A 3-D interactive microbiology laboratory via virtual reality for enhancing practical skills.

Virtual Reality (VR) laboratories are a new pedagogical approach to support psychomotor skills development in undergraduate programmes to achieve practical competency. VR laboratories are successfully used to carry out virtual experiments in science courses and for clinical skills training in professional courses. This paper describes the development and evaluation of a VR-based microbiology laboratory on Head-Mounted Display (HMD) for undergraduate students. Student and faculty perceptions and expectations were collected to incorporate into the laboratory design. An interactive 3-dimensional VR laboratory with a 360° view was developed simulating our physical laboratory setup. The laboratory environment was created using Unity with the (created) necessary assets and 3D models. The virtual laboratory was designed to replicate the physical laboratory environment as suggested by the students and faculty. In this VR laboratory, six microbiology experiments on Gram staining, bacterial streaking, bacterial motility, catalase test, oxidase test and biochemical tests were placed on the virtual platform. First-year biomedical science students were recruited to evaluate the VR laboratory. Students' perception of the virtual laboratory was positive and encouraging. About 70% of the students expressed they felt safe using the VR laboratory and that it was engaging. They felt that the VR laboratory provided an immersive learning experience. They appreciated that they could repeat each experiment multiple times without worrying about mistakes or mishaps. They could personalise their learning by concentrating on the specific experiments. Our in-house VR-based microbiology laboratory was later extended to other health professions programmes teaching microbiology.

Managing assessment during curriculum change: Ottawa Consensus Statement.

Curriculum change is relatively frequent in health professional education. Formal, planned curriculum review must be conducted periodically to incorporate new knowledge and skills, changing teaching and learning methods or changing roles and expectations of graduates. Unplanned curriculum evolution arguably happens continually, usually taking the form of "minor" changes that in combination over time may produce a substantially different programme. However, reviewing assessment practices is less likely to be a major consideration during curriculum change, overlooking the potential for unintended consequences for learning. This includes potentially undermining or negating the impact of even well-designed and important curriculum changes. Changes to any component of the curriculum "ecosystem "- graduate outcomes, content, delivery or assessment of learning - should trigger an automatic review of the whole ecosystem to maintain constructive alignment. Consideration of potential impact on assessment is essential to support curriculum change. Powerful contextual drivers of a curriculum include national examinations and programme accreditation, so each assessment programme sits within its own external context. Internal drivers are also important, such as adoption of new learning technologies and learning preferences of students and faculty. Achieving optimal and sustainable outcomes from a curriculum review requires strong governance and support, stakeholder engagement, curriculum and assessment expertise and internal quality assurance processes. This consensus paper provides guidance on managing assessment during curriculum change, building on evidence and the contributions of previous consensus papers.

Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study.

BACKGROUND: The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences. METHODS: A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests. RESULTS: 'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher). LIMITATIONS: Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution. CONCLUSION: There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Supporting validity: steps to contextualise applications for technology and assessment, for learning.

In the paper, the authors offer perspectives on the uses of technology and assessment, that support learning. The perspectives are viewed through validity (from the field of assessment) as a framework and they discuss four aspects of an interconnected technology, learning and assessment space that represent theory informed, authentic practice. The four are: 1) integrated coherence for learning, assessment and technology; 2) responsibilities for equity, diversity, inclusion and wellbeing; 3) sustainability; and 4) balancing resources in global contexts. The authors propose steps and considerations for medical and health professions educators who need to contextualise applications for technology, learning and assessment, for positive impact for learners, faculty, institutions and patient care.

A Qualitative Study on the Experiences of Preclinical Students in Learning Clinical and Communication Skills at a Simulation Centre.

