of students not being competent to enter clinical training courses. To improve clinical training, the introduction of clinical clerkships and cooperation with community facilities outside universities were the main issues.