Community immersion project to enhance medical students understanding of the health needs of the most vulnerable in the community.

AIM: A group of eight fourth year medical students formed the 'UBMS public health crew' to conduct a community immersion project within elderly ethnic minority communities. The aim of the study was to understand their health perceptions regarding influenza vaccinations and learn about the enablers and barriers in accessing the vaccination. METHODOLOGY: Interviews were held by the students at community lunch clubs with the help of questionnaires. RESULTS: 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey. CONCLUSION: This project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. RESULTS: 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey. this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. METHODS: Interviews were held by the students at community lunch clubs with the help of questionnaires. 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey which found that this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. AIM: A group of eight fourth year medical students formed the 'UBMS public health crew' to conduct a community immersion project within elderly ethnic minority communities. The aim of the study was to understand their health perceptions regarding influenza vaccinations and learn about the enablers and barriers in accessing the vaccination. Interviews were held by the students at community lunch clubs with the help of questionnaires. 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey which found that this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care.

Face-to-face versus online clinically integrated EBM teaching in an undergraduate medical school: a pilot study.

OBJECTIVES: The aim of this study was to test the feasibility and effectiveness of two models (face-to-face vs online teaching) of clinically integrating evidence-based medicine (EBM) teaching in an undergraduate medical school. DESIGN AND SETTING: A pilot study of face-to-face versus online EBM teaching. PARTICIPANTS: This study focused on undergraduate medical students who entered the University of Buckingham Medical School MBChB course in 2016 (n=65). Of the 65 students, 45 received face-to-face teaching, while 20 received online teaching. MAIN OUTCOME MEASURES: Feasibility was assessed by the ability to deliver the content, students' engagement during teaching and their completion rates in formative assessments-Assessing Competency in EBM (ACE) tool, and educational prescriptions (EPs). Effectiveness of teaching for the two models was compared by evaluating students' performance in the formative assessments and in the summative final professional examination and final year EBM objective structured clinical examination (OSCE). RESULTS: We had similar students' engagement and completion rates in formative assessments in both models. Students receiving face-to-face teaching performed better in EPs (mean difference=-2.28, 95% CI: -4.31 to -0.26). There was no significant difference in performances in the ACE tool (mean difference=-1.02, 95% CI: -2.20 to 0.16); the written final professional exams (mean difference=-0.11, 95% CI: -0.65 to 0.44) and the EBM OSCE station (mean difference=-0.81, 95% CI: -2.38 to 0.74). CONCLUSIONS: It was feasible to deliver both models of clinically integrated EBM teaching. While students in the face-to-face model scored higher in EPs; there was no significant difference between the two models of teaching as measured by performances in the ACE tool or the summative assessments.

The rOSCE: A remote clinical examination during COVID lockdown and beyond.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has created a challenge for all medical educators. There is a clear need to train the next generation of doctors whilst ensuring that patient safety is preserved. The OSCE has long been used as the gold standard for assessing clinical competency in undergraduates ( Khan et al., 2013a). However, social distancing rules have meant that we have had to reconsider our traditional assessment methods. We held a remote eight-station summative OSCE (rOSCE) for three final year resit students using Microsoft Teams. Apart from clinical examinations and practical procedures which are assessed elsewhere in our programme, the content was similar to our standard OSCE. Staff and student training ensured familiarity with the assessment modality. The rOSCE was found to be a feasible tool with high face validity. The rOSCE is a remote assessment tool that can offer an alternative to the traditional face to face OSCEs for use in high stakes examinations. Although further research is needed, we believe that the rOSCE is scalable to larger cohorts of students and is adaptable to the needs of most undergraduate clinical competency assessments.

A systematic review and taxonomy of tools for evaluating evidence-based medicine teaching in medical education.

BACKGROUND: The importance of teaching the skills and practice of evidence-based medicine (EBM) for medical professionals has steadily grown in recent years. Alongside this growth is a need to evaluate the effectiveness of EBM curriculum as assessed by competency in the five 'A's': asking, acquiring, appraising, applying and assessing (impact and performance). EBM educators in medical education will benefit from a compendium of existing assessment tools for assessing EBM competencies in their settings. The purpose of this review is to provide a systematic review and taxonomy of validated tools that evaluate EBM teaching in medical education. METHODS: We searched MEDLINE, EMBASE, Cochrane library, Educational Resources Information Centre (ERIC), Best Evidence Medical Education (BEME) databases and references of retrieved articles published between January 2005 and March 2019. We have presented the identified tools along with their psychometric properties including validity, reliability and relevance to the five domains of EBM practice and dimensions of EBM learning. We also assessed the quality of the tools to identify high quality tools as those supported by established interrater reliability (if applicable), objective (non-self-reported) outcome measures and achieved ≥ 3 types of established validity evidence. We have reported our study in accordance with the PRISMA guidelines. RESULTS: We identified 1719 potentially relevant articles of which 63 full text articles were assessed for eligibility against inclusion and exclusion criteria. Twelve articles each with a unique and newly identified tool were included in the final analysis. Of the twelve tools, all of them assessed the third step of EBM practice (appraise) and four assessed just that one step. None of the twelve tools assessed the last step of EBM practice (assess). Of the seven domains of EBM learning, ten tools assessed knowledge gain, nine assessed skills and-one assessed attitude. None addressed reaction to EBM teaching, self-efficacy, behaviours or patient benefit. Of the twelve tools identified, six were high quality. We have also provided a taxonomy of tools using the CREATE framework, for EBM teachers in medical education. CONCLUSIONS: Six tools of reasonable validity are available for evaluating most steps of EBM and some domains of EBM learning. Further development and validation of tools that evaluate all the steps in EBM and all educational outcome domains are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116203.

