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Background As the most basic unit of infectious disease prevention and control，community health service institutions are the frontline and important gateway for the prevention and control of infectious disease. Primary care physicians are responsible for epidemic surveillance，vaccination，health promotion and assistance to centers for disease control in investigating and disposing outbreaks and public health emergencies in their districts，and play an active role in disease prevention and control by groups，susceptible population protection，infectious source control and health education，as well as the effective prevention and control of infectious diseases. Objective To understand the ability of primary care physicians to diagnose and treat infectious diseases in the community，analyse their existing problems and shortcomings，design and conduct a series of intensive training related to infectious diseases for improving the capacity of infectious disease prevention and control at the primary level；To evaluate the effectiveness of online continuing medical education，so as to provide a reference for better continuing medical education on infectious diseases in the community. Methods All participants of the National Community Infectious Diseases Continuing Education Conference held by the Department of Family Medicine of the University of Hong Kong-Shenzhen Hospital in November 2021 were selected as research subjects from November 2021 to March 2022. The questionnaires were distributed to all registered attendees before and after the conference through the QR code of the questionnaire star，and the content of pre-conference questionnaire included demographic characteristics of the participants，participation in infectious disease training in the community since started working，diagnosis and treatment of infectious diseases in the community，subjective attitudes towards the prevention and control of infectious diseases in the community（willingness to manage infectious diseases in the community，satisfaction with their own infectious disease management skills），expertise in infectious disease prevention and control and knowledge related to conference content，attitude towards hepatitis B. The content of the post-conference questionnaire mainly included knowledge about the content of conference，attitude towards hepatitis B and satisfaction survey of this online conference. A total of 301 primary care physicians completed the questionnaire before and after the conference，and a total of 194 completed the questionnaire before and after the conference. Results Among all participants，166 （55.1%） had attended infectious disease training in the community，of whom 49（29.5%） were satisfied with their infectious disease diagnosis and treatment ability；135（44.8%） had not attended the training，of whom 22（16.3%） were satisfied with their infectious disease diagnosis and treatment ability. 143（86.1 %） of 166 participants who had attended infectious disease training in the community indicated their willingness to manage community infectious diseases，99（73.3%） of 135 participants who had not attended infectious disease training in the community indicated their willingness to manage community infectious diseases. 66（27.3%） of participants who were satisfied with their infectious disease diagnosis and treatment ability indicated their willingness to manage community infectious diseases. The top three infectious disease tests conducted by the institutions were hepatitis B，AIDS，and hepatitis C；the top three infectious diseases treated in the past six months were hepatitis B，influenza，hand，foot and mouth disease. Different self-evaluation and willingness to train may affect the willingness to manage community infectious diseases（P<0.05）. Among the participants who completed the questionnaire both before and after the conference，the highest correct answer rate for compulsory management of statutory infectious diseases before the conference was 89.7%，the owest accuracy rate for the type of disinfection of the COVID-19 infection was only 17.0%，the correct rates of other questions ranged from 34.0% to 40.7%. The correct rates of the questions after the conference were higher than those before the conference，and the correct rates ranged from 48.9% to 52.6%. The score of attitude towards hepatitis B after the conference was higher than that before the conference （P<0.05）. In terms of feedback after conference，254（98.1%） expressed satisfaction in the total of 259 questionnaires. In terms of suggestions for online conference，179（69.1%） and 174（67.2%） participants believed that online fluency and online interaction need to be improved. Conclusion The primary care physicians receive relatively less infectious diseases training in the community，inadequate infectious diseases training in the community can improve the confidence of self-competence，attitude of active management of infectious diseases and diagnosis and treatment ability in the primary care physicians. The future direction of continuing medical education should focus on the training of emerging infectious diseases and novel medical concepts，relevant experts should be invited to comment on the necessity and effectiveness of training in the community. © 2023 Chinese General Practice. All rights reserved.
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Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.
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Introduction: The COVID-19 pandemic has negatively impacted clinical experience and case volumes. Surgical simulation is now an even more powerful training tool and, to maximize potential, we must ensure learner engagement. Our aim was to identify barriers to surgical simulation engagement and strategies to mitigate these. Method(s): Scoping search was performed with a trained librarian of PubMed, EMBASE and Web of Science. Title and screening were completed with inclusion criteria: articles describing barriers to engagement with surgical simulation. After full text screening, data was extracted from included articles: type of study, MERSQI score, type/number of participants, barriers to engagement and strategies to mitigate these. Result(s): Twenty-nine manuscripts were included with 951 faculty and 2,467 residents. The majority (86%) were in high income countries (HIC) and four in LMICs. Most were surveys (22/29), and five involved semi-structured interviews/focus groups. Mean adjusted MERSQI score was 8. Commonest barriers to HIC engagement were learner clinical duties (9/25), lack of learner time (13/25), lack of learner interest/motivation (9/25) and lack of faculty time or interest to participate (12/25). In LMIC, commonest barriers were lack of simulation lab/equipment (4/4), cost (3/4) and inadequate supervision (3/4). Strategies to improve HIC engagement were mandatory/protected resident simulation training (9/25) and, in LMIC, low cost simulators (4/4) and sharing resources (2/4). Conclusion(s): Identification of barriers to simulation engagement is crucial for successful learning. Given the increased importance of simulation education due to the COVID-19 pandemic, surgical educators should strategize to maximize engagement.