Introduction: Simulation centres (SC) and its learning resources are now firmly established as part of medical education. In SC, medical students obtain both knowledge and skills based on a combination of theory and practice using provided resources. This study aims to explore medical students' use of SC learning resources to learn clinical and communication skills based on Kolb's experiential learning cycle. This is based on the research question 'How are the SC resources useful in supporting preclinical medical students' clinical and communication skills learning?' The findings of the study can make a case for further enhancement of SC design and resources for medical students in the preclinical phase. Methods: A qualitative study involving 20 preclinical medical students with learning experiences in SC was conducted between December 2019 and 2020 at a medical school in Malaysia. Semi-structured interview questions were developed based on Kolb's learning cycle. The data were thematically analysed using the six phases of Braun and Clarke's thematic analysis. Results: Three main themes were identified based on preclinical medical students' experiences in SC; they were 'preparation for authentic clinical experience', 'accessibility of multiple resources for learning and support' and 'opportunities to learn and improve'. Conclusions: The SC's resources have a significant and positive role in supporting preclinical medical students learn clinical and communication skills. The SC resources prepared them for authentic clinical experiences with a patient-centred care approach and self-directed learning opportunities. Social support from peers, peer tutors and academics emerged as a key finding and resource of the SC as they help preclinical students learn and improve.

Faculty perceptions regarding an individually tailored, flexible length, outcomes-based curriculum for undergraduate medical students.

PURPOSE: The perception of faculty members about an individually tailored, flexible-length, outcomes-based curriculum for undergraduate medical students was studied. Their opinion about the advantages, disadvantages, and challenges was also noted. This study was done to help educational institutions identify academic and social support and resources required to ensure that graduate competencies are not compromised by a flexible education pathway. METHODS: The study was done at the International Medical University, Malaysia, and the University of Lahore, Pakistan. Semi-structured interviews were conducted from 1st August 2021 to 17th March 2022. Demographic information was noted. Themes were identified, and a summary of the information under each theme was created. RESULTS: A total of 24 (14 from Malaysia and 10 from Pakistan) faculty participated. Most agreed that undergraduate medical students can progress (at a differential rate) if they attain the required competencies. Among the major advantages mentioned were that students may graduate faster, learn at a pace comfortable to them, and develop an individualized learning pathway. Several logistical challenges must be overcome. Providing assessments on demand will be difficult. Significant regulatory hurdles were anticipated. Artificial intelligence (AI) can play an important role in creating an individualized learning pathway and supporting time-independent progression. The course may be (slightly) cheaper than a traditional one. CONCLUSION: This study provides a foundation to further develop and strengthen flexible-length competency-based medical education modules. Further studies are required among educators at other medical schools and in other countries. Online learning and AI will play an important role.

Remote online open book examinations: through the lenses of faculty and students in health professions programmes.

BACKGROUND: Open book examinations have been used to assess students' higher order cognitive skills. These examinations can be conducted online remotely with the advancement of technology. However, there are concerns regarding its validity and reliability particularly if the examinations are not proctored. The objective of this study was to explore the perceptions of faculty and students in health professions programmes about remote online open book examinations (ROOBE). METHODS: Semi-structured interviews were conducted among 22 faculty staff who were involved in ROOBE in health professions programmes. All interviews were audio recorded, transcribed verbatim and analysed using a thematic analysis approach. The perceptions of 249 medical students were obtained using an online questionnaire after they completed ROOBE. RESULTS: The faculty agreed that open book examinations could promote students' higher order cognitive skills and reduce students' stress. However, they were concerned about students' academic integrity during non-invigilated ROOBE which could affect recognition by accreditation and professional bodies. The shift from traditional practice of closed-book examinations to ROOBE required change management with the support of guidelines and faculty training.  Majority of the students claimed that the examinations were challenging as they assessed their ability to apply knowledge in real world problems. Nevertheless, they preferred ROOBE due to less anxiety and memorisation, and more emphasis on problem solving skills. The shortcomings were insufficient time for information searching during examinations and uncertainty in preparedness for future practice as they focused less on memorisation of factual knowledge during examination preparation. Cheating among peers and internet instability during non-invigilated ROOBE were the concerns highlighted by some students. CONCLUSIONS: Faculty and students expressed favourable views about ROOBE in promoting higher order cognitive skills. Adequate technological support was essential during ROOBE. While there was a need to address issues related to academic integrity, ROOBE could be included as an authentic assessment within the systems of assessment.

Rating and ranking preparedness characteristics important for veterinary workplace clinical training: a novel application of pairwise comparisons and the Elo algorithm.

