Enhancing Stoma Care Education for Junior Doctors: A Comprehensive Teaching Series.

Introduction Colorectal stomas are prevalent in surgical wards and demand careful medical attention, particularly in stoma management. Junior doctors play a vital role in this care, but their limited exposure and training may hinder their ability, impacting patient care. Given the dearth of literature, we aimed to assess junior doctors' stoma care knowledge and the efficacy of a specialized teaching course in boosting their confidence and skills. Methods The research, conducted at the West Suffolk Hospital NHS Trust in the UK, engaged 60 junior doctors, predominantly from Foundation Year 1 and Year 2, from August 2021 to December 2022. To ensure effective management and assessment, participants were divided into four groups, each comprising 15 doctors. A pivotal aspect of the study was implementing a structured stoma teaching series delivered by a panel of seasoned surgical experts. This series, conducted every Friday for three weeks, comprehensively covered all facets of stoma care. Both before and after the teaching series, assessments were administered to measure the impact of this educational intervention on the participants' understanding of stomas. The study meticulously adhered to ethical guidelines, with all participants providing informed consent, and measures were implemented to guarantee anonymity, thus safeguarding the privacy and confidentiality of all individuals involved. The primary objective of this investigation was to evaluate the efficacy of the stoma teaching series in augmenting the knowledge and comprehension of stomas among junior doctors. The findings of this study hold significant potential in guiding healthcare professionals toward developing more efficacious stoma education programs, ultimately leading to improved patient care outcomes. Results The study involved 60 junior doctors categorized into four groups from August 2021 to December 2022. It aimed to assess their understanding of colorectal stomas, focusing on complications and their knowledge about stoma appliances and care nurses. A questionnaire was used to evaluate their knowledge in these areas at the start of their surgical rotation, which showed significant knowledge gaps among participants. Of the 60 participants, 48 (80%) expressed slight or no confidence in basic stoma care, while 54 (90%) admitted unfamiliar with managing stoma complications. Astonishingly, all 60 (100%) participants lacked awareness of fundamental stoma care concepts. Significant improvements were observed following a comprehensive stoma teaching series covering basic stoma knowledge, its complications and management, and practical stoma care. Feedback from the course revealed positive outcomes, with 54 (87%) doctors feeling confident or very confident in basic stoma knowledge and 48 (80%) reporting increased familiarity with managing stoma complications. Remarkably, all 60 (100%) doctors indicated comfort with stoma care concepts after the sessions. Participants emphasized the course's value in medical education and professional development, citing enhanced practical skills such as communication and teamwork. Conclusion Our study revealed junior doctors' limited stoma knowledge, emphasizing the need for a dedicated teaching program that significantly improves their understanding. Focused stoma education is vital for junior doctors to deliver optimal patient care, necessitating hospitals to promote awareness for improved patient outcomes.

Burnout rates among Lebanese pre-final and final year medical students during the COVID-19 pandemic: A multi-centered survey-based study.

BACKGROUND: Burnout among medical students has always been a major concern. OBJECTIVE: To evaluate changes in the prevalence rates of burnout among Lebanese pre-final and final year medical students while taking into consideration the impact of coronavirus 2019 (COVID-19) on both the academical and clinical experiences. METHODS: This is a multi-centered, survey-based, cross-sectional study conducted in October 2021. The Copenhagen Burnout Inventory questionnaire was used on 120 medical students from three different medical schools in Lebanon. RESULTS: The overall burnout prevalence was 40.01%. When further dividing it into domains, 39.36% of students had personal burnout, 41.52% had work-related burnout, and 39.16% had pandemic-related burnout. Theoretical learning and clinical training were reported to be affected in respectively 66.70% and 71.70%. However, only 10.00% of the students have regretted choosing medicine and 67.50% felt comfortable to get to the next academic level. CONCLUSION: High levels of burnout were reported among pre-final and final year medical students with a subsequent negative impact on their academic life and clinical training. Medical schools should start adopting a conscious view of how to guide medical students in finding adequate coping mechanisms during these times of crisis.

Differences between international medical graduates and Canadian medical graduates in a medical learning environment: From matching to residency and beyond.