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The COVID-19 pandemic has led to the more intensive use of digital technologies in higher medical education. The purpose of the study was to analyze the effectiveness of the implementation of digital technologies in the educational process of Ukrainian medical universities, to identify the current challenges e-learning faces, and to propose potential ways of optimization. General scientific methods (for example analysis, synthesis) specific pedagogical methods (specification, ion, comparison forecasting) were used for the research. The results outline the main advantages of using digital technologies in the medical higher school system. Attention is also drawn to the main challenges that have a certain negative impact on the educational process. Among the latter, problems with the practical training of future doctors were noted since distance learning does not provide an opportunity to fully implement skills building component. The results also highlight possible ways to solve the problems of using digital technologies in medical higher education institutions. It is proposed to introduce to use not only distance learning technologies, but to combine them with the traditional approach and independent learning. It is emphasized about further studies, as empirical measurements of the effectiveness of distance education in the medical field. And, this effectivenessstill needs to be ultimately proven.
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Self-medication is a widespread public health concern. University students are likely to be more prone to it since self-medication rates increase with educational level. Studies have shown that self-medication rates vary among academics belonging to different faculties, and medical students have the highest self-medication rates. However, it is unknown whether this holds in a vulnerable situation, such as the COVID-19 pandemic. It is also unknown whether differences in technical knowledge of drugs influence self-medication rates among students. Thus, this study analyzes and compares prophylactic self-medication among graduate students of different faculties in the context of the COVID-19 pandemic. This cross-sectional observational study was conducted at a private university in southern Brazil. Students from the medicine, law, life sciences, and fine arts faculties were surveyed, and their responses were compared using a chi-square test. Among 396 respondents, 29.5% reported using preventive medication for COVID-19, and medical students were the least likely to do so. The self-medication rate was 13.6% among respondents, and self-medication did not differ significantly between students of different faculties. Of the students who self-medicated 63% reported having studied the medication before using them. Furthermore, the media did not induce drug use among 81.8% respondents. These results show that medical students used fewer preventive medications during the pandemic and refute the assertion that self-medication rates are higher among medical students. They also show that self-medication rates during the pandemic were significantly lower than those before the pandemic. These revelations show a new aspect of self-medication.Copyright © 2021 Muslim OT et al.
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Objective Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. Methods The Journal of Hand and Microsurgery leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. Results Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. Conclusion Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents.Copyright © 2022. Society of Indian Hand & Microsurgeons. All rights reserved.
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Background: The coronavirus disease (COVID-19) pandemic has affected the medical education throughout the world. A study was done to assess the effect of education and psychological behavior on medical students. Aims and Objectives: The objective of the study is to evaluate the effect of COVID-19 on medical graduates in various aspects such as education, effect on clinical rotations, impact on the technology used for online classes, effect on quality of life, loneliness, sleep, and depressive symptoms. Material(s) and Method(s): A set of questions were distributed to Government Medical college, Suryapet students during November 2021-January 2022. Questionnaire aimed to study students' viewpoint of COVID-19's impact on their education, mental health, and willingness to participate clinically. Result(s): One hundred medical students from Government Medical College, Suryapet participated in this study. Most students (88%) agreed that pandemic had disrupted their medical education. About 64% agreed to attend clinical rotations and 68% of students accepting the risk of contracting COVID-19 in clinical rotations. COVID-19 had an impact on technology tools used for medical education. Students reported that COVID-19 had moderate impact on quality of life, sleep quality, anxiety, and depressive symptoms. Conclusion(s): The COVID-19 had an overall significant negative impact on undergraduate medical education. It is recommended that measures need to be taken to relieve students' stress.Copyright © 2023, Mr Bhawani Singh. All rights reserved.
