Development of a Supported Education Program for Students with Severe Mental Disorders in India.

BACKGROUND: The onset of severe mental disorders (SMDs) is during adolescence or young adulthood, which affects the well-being and the educational aspirations of the students. Models of supported education practiced in the West are not culturally suitable for Indian students or the Indian education system. This study aimed to develop a Supported Education Program (SEP) for students with SMDs to help them with academic reintegration in an Indian context. METHODS AND MATERIAL: To develop the SEP, a realist review was done, followed by an in-depth interview with eight mental health professionals (MHP) and nine lecturers, using a validated interview script. After each interview, interim analysis and modifications were done to improve the rigor of the interview. After all interviews, the SEP was circulated for a second round of iteration for consensual validation by four mental health experts. The outcome of the entire process was the final version of SEP for students with SMDs. RESULTS: The final SEP had two broad themes and 18 subthemes from the qualitative thematic analysis: theme 1 included issues and strategies relevant to the client or caregivers, and theme 2 was pertinent to the education system. CONCLUSION: The SEP developed and validated for people with SMDs has distinctive components: one for the individual and caregiver and the other for the educational system.

Management of arrhythmias in pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is a potentially devastating clinical condition with a poor long-term prognosis. Cardiac arrhythmias are frequent in PH, and pulmonary hypertensives are particularly susceptible to the adverse haemodynamic effects of heart rhythm disorders. However, arrhythmia management in PH patients can be more challenging than in the general population due to the particular physiological idiosyncrasies associated with the condition. Here, we summarise and appraise the data pertaining to multimodality treatment of cardiac arrhythmias in PH to help refine the management strategy for this vulnerable patient group. RESULTS: The majority of our understanding of the safety and effectiveness of different arrhythmia treatments in PH is based on observational and retrospective data. Rhythm control is the overall goal, and for atrial and ventricular tachyarrhythmias, referral for catheter ablation, ideally using electroanatomical mapping technology in specialist centres, is the preferable means of achieving this. Contradictory viewpoints are expounded regarding the safety of beta blocker use in PH, though in three small prospective clinical trials and at least six animal models they appear to be well-tolerated. Nevertheless, amiodarone remains the preferred pharmacological treatment. Direct current cardioversion can be carried out effectively to terminate tachyarrhythmias in both the emergency and elective setting, though mechanistic studies demonstrate a higher recurrence rate in PH patients. Individual reports and series suggest that device implantation may be technically challenging and associated with a higher complication rate due to anatomical distortion and chamber enlargement. Modulation of sympathetic input to the heart appears to reduce arrhythmia vulnerability in canine models of PH, and its clinical application in humans is a worthwhile area of further study. CONCLUSION: Prompt restoration of sinus rhythm improves outcomes in PH, and at present, the most reliable and safest strategy for long-term rhythm control is amiodarone and, where possible, ablation. Reinforcement of the evidence base with randomised prospective trials is necessary. This would be particularly beneficial to clarify the role of atrial fibrillation ablation and the safety and efficacy of beta-blockers. In addition, a more comprehensive assessment of the vulnerability of PH patients to potentially fatal brady- and ventricular tachyarrhythmias may help guide recommendations for provision of primary prevention device therapy.

Coronary artery dissection following radiofrequency ablation for atrial fibrillation: Case report and review of the literature.

Coronary artery injury following catheter ablation for cardiac arrhythmias is very rare. We present a case of left circumflex (LCx) coronary artery dissection causing inferoposterior ST-elevation myocardial infarction following radiofrequency (RF) ablation for atrial fibrillation (AF) in a 39-year-old male with no cardiovascular risk factors. This was confirmed on coronary angiography and intracoronary vascular ultrasound (IVUS). The likely etiology is thermal injury during RF ablation for AF, due to the close proximity of the left atrial appendage and left pulmonary veins to the LCx. He was successfully treated with primary percutaneous coronary intervention with good outcome. This is, to our knowledge, the first reported case of proven acute coronary dissection secondary to RF ablation for AF reported in the literature, and highlights the importance of considering this as a mechanism for coronary occlusion in these patients.

A Guide to Competencies, Educational Goals, and Learning Objectives for Teaching Medical Histology in an Undergraduate Medical Education Setting.