Objective: To determine the differences between international medical graduates (IMG) and canadian medical graduates (CMG) in the medical learning environment (MLE) as there is progression from matching to residency and beyond. Method: A narrative literature review was done using the search engines pubmed, medline and embase on publications from 2000 to 2021 comparing IMG to CMG and those that compared IMG to non IMG in international publications were also considered. Results: The IMGs are offered less residency program positions compared to CMGs during the CaRMS selection process and specifically less in specialty programs. Amongst the article, 66% of IMGs compared to 90% of CMG were successful in the certification examination of the college of family physicians of Canada. A US article on the other hand found similarities in performance of USMGs and IMGs in a surgical residency program. Conclusion: A lot of IMG face several challenges including perceived systemic and individual discrimination, lack of mentorship and poor ability to navigate after immigration even after they are matched into a Canadian residency program. These are significant issues that should be dealt with to enable increase success and survival of IMGs in the MLE.

La importancia del desarrollo de las habilidades comunicacionales en estudiantes del área de la salud / The importance of developing communication skills in students in the health área

INTRODUCION Estos últimos años la Educación Superior ha tenido que incorporar en su curricular el desarrollo de habilidades comunicacionales, siendo actualmente considerada por la Asociación de Colegios Médicos Americanos (AAMC), Asociación Americana de Escuelas de Medicina(AAME) y Escuela de aprendizaje, conductual y de habilidades (EACH) como una competencia básica del profesional del área salud y que en ocasiones determina el éxito o fracaso del proceso asistencial, existiendo evidencia que el proceso comunicativo que se da en los centros de atención médica referida a la interacción médico-paciente determina la precisión del diagnóstico, toma de decisiones y adherencia del tratamiento que permite una excelente práctica médica. Frente a esta necesidad las Universidades han implementado diversas actividades realizadas en países anglosajones que deben ser ajustadas a las necesidades y contexto social chileno.

In recent years, Higher Education has had to incorporate in its curriculum the development of communication skills, being currently considered by the Association of American Medical Colleges (AAMC), American Association of Medical Schools (AAME) and School of Learning, Behavioral and Skills (EACH) as a basic competence of the health professional and that sometimes determines the success or failure of the care process, there is evidence that the communicative process that occurs in health care centers related to doctor-patient interaction determines the accuracy of diagnosis, decision making and adherence to treatment that allows excellent medical practice. Faced with this need, the Universities have implemented various activities carried out in Anglo Saxon countries that must be adjusted to the needs and social context of Chile

Investigating a Newly Developed Educational Orthopedic Application for Medical Interns in a Before-after Quasi-clinical Trial Study.

BACKGROUND: In COVID 19 era, the literature on e-learning, or particularly m-learning, has considerably increased focusing on the subject of medical knowledge transfer. Considering the importance of orthopedic knowledge for general practitioners and the inadequacy of the orthopedics internship duration in Mashhad University of Medical Sciences (MUMS), we have developed and investigated a smartphone orthopedic educational application named "Orthobox". METHODS: In a quasi-clinical before-after trial study, we investigated the benefits of Orthobox application for medical interns attending MUMS orthopedic departments. A total of 120 students (64 and 56 students in control and case groups respectively) were recruited. The application consists of five main parts of medication, common order samples, common prescriptions, cast and splint types, and educational movies. Students who passed the course without getting access to the application (control group) and students who were also using application during the course (case group) were defined, and comparison was done between them objectively through final exam score comparison and subjectively through Visual Analogue Scale (VAS) questionnaire score comparison. Besides, using case group students' activity report provided by the application panel, correlational analysis was done on their amount of activity on each of the main parts of the application and the corresponding question exam and VAS score separately. RESULTS: The case group of the study generally achieved higher final exam scores, mainly on Order question score (P value<0.001). Total VAS scores were also greater in case group (P value =0.001). It has also been identified that there is a notable positive trend between student's amount of usage of the application and their final exam scores through correlational analysis. This correlation was not significant about students' application visit numbers and VAS scores. CONCLUSION: These results suggest that m-learning has got the potential to improve students' medical knowledge and skills by organizing must-to-learn content specified for intern students of orthopedics on one hand, and cause more satisfaction in students about their education on the other hand. TRIAL REGISTRATION: This study was not registered because it is a quasi-clinical trial study. LEVEL OF EVIDENCE: Level III (Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).