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The shortage of medical personnel is becoming a heavy burden on modern healthcare systems around the world. All countries, without exception, turned out to be vulnerable, regardless of the level of income and available forms of medical care. This study addresses the issue of staffing at the time of transition to a new technological level of the healthcare system in the United States. The paper shows that at the present stage in the country there is a need for fundamental changes in the personnel policy in the medical field. The challenges caused by the COVID-19 pandemic not only exposed all the vulnerabilities of the national health system, but also opened up opportunities considering the lessons learned to rethink the long-term vision of solving the workforce problems directly related to the use of new technologies. Based on the analysis of statistical data and sociological research, the author identified the latest trends of overcoming barriers in the field of training and retraining of personnel in the context of the transition to digital medicine. Overexertion among medical personnel associated with increased workload has exacerbated the problem of their professional burnout. The mass protests of physicians necessitated the development of new approaches to the labor protection of employees in the medical field. Solution of such important social problems will require a long time and financial costs and is possible only through the joint efforts of the state and the entire community as a whole. © 2023, Russian Academy of Sciences.
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The COVID-19 pandemic had a significant impact on medical care and medical education in Peru. In response, the Peruvian American Medical Society (PAMS), a charitable medical organization based in the USA, pursued its medical and educational missions in Peru by adopting virtual learning technology. We developed closer collaborative relationships with several medical schools and the Peruvian Association of Medical Schools (ASPEFAM) while offering a faculty panel of twenty-four members to provide lectures and multidisciplinary webinars in Spanish. We conducted 19 webinars including COVID -19 and non-COVID-19 related topics that over the last two years attracted 14,489 participants from 23 countries. They were the foundation for twenty publications in Peruvian medical journals. Our clinical investigations competition was positively received as was our pilot project on research mentorship. The COVID -19 pandemic had a positive effect on the educational mission of PAMS in Peru.
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Medical education, an integral part of the modern health-care system, had faced the thrust of the outbreak for the last couple of years. Although the immediate impacts were trivial and managed with online pedagogical approach, on a long run, it seems to spill serious repercussions on medical students, teaching faculties, and administration. Different countries are handling with the situation depending on their financial conditions, task force, and resource allocation. Hence, momentarily, it is quite impractical to reach a global consensus regarding what is the best for students and communities in long run. Meanwhile, each country needs to formulate its own regime to continue with high standard medical teaching and training. Obviously, it may solicit time span, prioritization, and empathy to restructure the medical education without disfiguring its original fabric. The unprecedented use of online pedagogy (prerecorded lectures, medical simulations, virtual cadavers, and video conferencing) has transformed medical education drastically. Although these newer teaching-training policies assisted us to continue with the ongoing curriculum, medical placement/clerkship just resumed with necessary precautions. The assessment part needs extra care and vigilance, as any change or incorporation of newer methods of assessment may even worsen the present state of affairs for both the assessor and the student.Copyright © 2022 National Journal of Clinical Anatomy.
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Background. After COVID-19 emergence, medical education witnessed a shift from face-to-face education to digital education, which inevitably affected medical students. Globally, due to the closure of schools and universities, medical education was shifted to electronic learning (E-learning). This paper aimed to assess the effects of the COVID-19 pandemic on medical education and determine medical students' knowledge, attitude, and practices towards E-learning in the Kurdistan Region of Iraq.Materials and Methods. An online cross-sectional study was conducted among 500 undergraduate students of seven medical colleges in the Kurdistan Region, Iraq, in November 2021, to assess their state during the COVID-19 pandemic and how this affected their education.Results. There were 50.6% of males and 49.4% of females. The mean age was 20.6 ( +/- 1.5 SD) years. Approximately 17% of participants mentioned having financial issues, while 19.2% of students experienced health-related problems. As many as 67% of participants reported that the Internet quality was good or very good, whereas 46.8% of students disagreed that E-learning was a possible substitute for traditional learning. About two-thirds of participants agreed or were neutral that downloadable content was better than live content;however, only 19.2% of students agreed that E-learning could be used in the clinical aspect. A total of 52.2% of participants disagreed that E-testing could replace traditional learning methods. Surprisingly, 86.4% of students stated that they regularly used the Internet in their study.Conclusions. E-learning was the main adjustment made in the educational system, including medical education. The study concluded with insights into how different circumstances could have different conse-quences on the efficacy of medical education. E-learning showed effective results in continuing learning until the educational system switched to a blended system. Training programs for medical education personnel are vital in effective E-learning opportunities.
