Impacts of service learning-based social responsibility training on medical students.

Social responsibility (SR) is a fundamental value among physicians, who must maintain a positive attitude toward it during medical education by providing community service. This study investigated the impacts of service learning-based social responsibility training (SRT) by evaluating the SR perceptions of medical students who had participated in an SRT program and their views on the impacts of SRT on themselves, their institution, and the studied target groups. Four focus group interviews were held with 32 medical students, following a determined purposeful sampling method. Guided by qualitative content analysis, the data were analyzed through an iterative coding process. The analysis of the students' perceptions of SR revealed 13 themes in the impact of SRT: 7 for medical students, 4 for the medical school, and 2 for the studied target groups. The students explained SR with concepts of responsibility, volunteering, sensitivity, kindness, and community orientation and believed that SRT practices based on service learning effectively deepen the understanding of SR and the needs of the target groups in which they work. Communication, teamwork, leadership, and project management skills were defined as students' achievements. SRT practices had a positive effect on the studied target groups by meeting their physical and emotional needs; furthermore, they increased their medical school's recognition and accountability in society. Therefore, providing service learning-based experiences with reflection opportunities throughout medical education supports the development of medical students' understanding of SR, which can be strengthened with a supportive corporate culture and by improving the faculty's role-modeling and tutoring skills.NEW & NOTEWORTHY Social responsibility is a fundamental value among physicians, who must maintain a positive attitude toward it during medical education by providing community service. Providing service learning-based experiences with reflection opportunities throughout medical education supports the development of medical students' understanding of social responsibility, which can be strengthened with a supportive corporate culture and by improving the faculty's role-modeling and tutoring skills.

Social accountability: A national framework for Turkish medical schools.

PURPOSE: To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. METHODOLOGY OF THE STUDY: The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. RESULTS: In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. CONCLUSION: A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.

From the lens of the clinical residents: undergraduate to postgraduate medical education and the transition process.

The concept of continuity in medical education reflects the progressive professional and personal development that physicians need in education. The aim of this study is investigating the views of the residents about the adequacy of undergraduate and postgraduate education in the context of preparing them for the next stage and their perceptions about the transition period. This phenomenological study was conducted at Hacettepe University Medical School. The study group consisted of medical and surgical sciences residents in the first year and last year of postgraduate medical education. Four focus group interviews were held with the participation of 21 residents. The participants emphasised that practising with real patients under supervision by taking an active role in healthcare teams was important for their preparation for the next stage in their carrier. However, their educational experiences during undergraduate medical education differed in community-based education, scientific research training, learning in small groups, internship and guidance of clinical educators. The transition period has been expressed with the concepts of identity change, high responsibilities and expectations required by the new identity, adaptation to the healthcare team, institution, and health system, meeting the expectations in an overly busy work environment, and feelings of incompetence. Participants pointed out that curriculum, which was declared and taught, educational environments, assessment approaches, consultancy systems and practices differed between the clinical departments. In line with the principles of competency-based education, practices related to the development and assessment of the competencies with all professional aspects in postgraduate medical education can be strengthened.

The state of ethics education at medical schools in Turkey: taking stock and looking forward.

BACKGROUND: Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown. METHODS: The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78%). RESULTS: Although most institutions had an undergraduate ethics curriculum (91.1%), the findings suggest deficiency of teaching personnel (34.2% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1%). CONCLUSIONS: Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.

Determinants of self-regulated learning skills: the roles of tutors and students.

Problem-based learning (PBL) is an instructional method that offers students the opportunity to develop self-regulatory strategies as an explicit learning outcome. As a multifaceted PBL environment, the guidance of tutors is important to students as they develop self-regulatory learning (SRL) skills and self-efficacy, the most focused motivational element in SRL. The present study examines the relationship between academic achievement and PBL self-efficacy levels, as well as the role played by tutors. A cross-sectional study was conducted with third- year medical students (n = 257; 75%). The SRL perception (SRLP) scale, the self-efficacy for PBL scale (SPBL), tutor evaluation scale (TES), and an achievement test were used to gather data in this study. In every scale, participant scores were higher than the midpoint, which is 3. There were positive correlations between SRL, self-efficacy, and the tutoring scores of tutors. As the correlation between SRLP and achievement was not significant, achievement was removed from the regression equation, and only SPBL and TES results were used. The results of the regression analysis indicated that SPBL and TES explained 36% of the variance. The level of self-efficacy in PBL predicted the students' SRL abilities, as did tutor evaluations. The findings show that students used their SRL skills and had beliefs about their ability to learn effectively in the PBL context. Both the tutors' tutoring skills and the students' self-efficacy made important contributions to improving the students' self-regulated learning skills.

Medical students' self-efficacy in problem-based learning and its relationship with self-regulated learning.

BACKGROUND: Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students' motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students' self-reported SRL skills and their self-efficacy in PBL. METHODS: A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. RESULTS: The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students' views on benefiting from PBL. The female students' mean score was higher for the 'planning and goal setting' subscale of SRLP (p=0.017), and the second-year students' mean score was higher than that of the third-year students for the 'lack of self-directedness' subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the 'responsibility' subscale of SPBL (p=0.003; Cohen's d=0.26). CONCLUSIONS: The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students' development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning environment, individual differences, and how these can affect the SRL process.

Turkish students' perceptions of professionalism at the beginning and at the end of medical education: a cross-sectional qualitative study.

AIM: Medical students' perceptions of professionalism might reflect the impact of the current educational processes on their professional identity development. This study focuses on Ankara University Faculty of Medicine students' perceptions of 'good doctor' along with the factors effective on the formation of these perceptions. METHOD: Six focus groups with 59 medical students from Grade-1 and Grade-6 were held. The transcripts of discussions were analyzed thematically. RESULTS: Results regarding 'being a good physician' mostly mirrored the findings of previous studies framing the medical professionalism concept. The thematic pattern of the discussions on the relation between professional development and medical education suggests that students suffer from a gradual erosion of perception during medical education. That the education cannot either change the person for the better or might downgrade the person instead of improving her/him were shared by participants from both grades. Students consider clinical practice and role models two main variables determining the person's qualification as a professional. CONCLUSIONS: The formal and hidden programs determine the quality and efficacy of the professional education together. Attempts to restructure medical education must recognize the reciprocal dynamics between these two components and, thus, should carefully work out the practical aspect of the educational processes.