Comunicación efectiva en salud: evaluación de una experiencia docente en estudiantes de medicina de Cuenca, Ecuador / Effective communication in Health: evaluation of a teaching experience in Medicine School of Cuenca, Ecuador

Introducción: La comunicación dentro del ámbito médico es esencial para obtener buenos resultados en consulta; esta habilidad debe aprenderse a lo largo de la carrera y no suponer que es innata. Luego de una revisión sistemática de la metodología de enseñanza en Ecuador y el poco desarrollo que ha tenido dentro de las universidades, vemos la necesidad de realizar un estudio evaluando las habilidades comunicacionales de los estudiantes de medicina. Metodología: se incluyó cien estudiantes de sexto año que realizan el internado en el Hospital Vicente Corral Moscoso. Se valoró las entrevistas por observación directa utilizando una lista de verificación sustentada en la Guía Calgary-Cambridge. Se analizaron los datos buscando diferencia estadística. Resultados: No hubo diferencia estadística entre los grupos. El promedio obtenido por los evaluados fue de 13,96 de 23 habilidades. Se comparó por dos grupos: estudiantes que tenían formación en comunicación médica (19) y los que no tenían ninguna (81). Se encontró que los estudiantes con formación en comunicación desarrollan entrevistas con mayor empatía, escucha efectiva, respeto por las expectativas de los pacientes y capacidad de resumir los hallazgos en busca de resultados más eficaces. Conclusión: Se observan algunas diferencias entre ambos grupos comparables con estudios internacionales. Se recomienda a las escuelas establecer un currículo formal para el aprendizaje de la comunicación como habilidad efectiva en la formación médica. El objetivo es humanizar la comunicación y favorecer una mejor relación entre médico y paciente (AU)

Introduction: Communication within the medical field is essential to obtain good results from the consultation. This skill must be learned throughout the career and not assumed to be innate. After a systematic review of teaching methodology in Ecuador and the little development it has had within medical schools, we carried out an observational study evaluating communication skills of medical students. Methodology: One hundred final-year students working at the Vicente Corral Moscoso Hospital were included. Direct observation interviews were assessed using a checklist tool supported by the Calgary-Cambridge Guide. Data were analyzed looking for statistical significance. Results: There was no statistical significance between groups. Mean score was 13.96 out of 23 skills evaluated. Two groups were randomized: students who had training in medical communication (19) and those who had none (81). Students with communication training developed empathic interviews, effective listening, respect for patient expectations and were capable to summarize findings for effective communication outcomes. Conclusion: There are some differences between both groups comparable with international studies. Ecuadorian Medical Schools are encouraged to establish a formal curriculum in learning and training communication skills. The objective is to humanize communication and to promote better relationship between doctor and patient (AU)

Introducció: La comunicació dins de l'àmbit mèdic és essencial per a obtenir bons resultats en consulta; aquesta habilitat ha d'aprendre's al llarg de la carrera i no suposar que és innata. Després d'una revisió sistemàtica de la metodologia d'ensenyament a l'Equador i el poc desenvolupament que ha tingut dins de les universitats, veiem la necessitat de realitzar un estudi avaluant les habilitats comunicacionals dels estudiants de medicina. Metodologia: Es va incloure cent estudiants de sisè any que realitzen l'internat a l'Hospital Vicente Corral Moscoso. Es va valorar les entrevistes per observació directa utilitzant una llista de verificació sustentada en la Guia Calgary-Cambridge. Es van analitzar les dades buscant diferència estadística. Resultats: No va haver-hi diferència estadística entre els grups. La mitjana obtinguda pels avaluats va ser de 13,96 de 23 habilitats. Es va comparar per dos grups: estudiants que tenien formació en comunicació mèdica (19) i els que no tenien cap (81). Es va trobar que els estudiants amb formació en comunicació desenvolupen entrevistes amb major empatia, escolta efectiva, respecte per les expectatives dels pacients i capacitat de resumir les troballes a la recerca de resultats més eficaços. Conclusió: S'observen algunes diferències entre tots dos grups comparables amb estudis internacionals. Es recomana a les escoles establir un currículum formal per a l'aprenentatge de la comunicació com a habilitat efectiva en la formació mèdica. L'objectiu és humanitzar la comunicació i afavorir una millor relació entre metge i pacient (AU)

The United States Medical Licensing Examination Step 1 Is Changing-US Medical Curricula Should Too.