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Introduction: The COVID-19 pandemic significantly impacted the global teaching and learning process (TnL). Unfortunately, to date, not many qualitative studies have been published specifically on the impact of COVID-19 on the Family Medicine course, particularly in Malaysia. Hence, this study aimed to explore the impact of COVID-19 pandemic on the teaching and learning experience of undergraduate students undergoing their Family Medicine course at a local university. Methods: A qualitative study using focused group discussion (FGD), was conducted among undergraduate students during the lockdown period. A semi-structured interview guide was used to interview 20 students, in their fifth undergraduate year, undertaking their fourth to fifth week of a total six-week course. They were selected using purposive snowball sampling method. There were four focus group discussions (FGD) with five students in a group. All interviews were audio-taped, transcribed verbatim, and the contents were analysed using the standard content analysis framework. Subsequently, thematic content analysis was conducted, and three major themes were produced. Results: The three major themes were (1) facilitators to learning, (2) barriers to learning, and (3) rooms for improvement. Conclusion: Although COVID-19 pandemic had significant impact on TnL of Family Medicine course among undergraduates, the students remained optimistic and proposed some improvement from their point of view. However, a creative, realistic, effective, and impactful way of TnL, particularly in clinical aspects should be developed and experimented. Technological progress and advancement should permit this idea to be achievable and implemented in near future. [ FROM AUTHOR] Copyright of Malaysian Journal of Medicine & Health Sciences is the property of Universiti Putra Malaysia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Introduction: The unprecedented COVID-19 pandemic has led to unavoidable new norms, including increasing demands for online learning. In view of the potential constraints to virtually learn anatomy among medical students, this study was conducted to identify the level of exposure towards online anatomy learning as well as the perceived constraints among medical students in a public university in Malaysia. Methods: A cross sectional study utilizing online survey was conducted during the movement control order (MCO) enforcement in Malaysia between March and October 2020 among all consented medical students at a public university in the Klang Valley area. The data was collected using a validated self-administered questionnaire which was distributed using Google Form application. Results: A total of 281 medical students consented and completed the online survey, with 94.3% students had low level of exposure towards online anatomy learning. Year of study and accessibility towards computing facilities and internet connection were significantly associated with online anatomy learning, with the non-clinical students are 19.9 (aOR= 19.888, B=2.990, 95%CI: 2.484-159.220) times more likely to have higher exposure towards online anatomy learning respectively. Conclusion: A very high proportion of medical students having low exposure towards online anatomy learning was observed in this study, which was predicted among the clinical students. Strengthening the utilization of online learning should be seriously considered in parallel with the new norms and the many uncertainties with COVID-19 pandemic, to ensure continuity of effective and quality learning. [ FROM AUTHOR] Copyright of Malaysian Journal of Medicine & Health Sciences is the property of Universiti Putra Malaysia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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BackgroundThe use of interactive patient scenarios has long been a valuable component of medical school curricula, as this type of learning facilitates empathy, comprehensive understanding, and cultural sensitivity.[1] The COVID-19 pandemic, however, has precipitated a shift to more virtual strategies to keep students, faculty, and patients safe.[2]ObjectivesTo evaluate second year medical students' (MS2s) perceptions on the use of live patient encounters during the teaching of the skin and rheumatology course (BMS 6635) using different teaching formats due to changes from the COVID-19 pandemic.MethodsFour to five patients with dermatologic, autoimmune, and musculoskeletal diseases volunteered to participate in an interactive teaching session with MS2s at the University of Central Florida College of Medicine. MS2s enrolled in BMS 6635 were asked to voluntarily complete a survey about their learning experiences using these patient cases. Students who did not respond to the survey were excluded. Data analysis using Chi Square testing was performed on survey responses obtained pre-pandemic as compared to those collected in academic years 2020-2021 and 2021-2022 during the COVID-19 pandemic.Results700 surveys were obtained after patient cases given in different formats. When the interactive patient cases were given in person before COVID-19, 93% of students enjoyed the cases and 95% of students believed that the cases were an appropriate learning experience in their education. When these cases were delivered virtually beginning in the academic year 2020-2021, however, students' enjoyment of these cases decreased to 86%, with 92% of students believing that the cases were an appropriate learning experience. This is a 7% and 9% decrease, respectively, from pre-pandemic years. During the academic year 2021-2022, use of a hybrid model, with students and faculty in-person and patients participating virtually, resulted in 81% of students enjoying the interactive patient cases and 83% of students believing that the cases were an appropriate learning experience. This was a 12% decrease from before the COVID-19 pandemic (p <.001) and a 5% and 9% decrease, respectively, from the previous year (p <.001) (Figure 1). 37% of students who had their cases in a completely virtual format preferred the interactive patient sessions to stay completely virtual, while 51% of students who participated in hybrid sessions during COVID-19 preferred the sessions to be completely virtual (p<.029) (Table 1).Table 1.Medical student survey responses comparing live patient encounters given in person, completely virtually, and a hybrid formatIn person pre-Covid (2016-2020)Completely virtual-Covid (2020-2021)Hybrid Format-Covid (2021-2022)Totalp-valueI enjoyed the Live Patient cases43993%9186%9881%628<.001*The Live Patient cases were an appropriate learning experience at this stage in my education44895%9792%10183%646<.001*The Live Patient cases helped me remember the diseases well for the exam9583%8075%8671%261.111Would you prefer the Live Patient sessions to be on Zoom?3937%6251%49.029** = Statistical significance defined as p<0.05Figure 1.Medical students' feedback on live patient cases given in different platforms before COVID-19 and during the COVID-19 pandemic.[Figure omitted. See PDF]ConclusionThe use of interactive patient cases in medical education has been met with positive feedback over the years and should continue to be used in medical education. This study showed that MS2s enjoyed the patient encounters more when delivered in-person vs a virtual or hybrid format. Careful consideration should be given to delivery format to optimize student learning and enjoyment.References[1] Spencer J, Blackmore D, Heard S, et al. Patient-oriented learning: a review of the role of the patient in the education of medical students. Med Educ. 2000;34(10):851-857. doi: 10.1046/j.1365-2923.2000.00779.x.[2] Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020;323(21):2131-2132. doi: 10.1001/jama.2020.5227.Acknowledgements:NIL.Disclosure of I terestsNone Declared.