Quantitatively eliciting perspectives about a large number of similar entities (such as a list of competences) is a challenge for researchers in health professions education (HPE). Traditional survey methods may include using Likert items. However, a Likert item approach that generates absolute ratings of the entities may suffer from the "ceiling effect," as ratings cluster at one end of the scale. This impacts on researchers' ability to detect differences in ratings between the entities themselves and between respondent groups. This paper describes the use of pairwise comparison (this or that?) questions and a novel application of the Elo algorithm to generate relative ratings and rankings of a large number of entities, on a unidimensional scale. A study assessing the relative importance of 91 student "preparedness characteristics" for veterinary workplace clinical training (WCT) is presented as an example of this method in action. The Elo algorithm uses pairwise comparison responses to generate an importance rating for each preparedness characteristic on a scale from zero to one. This is continuous data with measurement variability which, by definition, spans an entire spectrum and is not susceptible to the ceiling effect. The output should allow for the detection of differences in perspectives between groups of survey respondents (such as students and workplace supervisors) which Likert ratings may be insensitive to. Additional advantages of the pairwise comparisons are their low susceptibility to systematic bias and measurement error, they can be quicker and arguably more engaging to complete than Likert items, and they should carry a low cognitive load for respondents. Methods for evaluating the validity and reliability of this survey design are also described. This paper presents a method that holds great potential for a diverse range of applications in HPE research. In the pursuit quantifying perspectives on survey items which are measured on a relative basis and a unidimensional scale (e.g., importance, priority, probability), this method is likely to be a valuable option.

Communication skills in primary care settings: aligning student and patient voices.

INTRODUCTION: Effective communication is essential for patient-centred relationships. Although medical graduates acquire communication skills during undergraduate training, these have been shown to be inadequate in early practice. Both students' and patients' perspectives are required to improve readiness for the workplace, patient satisfaction, and health outcomes. Our research question was: to what extent are medical students prepared with patient-centred communication skills in primary care settings? METHODS: A qualitative descriptive research study using in-depth semi-structured interviews was conducted with Year 3 medical students and patients to study their experiences at a primary care clinic, over two weeks. Data were transcribed verbatim and analysed using Braun and Clark's thematic analysis. Both students' and patients' views on communication skills were obtained. RESULTS: Three themes were established based on student-patient communication in primary care settings: socio-cultural elements in student-patient communication; cognitive and emotional challenges for effective communication; and enablers for effective student-patient communication. The themes and sub-themes describe both students and patients valuing each other as individuals with socio-cultural beliefs and needs. CONCLUSION: The findings can be used to structure new approaches to communication skills education that is patient-centred, culturally sensitive, and informed by patients. Communication skills training should encourage students to prioritise and reflect more on patient perspectives while educators should engage patients to inform and assess the outcomes.

Inclusion in global health professions education communities through many lenses.

In this paper, we reflect on what inclusion can mean to the global Health Professions Education (HPE) community, the impact of lack of inclusion, and offer suggestions on how to be inclusive. To illustrate the impact of inclusion, we offer perspectives from the lens of a medical student, junior doctor, educators, and educational leaders. The viewpoints offered in this communication can be useful to broaden and nurture inclusive pedagogy and scholarship. Furthermore, since the aim of HPE is high quality patient care and social advocacy, emphasising inclusion in HPE could enhance inclusion in patient care.

Synthesis and perspectives from the Ottawa 2022 conference on the assessment of competence.

INTRODUCTION: The Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions was first convened in 1985 in Ottawa. Since then, what has become known as the Ottawa conference has been held in various locations around the world every 2 years. It has become an important conference for the community of assessment - including researchers, educators, administrators and leaders - to share contemporary knowledge and develop international standards for assessment in medical and health professions education. METHODS: The Ottawa 2022 conference was held in Lyon, France, in conjunction with the AMEE 2022 conference. A diverse group of international assessment experts were invited to present a symposium at the AMEE conference to summarise key concepts from the Ottawa conference. This paper was developed from that symposium. RESULTS AND DISCUSSION: This paper summarises key themes and issues that emerged from the Ottawa 2022 conference. It highlights the importance of the consensus statements and discusses challenges for assessment such as issues of equity, diversity, and inclusion, shifts in emphasis to systems of assessment, implications of 'big data' and analytics, and challenges to ensure published research and practice are based on contemporary theories and concepts.

Entrustable professional activities in undergraduate dental education: A practical model for development and validation.