In recent years, US medical students have been increasingly absent from medical school classrooms. They do so to maximize their competitiveness for a good residency program, by achieving high scores on the United States Medical Licensing Examination (USMLE) Step 1. As a US medical student, I know that most of these class-skipping students are utilizing external learning resources, which are perceived to be more efficient than traditional lectures. Now that the USMLE Step 1 is adopting a pass/fail grading system, it may be tempting to expect students to return to traditional basic science lectures. Unfortunately, my experiences tell me this will not happen. Instead, US medical schools must adapt their curricula. These new curricula should focus on clinical decision making, team-based learning, and new medical decision technologies, while leveraging the validated ability of these external resources to teach the basic sciences. In doing so, faculty will not only increase student engagement but also modernize the curricula to meet new standards on effective medical learning.

Orderly display of limb lead ECGs raises Chinese intern's diagnostic accuracy when determining frontal plane QRS axis.

BACKGROUND: There is limited information on whether the orderly display of limb lead ECGs (electrocardiograms) can facilitate students to determine frontal plane QRS complex wave electrical axis. OBJECTIVES: The study investigated whether the orderly display of limb lead ECGs can raise Chinese undergraduate intern's diagnostic accuracy when determining frontal plane axis. DESIGN: A total of 147 fifth-year undergraduate interns aged between 21 and 25 years were randomly arranged into 2 groups: one group was given classically displayed ECGs of limb leads while the other group was given orderly displayed ECGs of limb leads. They were then taught to determine frontal plane axis with one of the above displays. The intern's diagnostic accuracy and time used were measured. RESULTS: After teaching, the orderly display can more effectively raise diagnostic accuracy when determining axis as compared to the classical display (76.65 ± 23.16% vs. 68.88 ± 23.21%, P < 0.05), although diagnostic accuracy in axis determination was improved in both groups as compared to the axis determination at baseline (all P < 0.05). CONCLUSIONS: Orderly display of limb lead ECGs may raise Chinese intern's diagnostic accuracy when determining frontal plane axis.

Talleres integradores interdisciplinarios en el tratamiento de los contenidos básicos biomédicos y clínicos / Integrating cross-discipline workshops for basic and clinical content treatment

Los espacios educativos de interacción social resultan excelentes ámbitos para explicitar contenidos y encontrarle significado, lo que constituye una verdadera toma de conciencia de su utilidad. El presente artículo tiene como objetivo ofrecer valoraciones acerca del papel de los talleres integradores interdisciplinarios en el tratamiento de los contenidos básicos biomédicos y clínicos. Las valoraciones ofrecidas se sustentan en tres aspectos medulares: la importancia que tienen los talleres como espacios de construcción del conocimiento interdisciplinar, el valor de los postulados socio-constructivistas para el sujeto que aprende en estos espacios y las experiencias prácticas de los autores. Se puede expresar que este tipo de talleres, desde la concepción asumida para su realización, posibilitan un adecuado tratamiento de los contenidos básicos biomédicos y clínicos en la carrera de Medicina, debido a que permiten conseguir objetivos específicos integradores en el aprendizaje de los contenidos (objeto de integración). Además, exigen el uso  de tareas docentes integradoras para el logro de dichos objetivos y facilitan el empleo de procedimientos didácticos integradores en el tratamiento de los contenidos.

Educative spaces of social interaction result in excellent environments for explaining contents meaningfully, which generates true consciousness of its utility. The present article is aimed at offering assessments on the role of cross discipline integrating workshops for basic and clinical content treatment. The offered appraisals are based on three key elements: the importance of these workshops for constructing cross discipline knowledge, the value of socio-constructivist postulate for the subject who learns in these spaces and the authors' practical experience. It may be stated that from the conception assumed for their development, this type of workshop allows an adequate basic bio-medical and clinical content treatment in the Medicine career, since it is possible to achieve integrating specific objectives in learning new contents to be linked. In addition, they demand the use of teaching tasks for achieving these objectives and facilitate the use of didactic procedures for content treatment.