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Introduction: The COVID-19 pandemic necessitated proliferation of telesimulation. This pedagogy may be useful in rural areas to increase procedural adoption and reduce healthcare disparities. Our aim was to determine the current status of surgical simulation education to retool rural practicing Urologists. Method(s): Literature search was performed with a trained librarian for PubMed, EMBASE and Web of Science. Title/ screening were performed to include all studies of surgical simulation involving rural surgical learners to identify simulation education opportunities for practicing rural Urologists. Data was then extracted: simulation event, skills focus, MERSQI score, type/number of learners, learner assessment and event evaluation. Result(s): Seven manuscripts met inclusion criteria. Most were published 2019-2020 and were cross sectional (5/7, 71%). Mean adjusted MERSQI score was 13 (range 6-15.5). A wide range of surgical skills were taught (incl. laparoscopy, cricothyroidotomy, chest tube insertion, damage control laparotomy), but no Urological surgical skills. Two articles described mobile simulation units for rural areas. A total of 232 learners were identified including 69 medical students. One fifth of rural learners were non-medical or non-physicians. Only one study involved faculty, who were general surgeons. Conclusion(s): Telesimulation education for practicing Urologists in rural areas is lacking. Current in-operating room telementoring for rural Urologists requires surgeons to travel and perform their first cases utilizing this new technique on patients. Telesimulation to teach Urological skills in rural areas of the US may increase dissemination of techniques with no patient risk and has significant potential to redress current healthcare disparities.
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INTRODUCTION: Within obstetrics care, it can be difficult to discuss death and advances directives (AD). Recent maternal illnesses and deaths secondary to COVID-19 highlight the importance of these conversations. There is little available research regarding AD in obstetrics, especially within medical education. This study aimed to establish a baseline of obstetric provider comfort and knowledge with this material, provide education, and then reassess comfort and knowledge. METHODS: Institutional review board committee approval was waived for this study. A pre-intervention survey, including a unique identifier to allow for pairing of pre/post-surveys, was emailed to residents of a large university obstetrics and gynecology department with questions assessing comfort and knowledge of AD. The intervention was a 45-minute lecture covering definitions and local state laws relating to AD. A postsurvey, with identical questions to the presurvey, was sent 2 weeks after the intervention. Only paired responses were analyzed, using paired t test. RESULTS: Twenty-three residents (96% of program) participated in the presurvey;17 (71%) participated in the postsurvey. All were matched to presurvey responses and analyzed. In the presurvey, 41% of respondents were usually or always comfortable identifying surrogate decision makers, which increased to 82% in the postsurvey, a 41% difference (P =.01). With regards to the knowledge-based questions, the mean correct response was 56% in the presurvey and 87% in the postsurvey, a 31% difference (P <.001). CONCLUSION: A simple didactic intervention showed improvement in comfort and knowledge surrounding topics of AD for ob-gyn residents. Additional research relating to patient awareness of AD during pregnancy could be explored. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
ContextNorth Manchester General Hospital is a large District General Hospital in Greater Manchester, serving a relatively disadvantaged population. The overall culture change project involved practically all facets of a functioning medical organisation, including the Senior Medical Leadership Team (SMLT), Transformation team, Human Resources, Finance, and many more. However, one of the key aims of the change was to improve the experience of Junior Doctors working at NMGH. Therefore, postgraduate doctors in training have been key to all of the development, including the Medical Director's Leadership Fellow (MDLF), Junior Doctors' Leadership Group (JDLG), and every staff member that they represent.Issue/ChallengeHistorically, North Manchester General Hospital (NMGH) has had a reputation as a poor place to work;staff aimed to avoid the site. The hospital was unable to retain highly-skilled employees, and trainee experience was extremely low, impacting on patient safety metrics. The site was stuck in a continuous cycle of having this reputation, leading to an inability to attract permanent staff, causing a deficit in teaching and training opportunities, further diminishing the reputation.Rotational junior doctors are the most transient group of NHS healthcare workers (HCWs). Their experience is reflective of organisational culture and that of other, less vocal groups of HCWs. Prior to 2020, many junior doctors considered NMGH to be a ‘rite of passage' ‘ one to be avoided if possible, but if unavoidable, just get through it. On-call teams were chronically short-staffed, 3 services were in enhanced General Medical Council (GMC) monitoring, and GMC survey results were unsatisfactory. Teams were forced to be tenacious, lateral thinking, and resilient to cope with the stresses of work.2019 saw NMGH receive significant criticism from GMC and Health Education North West (HENW) monitoring visits. The General Surgery (GS) Department remained in ‘enhanced monitoring', and patient