OBJECTIVE: Entrustable professional activities (EPAs) are tasks that a person who is qualified or is in the process to be credentialed are allowed to engage. There are several levels of entrustment based on degrees of supervision assigned to each EPA. This paper aims to describe the process and outcome of creating EPAs; validate EPAs relevant to undergraduate dental training. METHODS: A draft set of EPA statements was developed based on the consensus of an expert panel. These were then mapped to the nationally determined minimum experience thresholds (clinical and procedural experiences/competencies) and aligned to task-based instructional strategy. The EPAs were validated to improve the relevance by using a criterion-based rubric. RESULTS: An end-to-end process workflow led to the development of an EPA-based educational framework to bridge the gaps in the curriculum. The process identified a total of 41 EPAs and out of which, 10 EPAs were notated as core EPAs and will be subjected to structured workplace-based assessment complying to the national standards. The validation exercise rated core EPAs with an overall score matching close to the cut-off of 4.07 (Equal rubric). CONCLUSION: The end-to-end process workflow provided the opportunity to elaborate a structured process for the development of EPAs for undergraduate dental education. As validation is a continuous process, feedback from implementation will inform the next steps.

Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148.

Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.

Stakeholder perspectives on veterinary student preparedness for workplace clinical training - a qualitative study.

BACKGROUND: The success of workplace clinical training (WCT) is important given that veterinary students are licensed to work independently upon graduation. Considering this, it is perhaps surprising that there is limited published work describing what it means to be prepared for this educational experience, particularly given that the transition to WCT can be stressful for students. This paper reports the results of a qualitative study aiming to generate a rich understanding of veterinary student preparedness for WCT using emic, or insider, perspectives of key stakeholders. METHODS: From a constructivist standpoint, homogenous online group interviews were held with final year veterinary students, recent student alumni, clinical supervisors, faculty, and academic educationalists to discuss what it means to be prepared for WCT. The data was analysed using a template analysis approach. RESULTS: A three-tier taxonomy to describe preparedness for WCT was constructed from the data. At the topmost level, there were seven themes to illuminate different aspects of preparedness: students should be prepared 1) for the transition to learning and working in a clinical and professional environment, 2) for self-directed and experiential learning whilst working, 3) with a growth mindset, 4) with intrinsic motivation and enthusiasm for learning and working, 5) for communication, consultation and clinical reasoning, 6) with the knowledge for work, and 7) with the practical competence and confidence for work. CONCLUSIONS: This study provides a deeper understanding of the tools we can provide, and the attributes we can nurture in, senior veterinary students to facilitate their learning and working during WCT. This improved understanding is a necessary precursor to refining pedagogical support and curriculum design within veterinary schools.

An exploratory study on the challenges faced and coping strategies used by preclinical medical students during the COVID-19 crisis.

PURPOSE: The impact of the coronavirus disease 2019 crisis on medical education includes reduced clinical training, a significant loss of learning time and a probable decline in confidence of being a doctor. These recent changes will have significant effect on the well-being of medical students and interventional support needs to be given early. This study explores the challenges faced and coping strategies used by preclinical medical students during the crisis. METHODS: A qualitative study involving 13 preclinical medical students was conducted between August and September 2020 at a medical school in Malaysia. An in-depth individual interview via Microsoft Teams (Microsoft Corp.) with semi-structured questions was conducted. The recorded interview data were thematically analyzed using the six phases of Braun and Clarke's Thematic Analysis. RESULTS: The challenges faced were identified under three themes: psychosocial impact of lockdown, significant lifestyle changes, and impact on professional progression. Meanwhile, four themes emerged in coping strategies that include behavioral strategies, re-appraisal of the uncertainties of situation, active coping mechanisms, and regulation of emotion with coping reserve. There are indications that personality traits determine strategies to cope with challenges faced during the crisis which may either lead to resilience building or experiencing burnout. CONCLUSION: The findings of the study highlighted the urgent need to develop early preventive and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being in times of crisis.

Mind your language: the importance of english language skills in an International Medical Programme (IMP).