Actividades prácticas en anatomía: factor nivelador de los contrastes de origen entre los alumnos de medicina / Practical activities in anatomy: leveling factor for the origin related contrasts among medical students

Las mediciones de los logros educacionales y las pruebas de selección de ingreso a la educación superior están fuertemente correlacionadas con los antecedentes socioeconómicos y el tipo de establecimiento educacional del postulante, situación que representaría un factor predictor del rendimiento para los alumnos de primer año universitario. Considerando que los puntajes de ingreso para la carrera de medicina presentan una diferencia significativa entre los primeros y últimos seleccionados, nos preguntamos si existe algún factor nivelador que reduzca esa brecha de origen. Se analiza el rendimiento en las evaluaciones prácticas y pruebas teóricas, al comienzo y al final del año académico 2009 comparando los primeros y últimos seleccionados de acuerdo al puntaje de ingreso PSU a la carrera de medicina de la Pontificia Universidad Católica de Chile. Se observan diferencias significativas en el rendimiento de la primera evaluación Teórica de Anatomía y en la Nota Final obtenida en el curso, en cambio, no se encuentran diferencias significativas tanto en la primera Evaluación Práctica cómo en el examen final práctico del curso. Nuestros resultados sugieren que la única evaluación niveladora, que logra superar las diferencias de origen de los examinados, la constituyen nuestras pruebas prácticas; evaluaciones en las cuales el rendimiento de los primeros y de los últimos seleccionados de medicina es más homogéneo. Este tipo de evaluaciones prácticas, realizadas sobre preparaciones cadavéricas, demandan fundamentalmente experiencias vividas en nuestras actividades prácticas, colocándose por sobre la mayor o menor habilidad o experiencia que posea el estudiante relacionada con su establecimiento educacional de origen.

Level of educational achievement and screening tests for admission to higher education are strongly correlated with socioeconomic background and the type of school of the applicant, these situations would be a performance predictor for college freshmen students. Whereas the scores to be accepted into the medical career have a significant difference between the first and last selected, we wonder if there is a leveling factor that reduces the gap of origin. We analyze the performance in practical assessments and theory tests at the beginning and end of the academic year 2009 comparing the first and last selected according to the PSU score admission to medical studies at the Pontificia Universidad Catolica de Chile. Significant differences were observed in the performance of the first assessment of the theory of Anatomy and the final score obtained in the course, however, no significant differences in both the first practical test and practical final exam of the course. Our results suggest that the only evaluation level, which overcomes the differences of origin of the examined, are our practical tests; assessments in which the performance of the first and the last selected medical student is more homogenous. This type of practical assessments, performed on cadavers, primarily demanded experiences in our practical segment, standing by on the degree of skill or experience held by the students related to their educational institution of origin.

Formal mentorship in a surgical residency training program: a prospective interventional study.

BACKGROUND: Otolaryngology-Head and Neck surgery resident physicians (OHNSR) have a high prevalence of burnout, job dissatisfaction and stress as shown within the literature. Formal mentorship programs (FMP) have a proven track record of enhancing professional development and academic success. More importantly FMP have an overall positive impact on residents and assist in improving job satisfaction. The purpose of the study is to determine the effects of a FMP on the well-being of OHNSR. METHODS: A FMP was established and all OHNSR participation was voluntary. Eight OHNSR participated in the program. Perceived Stress Survey (PSS) and the Maslach Burnout Inventory (MBI) were administered at baseline and then at 3, 6, 9, and 12 month intervals. World Health Quality of Life-Bref Questionnaire (WH-QOL) was administered at baseline and at 12 months. RESULTS: Baseline statistics found a significant burden of stress and burnout with an average PSS of 18.5 with a high MBI of 47.6, 50.6, and 16.5 for the emotional, depersonalization, and personal achievement domains respectively. Quality of life was also found to be low with a WH-QOL score of 71.9. After implementation of the FMP, PSS was reduced to 14.5 at 3 months (p = 0.174) and a statistically significant lower value of 7.9 at 12 months (p = 0.001). Participants were also found to have lower emotional scores (14.9, p < 0.0001), levels of depersonalization (20.1, p < 0.0001), and higher personal achievement (42.5, p < 0.0001) on MBI testing at 12 months. Overall quality values using the WH-QOL was also found to be significantly improved (37.5, P = 0.003) with statistically significant lower scores for the physical health (33.9, p = 0.003), psychological (41.1, p = 0.001), social relationship (46.9, p = 0.019), and environment (53.5, p = 0.012) domains. CONCLUSION: This is the first study to show that FMP can potentially alleviate high levels of stress and burnout within a surgical residency program and achieve higher levels of personal satisfaction as well as overall quality of life.