Schwartz rounds in undergraduate medical education facilitates active reflection and individual identification of learning need.

This article was migrated. The article was marked as recommended. Strategies applying Schwartz Rounds to improve wellbeing of medical students has focused on the clinical years of study. This pilot study investigates whether Schwartz Rounds could be effective in developing students' reflective practice in Year 2 undergraduates. Engagement with the Schwartz Round was high with over 50% of the students identifying learning needs through reflection on the Round. Schwartz Rounds promoted recognition of the value of reflective practice and increased self-awareness of student needs.

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management.

BACKGROUND: Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. AIM: To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. DESIGN AND SETTING: A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. METHOD: The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. RESULTS: Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). CONCLUSION: Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review.

Assessing the impact of attrition in randomized controlled trials.

OBJECTIVES: A survey of randomized controlled trials found that almost a quarter of trials had more than 10% of responses missing for the primary outcome. There are a number of ways in which data could be missing: the subject is unable to provide it, or they withdraw, or become lost to follow-up. Such attrition means that balance in baseline characteristics for those randomized may not be maintained in the subsample who has outcome data. For individual trials, if the attrition is systematic and linked to outcome, then this will result in biased estimates of the overall effect. It then follows that if such trials are combined in a meta-analysis, it will result in a biased estimate of the overall effect and be misleading. The aim of this study was to investigate the impact of attrition on baseline imbalance within individual trials and across multiple trials. STUDY DESIGN AND SETTING: In this article, we used individual patient data from a convenience sample of 10 trials evaluating interventions for the treatment of musculoskeletal disorders. Meta-analyses using the mean difference at baseline between the trial arms were carried out using individual patient data from these trials. The analyses were first carried out using all randomized participants and secondly only including participants with outcome data on the quality-of-life score. Meta-regression was carried out to evaluate whether the level of baseline imbalance was associated with the level of attrition. RESULTS: The overall attrition rates for the quality-of-life score ranged between 4% and 28% of the total randomized patients. All trials showed some level of differential attrition between the treatment arms, ranging from 1% to 14%. Attrition within the control group ranged from 3% to 25% and within the intervention group, it ranged from 0% to 31%. For individual trials, there was no indication that attrition altered the results in favor of either the treatment or the control. Forest plots highlighted that the attrition had some impact on the baseline imbalance for the primary outcome score as more heterogeneity was introduced (I-squared value of 0.4% for the initial data set vs. I-squared value of 16.9% for the analyzed data set). However, the standardized mean difference increased only slightly (from 0.01 to 0.03 with 95% confidence interval [CI]: -0.05, 0.10). Meta-regression showed little or no evidence of a significant dose-response relationship between the level of attrition and the baseline imbalance (coefficient 0.73, 95% CI: -0.81, 2.28). CONCLUSION: Although, in theory, attrition can introduce selection bias in randomized trials, we did not find sufficient evidence to support this claim in our convenience sample of trials. However, the number of trials included was relatively small, which may have led to small but important differences in outcomes being missed. In addition, only 2 of 10 trials included had attrition levels greater than 15% suggesting a low level of potential bias. Meta-analyses and systematic reviews should always consider the impact of attrition on baseline imbalances and where possible any baseline imbalances in the analyzed data set and their impact on the outcomes reported.

Eosinophil adhesion to cholinergic nerves via ICAM-1 and VCAM-1 and associated eosinophil degranulation.

In vivo, eosinophils localize to airway cholinergic nerves in antigen-challenged animals, and inhibition of this localization prevents antigen-induced hyperreactivity. In this study, the mechanism of eosinophil localization to nerves was investigated by examining adhesion molecule expression by cholinergic nerves. Immunohistochemical and functional studies demonstrated that primary cultures of parasympathetic nerves express vascular cell adhesion molecule-1 (VCAM-1) and after cytokine pretreatment with tumor necrosis factor-alpha and interferon-gamma intercellular adhesion molecule-1 (ICAM-1). Eosinophils adhere to these parasympathetic neurones after cytokine pretreatment via a CD11/18-dependent pathway. Immunohistochemistry and Western blotting showed that a human cholinergic nerve cell line (IMR-32) expressed VCAM-1 and ICAM-1. Inhibitory experiments using monoclonal blocking antibodies to ICAM-1, VCAM-1, or CD11/18 and with the very late antigen-4 peptide inhibitor ZD-7349 showed that eosinophils adhered to IMR-32 cells via these adhesion molecules. The protein kinase C signaling pathway is involved in this process as a specific inhibitor-attenuated adhesion. Eosinophil adhesion to IMR-32 cells was associated with the release of eosinophil peroxidase and leukotriene C(4). Thus eosinophils adhere to cholinergic nerves via specific adhesion molecules, and this leads to eosinophil activation and degranulation; this may be part of the mechanism of eosinophil-induced vagal hyperreactivity.