safety concerns were raised. These included inadequate ‘prescribing of admission medication', poor use of incident reporting systems, and challenges escalating sick patients. Trainees described ‘fire-fighting, not learning'. Improvement recommendations included addressing departmental culture, reinforcing the importance of incident reporting, and ensuring trainees had easy access to appropriate senior support at all times. Early in 2020, trainee experience further deteriorated in GS, due to a negative culture and deficiencies in support, education and training. This resulted in Foundation Year 1 doctors being removed from GS.The Senior Medical Leadership Team (SMLT) decided that enough was enough;the hospital culture needed a fundamental overhaul. There was a clear and urgent need to address staff experience.Assessment of issue and analysis of its causesThe Senior Medical Leadership Team (SMLT) set themselves an audacious goal: to support NMGH to transform into the best training and working experience for junior doctors in Greater Manchester. This goal was split into primary drivers, with each driver linked to specific future projects, and projects assigned to each leadership team member. These projects, identified through co-production with junior doctors, were aimed to improve employee experience, including facilitating access to breaks, improving supervision and support, and enhancing development opportunities â€' aiming to raise staff wellbeing and patient safety standards. Changes were made to General Surgery, resulting in huge investments in expanding the permanent junior doctor and consultant workforces.Several initiatives were implemented to help assess the scope of work required, including setting up a Junior Doctors' Leadership Group (JDLG), or ‘Shadow Board'. All hospital specialties are represented;some representatives sit on the SMLT, on Educational Board meetings, and the Clinical Leaders Forum. The SMLT join every JDLG meeting. Whilst acting as a conduit for rapid two-way communication between clinician and leadership teams (e.g. reliably informing doctors about last-minute changes to visiting policy during Covid surges, or effectively communicating crucial information to crash-call teams when building work closed part of the hospital), the group debates issues raised by junior doctor colleagues they represent, and feeds that back to the SMLT. Recent examples include raising patient safety concerns related to misinterpretation of the Emergency Department Referrals policy, and working collaboratively with junior doctors to address urgent staffing and patient safety risks related to the last wave of the pandemic.In addition to this, a Medical Director's Leadership Fellow (MDLF) role was established. This was fundamental in progressing projects related to the SMLT goal and ensuring appropriate input from junior doctors, Human Resources, the Communications and Transformation teams, and more. As a key member of the JDLG, the MDLF is a role designed in part to enhance junior doctor experience, foster better relationships between staff groups, and encourage feedback provision. The role has been vital in bridging the gap between doctors and hospital leaders, managers and executives – often a source of discontent amongst clinicians. Bridging this gap is important in developing the hospital's culture. Even though many projects are still ongoing, improvements are already being experienced.Impact2021 GMC Survey results showed improvement in 15/18 metrics compared to 2019. These included improvements in ‘Reporting Systems', ‘Workload', and ‘Clinical Supervision Out Of Hours'. 2020 Care Quality Commission inspection reports showed improvement in 11 individual aspects, including improvement to ‘outstanding' in 3 elements.HENW/GMC monitoring visits in 2021 reported ‘they have more robust teams to support the ward and on call workload', resulting from investment in clinicians. It also notes, ‘prescribing audits have shown improvements in prescribing of time critical medication', and demonstrable improvements in ‘use of incident reporting systems and sharing of lessons learnt'. Further comments note that there have been ‘significant improvements in culture in the [General Surgery] department over the past year';one doctor described the department as ‘the most supportive place he had worked'. The report summary noted, ‘through strong clinical leadership and oversight, and a concerted effort to improve departmental culture there have been significant improvements in General Surgical trainee experience with good support, supervision and education reported'. The department was subsequently removed from enhanced GMC monitoring.Although this rapid and impressive turnaround occurred within one department, benefits were seen elsewhere in the organisation.The efforts of the SMLT and JDLG have resulted in positive cultural changes. Surveys reflected: ‘friendly colleagues, less work-related stress, helpful management', and ‘thank you for your work to improve NMGH. I was worried about working at NMGH having heard ‘horror stories' about working there. However, these have not been reflected in reality at all, and NMGH has offered excellent training opportunities.InterventionThe JDLG helps ensure that important information is shared with the wider junior doctor group. Colleagues now feel that their voices are heard. The positives from the previous culture are still evident – leadership teams across the Trust have repeatedly recognised the ‘can-do attitudes' of NMGH staff, with the negative culture firmly in the past. Staff testimonials include: ‘there has definitely been an improvement over the years I have worked here;‘my supervisor was supportive