Real time medical learning using the WhatsApp cellular network: a cross sectional study following the experience of a division's medical officers in the Israel Defense Forces.

BACKGROUND: Primary care medical officers (MOs) are expected to maintain self-education while serving in their units in order to maintain professional standards. With the rise of smartphone use in the Israel Defense Forces (IDF), the WhatsApp application can facilitate medical learning. To date, there has been no description of the use of this tool by MOs in a military setting. This paper aims to describe the pattern of use of a WhatsApp application group by IDF's MOs. METHODS: We collected all the information (textual and visual) uploaded to a WhatsApp group called "The Division's Physicians", originally established two years earlier, during a randomly selected sample month. We analyzed the pattern of its use and explored the association between the number of questions and responses uploaded to the group and the duration of service of their senders. RESULTS: In December 2014, the "The Division's Physicians" WhatsApp group had 41 participants. We identified 478 messages classified as questions and 531 messages classified as responses. The number of questions asked by MOs in their first 2 months of service in the battalion (median = 14.5) and the number of questions asked by MOs with more than one year of their first assignment (median = 10.5) were significantly higher than the number of questions (median = 1.0) asked by MOs in their second assignment or later (p values for comparisons were 0.008 and 0.012 respectively). We also found that both the number of responses provided by MOs with more than one year of service in the battalion (median = 21) and the number of responses provided by MOs in their second assignment or later (median = 5) were significantly higher than the number of responses (median = 1) provided by MOs within their first 2 months of service in the battalion (p value for comparisons were 0.024 and 0.039 respectively). CONCLUSION: We conclude from our preliminary study that a WhatsApp group can facilitate the transfer of knowledge from more experienced MOs to those with less experience.

Clinical Correlations as a Tool in Basic Science Medical Education.

Clinical correlations are tools to assist students in associating basic science concepts with a medical application or disease. There are many forms of clinical correlations and many ways to use them in the classroom. Five types of clinical correlations that may be embedded within basic science courses have been identified and described. (1) Correlated examples consist of superficial clinical information or stories accompanying basic science concepts to make the information more interesting and relevant. (2) Interactive learning and demonstrations provide hands-on experiences or the demonstration of a clinical topic. (3) Specialized workshops have an application-based focus, are more specialized than typical laboratory sessions, and range in complexity from basic to advanced. (4) Small-group activities require groups of students, guided by faculty, to solve simple problems that relate basic science information to clinical topics. (5) Course-centered problem solving is a more advanced correlation activity than the others and focuses on recognition and treatment of clinical problems to promote clinical reasoning skills. Diverse teaching activities are used in basic science medical education, and those that include clinical relevance promote interest, communication, and collaboration, enhance knowledge retention, and help develop clinical reasoning skills.

'Let's talk more about this': An analysis of how experts engage novice physicians in pedagogical dialogue.

This exploratory study examines conversations between faculty physician preceptors and resident physicians to identify communicative actions that encourage pedagogical dialogue. Using a modified grounded theory approach, this study considers resident-preceptor conversations at the levels of the conversational exchange and the clause. Four categories of exchanges emerged from the analysis: presenting the case, teaching clinical concepts, initiating clinical discussion, and offering/requesting direct instruction. Focusing on the latter two categories, this study identifies common communicative actions in the clauses of speakers' conversational turns. I contend that clinical-discussion exchanges best support the academic goal of these conversations by engaging novices with open-ended, interpretation-focused questions, proposals, and assessments; in contrast, direct-instruction exchanges support the workplace objective of treating patients through imperative proposals and procedure-focused questions and assessments. This analysis offers communication scholars insight into how expert-novice conversations support professionalization and provides preceptors with an understanding of communicative actions that may facilitate pedagogical dialogue.