BACKGROUND: Language proficiency is crucial for doctors as they communicate with patients, peers and other healthcare professionals. Although proficiency in English is part of admission requirements, there is a gap in the knowledge of medical students' perception of factors enhancing English language (EL) skills during training in international medical programmes (IMPs). The gap prevents educators and policy makers from helping students who struggle with communication skills during medical training. This study therefore explores the importance of English language skills from medical students' perspectives. METHODS: Six focus group interviews with 24 medical students were conducted in an IMP. Data were analysed using Braun and Clarke's framework of thematic analysis. RESULTS: Results established three themes that constitute the importance of EL skills, namely the use of EL in medical training and practice, influence of university culture in EL mastery and individual EL proficiency as perceived by medical students. CONCLUSIONS: Findings of this study demonstrate how students perceived the importance of EL skills as a professional and social requirement during medical training and for future practice. It also informs that setting English language admission pre requisites needs to be complemented with opportunities to practice context specific communication skills. Thus, international medical programmes should embed diverse and inclusive strategies to support and develop medical students' English language skills.

Using Learning Theories to Develop a Veterinary Student Preparedness Toolkit for Workplace Clinical Training.

Learning theories are abstract descriptions which help us make sense of educational practice. Multiple theories can inform our understanding of a single concept, in this case: veterinary workplace clinical training (WCT), which occurs just prior to students' graduation as competent veterinary surgeons. The competency movement has strongly influenced reforms in veterinary education and is considered important. In reflection of this, the term "preparedness" is operationalised here as a measure of the likelihood that the veterinary student is going to be a competent learner and participant during WCT. Preparedness itself is therefore important because it directly impacts performance. Workplace clinical training is explored through the lenses of cognitivist, social constructivist and socio-culturalist learning theories and used to inform student preparedness characteristics ("tools") in terms of their behaviours, personal attributes, knowledge and skills, and awarenesses to optimise learning and participation. These form a new conceptual framework-the "Preparedness Toolkit."

Self-Regulated Learning Practice of Undergraduate Students in Health Professions Programs.

BACKGROUND: University students are expected to take charge of their learning without being dependent on teachers. Self-regulated learning (SRL) is the process by which students direct their learning to achieve their set targets and goals in a timely and controlled manner. This study was undertaken to explore the practice of SRL by undergraduate students from different programs in a health science focused university during COVID-19 pandemic. METHOD: Thirty-three undergraduate students of five health professions education programs were recruited to take part in focus group discussions to explore their SRL practice with online learning. Their responses were subjected to thematic analysis. RESULT: Our students appeared to practice SRL, going through the phases of forethought and goal setting, performance and self-reflection. They set goals for academic as well as personal development in the university. Academic goals like achieving target GPA or marks were achieved by following different study techniques, personal management including time management, and by creating a conducive learning environment. Personal development such as interpersonal skills, social networking was achieved through socializing and participating in extracurricular activities. The students also engaged in self-reflection and analysis of their own performance followed by designing strategies to manage the challenges they faced. CONCLUSION: Undergraduates of health professions programs appear to show evidence of practicing SRL. Although impacted by COVID-19 induced lockdown and online learning, they seem to have strategized and achieved their goals through individualized SRL processes. Promoting and fostering an atmosphere of SRL in universities to cater to the needs of the students would help them be more successful in their careers.

Co-creating scholarship through collaborative writing in health professions education: AMEE Guide No. 143.

This AMEE guide provides a robust framework and practical strategies for health professions educators to enhance their writing skills and engage in successful scholarship within a collaborative writing team. Whether scholarly output involves peer-reviewed articles, book chapters, blogs and online posts, online educational resources, collaborative writing requires more than the usual core writing skills, it requires teamwork, leadership and followership, negotiation, and conflict resolution, mentoring and more. Whilst educators can attend workshops or courses to enhance their writing skills, there may be fewer opportunities to join a community of scholars and engage in successful collaborative writing. There is very little guidance on how to find, join, position oneself and contribute to a writing group. Once individuals join a group, further questions arise as to how to contribute, when and whom to ask for help, whether their contribution is significant, and how to move from the periphery to the centre of the group. The most important question of all is how to translate disparate ideas into a shared key message and articulate it clearly. In this guide, we describe the value of working within a collaborative writing group; reflect on principles that anchor the concept of writing as a team and guide team behaviours; suggest explicit strategies to overcome challenges and promote successful writing that contributes to and advances the field; and review challenges to starting, maintaining, and completing writing tasks. We approach writing through three lenses: that of the individual writer, the writing team, and the scholarly product, the ultimate goal being meaningful contributions to the field of Health Professions Education.