and encouraged reflection through discussions about experiences;and ‘the senior staff are INCREDIBLE. They offer support, they teach, and they encourage us to learn new skills. I cannot be more thankful'. This is in contrast to historical Freedom To Speak Up (FTSU) submissions, which pointed to a culture of disregarding the opinions of NMGH staff.The ‘can-do' approach has been evident during the waves of Covid-19;members of the JDLG fed into management and governance structures to highlight problems in real time, increasing the organisation's responsiveness to challenges faced, working as a two-way conduit of information.During the 2021 HENW/GMC visit, the team reported that junior doctors knew the Medical Director and Director of Medical Education by first name, and felt able to raise concerns directly to them, evidencing a more flattened hierarchy. The visiting team reported being impressed by this positive change and were not aware of other organisations where this had been achieved to this extent.Having Postgraduate Doctors in Training play such a significant role within the Senior Leadership Team setup is relatively unique. As explained, empowering staff to feel they can raise any issues directly to the Medical Director or SMLT, or via the JDLG, has played a huge role in facilitating palpable cultural change through leadership structure additions. As a point of contact, the MDLF has acted as an extension of the JDLG, but works directly alongside the Medical Director and Associate Director of Medical Education, essentially enabling the SMLT to keep their ear to the ground, their fingers on the pulse of staff atmosphere and wellbeing.Examples of achievements of the MDLF include projects to introduce personalised theatre caps (benefits include enhanced communication, especially in emergencies, improving patient outcomes), formation of a Wellbeing group (representatives from all cohorts of staff across the site discuss wellbeing initiatives and colleagues' wellbeing concerns), and an impressive and rapid response to staffing crises and patient safety risks during the most recent Covid-19 wave. As a result of these outcomes, other Trusts haveapproached the SMLT, requesting further information regarding the JDLG and MDLF model;another MDLF has since been appointed at a different trust site.Involvement of stakeholders, such as patients, carers or family members:The SMLT itself is made up of clinicians from a variety of backgrounds, across medicine and surgery. SMLT members sit in morning medical handovers to actively gather clinician experience feedback. They also work closely alongside colleagues from Nursing, Finance, HR, Transformation teams, and more, which enables the SMLT to work collaboratively with the multidisciplinary team to improve culture at NMGH.The MDLF is in the perfect position to take advantage of this MDT approach. As a result, the MDLF sits on Group-level Patient Safety Panels (acting to highlight patient safety incidents, initiatives, and achievements across the entire Trust). This panel consists of representatives from hospital, community, and medical education staffing groups. The lessons learnt are then communicated to individual hospitals, no matter where the incident or initiative originated. A big part of the meeting is the FTSU aspect, and local FTSU Guardians are active within the panel.Given that the MDLF role is so closely linked to improving communication and feedback, a Freedom To Speak Up Champion role fitted well within the responsibilities of the post. Therefore, over the past year, the MDLF has worked alongside the FTSU team and has completed training as a FTSU Champion. As a consequence of working closely with shop-floor colleagues, the MDLF has received communications from a wide variety of staff roles and levels of seniority throughout the year, asking questions, or raising awareness about issues. The MDLF can then seek appropriate advice, signpost the colleague, and keep them updated on a potential resolution, further propagating the positive feedback loop and support of the wider MDT. As previously mentioned, the JDLG consists of representatives from all medical specialties, and each member is encouraged to raise concerns, suggest improvements, and lead on projects;these include an overhaul of the medical handover process, enabling a safer and more efficient handover, and escalating concerns of a coll ague speaking up about potential patient safety concerns within a department. Furthermore, speakers at JDLG meetings have included the Head of Nursing: Quality & Patient Experience, local FTSU Guardians, the Director of Human Resources, and the local Guardian of Safe Working Hours, enabling group members to share information from a wide range of disciplines with shop-floor colleagues. As a result of the efforts and MDT approach of the above groups, a placement feedback survey performed early in 2022 demonstrated that 93% of respondents felt their working environment supports a multidisciplinary approach.Key MessagesOne of the hallmarks of good medical leadership is putting all staff members, regardless of their role, seniority, or experience, in the best position for them to succeed. Giving Postgraduate doctors early opportunities to play a significant part in, and learn about, an organisation's leadership structure, is not only beneficial to the doctor, but helps the organisation capitalise on a previously relatively untapped market of ideas and solutions. Crucially, this is not limited to postgraduate doctors in training, but also locally-employed doctors, which make up a significant proportion of the workforce in any hospital yet typically remain underrepresented and under-utilised.NMGH has