Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study.

BACKGROUND: There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version. METHODS: A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach's alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument. RESULTS: A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach's alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX. CONCLUSION: The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education. TRIAL REGISTRATION: 2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.

A course, 'The Human in Medicine', as an example of a preclinical medical humanities program: a summary of 7 years.

BACKGROUND: This article is based on the experience with 'The Human in Medicine' (HIM) courses that had been a part of the preclinical program of the Marmara Medical School. AIM: The evaluation of the HIM course in terms of its efficacy and the impressions of the students. METHODS: Three groups of data were collected: (a) Students' feedbacks about the courses, (b) HIM final scores and (c) a thematic/content analysis of randomly selected students' reports. Stratified random sampling was used to select student reports for qualitative analysis. Content and thematic analyses were carried out by two researchers independently. RESULTS: In general, the HIM program was evaluated as moderate or above moderate by 60-80% of the students. Content and thematic analysis of student reports showed that there was a rich variety in individual definitions, descriptions of causal relationships and suggestions for possible solutions about themes medicalization and stigmatization. Student reports on the case were analysed in concordance with psychologic and social parameters. CONCLUSION: As a conclusion these results showed that program goals were mainly achieved and the multidisciplinary, preclinical HIM program can be seen as efficient starting point to complement the biologic perspective of medical education with a social and humanistic perspective.

Interactive lecturing for meaningful learning in large groups.

In order to enhance the quality of integration of physiological basic concepts with clinical sciences and to facilitate problem solving skills, a 'structured integrated interactive' two-hour block lecture on growth hormone physiology was implemented. A template showing the central regulation of growth hormone release and its peripheral effects was developed as an advanced organizer. Based on this template, new information was presented. Student feedback demonstrated that the lecture, based on the expository teaching model and enhanced by different forms of question and problem solving activities, was successful and interactive. It was also more motivating and was able to keep the attention of the students in relatively higher levels throughout the lecture. Furthermore, students felt that they had made important gains in transferable problem solving skills and this opinion was supported by their performance in clinical cases. These findings reinforced the idea that systematic incorporation of active learning strategies into lectures may minimize many of the weaknesses of traditional lectures.

Anti-inflammatory effect of acute stress on experimental colitis is mediated by cholecystokinin-B receptors.

We aimed to investigate the effects of electric shock (ES) on the course of experimental colitis and the involvement of possible central and peripheral mechanisms. In Sprague-Dawley rats (n = 190) colitis was induced by intracolonic administration 2,4,6-trinitrobenzenesulfonic acid (TNBS). The effects of ES (0.3-0.5 mA) or the central administration of corticotropin-releasing factor (CRF; astressin, 10 microg/kg) or cholecystokinin (CCKB; 20 microg/kg) receptor antagonists and peripheral glucocorticoid receptor (RU-486; 10 mg/kg) or ganglion (hexamethonium; 15 mg/kg) blockers on TNBS-induced colitis were studied by the assessment of macroscopic score, histological analysis and tissue myeloperoxidase activity. ES reduced all colonic damage scores (p < 0.05-0.01), while central CRF (p < 0.05-0.001) and CCKB receptor (p < 0.05-0.01) blockers or peripheral hexamethonium (p < 0.05-0.01) and RU-486 (p < 0.05) reversed stress-induced improvement. ES demonstrated an anti-inflammatory effect on colitis, which appears to be mediated by central CRF and CCK receptors with the participation of hypothalamo-pituitary-adrenal axis and the sympathetic nervous system.

Enterogastric brake in rats with segmental bowel resection: role of capsaicin-sensitive nerves.

1. Unabsorbed nutrients in the distal gut inhibit upper gastrointestinal motility. 2. The aim of the present study was to investigate changes in gastric motility following segmental resections and to evaluate the role of capsaicin-sensitive afferent neurons that may be responsible for these changes. 3. Wistar albino rats of both sexes (200-250 g) were used. Under aseptic conditions and anaesthesia (100 mg/kg ketamine), a baby-feeding tube was placed distal to the resection in either the ileum or caecum for intraluminal perfusion of saline or 20 lipid. In one group of rats, capsaicin was perfused (0.6) for afferent denervation. One group of rats underwent jejunal and ileal resections with end-to-end anastomosis of the remaining segments and were cannulated distal to these anastomosis. Ten days after the surgery, the percentage gastric emptying of a solid meal was calculated. 4. Intra-ileal (18) and intracaecal (34) lipid perfusions delayed gastric emptying compared with groups perfused with saline (54 and 74, respectively; P< 0.001 and P< 0.01). The delay in gastric emptying by ileal perfusion was significantly greater than that following caecal perfusion (P< 0.05). With both resections, gastric emptying was delayed compared with sham groups (P< 0.05-0.01). Local administration of capsaicin abolished the inhibitory effect of lipid on gastric emptying in healthy intact rats and in the jejunal-resection group, whereas a partial reversal was seen in the ileal-resection group. 5. In conclusion, the present data demonstrate that in both healthy intact rat groups and in short bowel groups, capsaicin-sensitive extrinsic neurons participate in brake mechanisms of the distal gut.