realised the potential that can be unlocked in Junior Doctors, through leadership placements and roles, and the positive benefit this can have on the individual, team and organisation.Lessons learntNorth Manchester General Hospital was fortunate in that the entire SMLT bought into everything: the overall project for culture change, the introduction of the MDLF into the SMLT, and empowering members of the JDLG to contribute to change at the highest level. Having spoken to other organisations looking to replicate our success, they have found that this buy-in is absolutely crucial. Recruiting effectively, to both the MDLF position and JDLG representative roles, is vital, as a huge amount of motivation to fight for change and the betterment of the system is required when overcoming barriers and challenges. Many of the barriers we faced are well-documented in literature, and to a point we expected them;these included resistance from non-medical stakeholders, which was somewhat abetted by further conversations, explanation of goals and objectives, and outlining the overall vision of the SMLT. Of course, resistance to change is important in any project, as it can highlight potential issues not yet visualised.Measurement of improvementFrom the start, we set out our intention to use openly-available, independent metrics of improvement, such as the GMC Nation Training Survey. To compliment this, the MDLF utilised a variety of temperature-check methods, including surveys (dissemination supported by the increasingly-established network of the Postgraduate doctors in training of the JDLG) and departmental visits. Importantly, having a fellow junior doctor asking for feedback, rather than a traditional member of the SMLT, enabled us to garner potentially more honest opinions, criticisms and ideas. As explained elsewhere, GMC survey results have shown improvement, and local surveys have displayed some very positive results. That said, it is recognised that the vision is a long-term project, and continuous improvement will be sought, rather than settling on the progress made thus far.Strategy for improvementThe SMLT sat down and brainstormed an overall vision alongside the individual large-scale projects that would contribute to achieving change. Within this, individual members of the SMLT were assigned roles leading one or more projects, and the MDLF role was created in part to support with the running of these projects where required. This enabled utilisation of the minds of the JDLG and other Postgraduate doctors in training. The MDLF role was instrumental in not only involving this cohort, but also reaching out to other organisations to share learned experiences when they had gone through implementation of similar projects. The team was kep accountable not by having a set timeline for implementation but by having regular away days, reporting back to their colleagues and the transformation team regarding progress.The JLDG, established in 2020, and reappointed every year, have been key to the success of the culture change, through engagement, sense-checking and feedback regarding strategy and relevant projects. Over time the organisation has increasingly engaged this Shadow Board in the development and role out of projects as well as problem solving of significant challenges. Through this team the SMLT has fedback key messages and challenges to the Junior Doctor workforce, which has resulted in increased engagement across the organisation.
ABSTRACT
Introduction: The onset and rise of COVID-19 and its sudden progression to a worldwide pandemic lead medical and dental institutes to change their way of teaching and conducting assessments to distance learning as compared to the previously applied conventional approaches. Teaching and assessment during this era have changed vastly, earlier it was solely traditional/live Objective Structured Clinical Examination (OSCE) but due to the current circumstances electronic/online OSCE (E-OSCE) method was introduced. In Pakistan also, Pakistan Medical Council (PMC) and the College of Physicians and Surgeons of Pakistan (CPSP) conducted online exams so that the scheduled exams do not get delayed. Aim(s): The main objective of this paper is to measure the reliability of an E-OSCE and to compare it with the traditional OSCE. Methodology: This was a cross-sectional study which got conducted at the Rawal Institute of Health Sciences, Islamabad. Traditional OSCEs and E-OSCEs were conducted with 71 participants including final year students and house officers. Each OSCEs had 10 stations, including one interactive station in traditional OSCE. Students' scores in both the OSCEs were collected and paired t-test was used to compare the mean scores at p<0.05. Result(s): Total number of house officers were 27 and final year students were 44. The scores of 71 participants were collected. The difference between mean scores of house officers' traditional OSCE and E-OSCE was statistically significant (p=0.000). The difference between final year students traditional OSCE and E-OSCE was also statistically significant (p=0.020). Finally, the overall difference between traditional OSCE and E-OSCE was also statistically significant (p=0.000) Practical implication: The main objective of this study was to assess the reliability of an E-OSCE and to compare whether the electronic method of conducting OSCE is more reliable than the traditional method of conducting OSCE. Conclusion(s): Despite limitations and the biases, the results of E-OSCE proved to be better than traditional OSCE. Further research needs to be conducted on E-OSCE to control the factors causing biases and limitations.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.