Horizontal and vertical integration within medical school curricula, truncated contact hours available to teach basic biomedical sciences, and diverse assessment methods have left histology educators searching for an answer to a fundamental question-what ensures competency for medical students in histology upon completion of medical school? The Liaison Committee for Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) advocate faculty to provide medical students with a list of learning objectives prior to any educational activities, regardless of pedagogy. It is encouraged that the learning objectives are constructed using higher-order and measurable action verbs to ensure student-centered learning and assessment. A survey of the literature indicates that there is paucity of knowledge about competencies, goals, and learning objectives appropriate for histology education in preclinical years. To address this challenge, an interactive online taskforce, comprising faculty from across the United States, was assembled. The outcome of this project was a desired set of competencies for medical students in histology with educational goals and learning objectives to achieve them.

Performance of the BMJ learning training modules for ECG interpretation in athletes.

To assess the accuracy of interpreting the athlete's ECG both pre and post a series of online training modules among a range of healthcare professionals. 10 512 healthcare professionals from 138 different nations commenced the online course. These were primarily doctors (43%), nurses (18.4%) and other healthcare professionals (3.9%). The users came from 102 different specialities, with General Practice/Family Medicine (24.5%), Cardiology (10.6%), Emergency Medicine (8.7%) and Sports Medicine (6.6%) predominating. Among the 2023 users who completed both the pre-course and post-course test, there was an overall improvement of 15.3% (95% CI 13.9% to 16.6%; p<0.001). 930 completed all four other modules, and these users fared significantly better (18.7% increase; 95% CI 17.3 to 20.0) than those completing no additional modules (11.7% increase; 95% CI 3.3 to 17.7, p=0.036). Demographic analysis showed that while the starting pre-test scores varied significantly between profession/specialty groups (57.8%-82.6%), post-test scores were largely consistent (80.8%-84.6%). Although users showed the most improvement when interpreting primary electrical diseases (12.4% increase), it was also an area of notable weakness compared with the modules of normal training-related findings and cardiomyopathies. With the evolving criteria for ECG interpretation eliciting ever improving levels of specificity and sensitivity in the detection of conditions associated with sudden cardiac death among athletes, training is required to ensure the infrastructure and personnel is in place to uphold these standards. The BMJ Learning course presented is a valuable first step and demonstrates that such an online tool can be effective in aiding ECG interpretation among healthcare professionals globally.

Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside.

The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis.

Institutional factors affecting participation in national faculty development programs: a nation-wide investigation of medical schools.

BACKGROUND: Medical schools have used faculty development programs as an essential means to improve the instruction of faculty members. Thus far, however, participating in such programs has been largely voluntary for individuals even though a certain degree of participation is required to achieve practical effectiveness. In addition, the learning behaviors of faculty members are known to be influenced by organizational contexts such as a hidden curriculum. Therefore, this study explored the organizational characteristics of medical schools affecting attendance at faculty development programs. METHODS: Forty medical schools in South Korea were included in this study. In total, 1,667 faculty members attended the faculty development programs at the National Teacher Training Center for Health Personnel between 2007 and 2015. For independent variables, information on the basic characteristics and the educational states was collected from all the medical schools. Themes were identified from their educational goals and objectives by inductive content analysis. RESULTS: The number of nine-year cumulative attendees from medical schools ranged from 8 to 104. The basic characteristics of the medical schools had little influence on faculty development program attendance, while several themes in the educational goals and objectives, including "cooperation", "serving various societies", and "dealing with a changing future" showed a significant difference in participation. The number of full-time faculty showed a significant positive correlation when it was smaller than the median, and the proportion of alumni faculty showed a significant negative correlation when it was higher than 50%. CONCLUSIONS: This study adds to existing knowledge on factors affecting attendance at faculty development programs by identifying related institutional factors that influence attendance. While the variations depending on the basic characteristics were minimal, the organizational environment surrounding medical education significantly contributed to attendance. Addressing institutional as well as individual factors could contribute to improving participation by faculty members in faculty development programs.

Parent-child value similarity in families with young children: The predictive power of prosocial educational goals.

Value transmission from one generation to the next is a key issue in every society, but it is not clear which parents are the most successful in transmitting their values to their children. We propose parents' prosocial educational goals as key predictors of parent-child value similarity. Accordingly, we hypothesized that the more parents wanted their children to endorse values of self-transcendence (helping, supporting, and caring for others) and the less parents wanted their children to endorse the opposing values of self-enhancement (striving for power and achievement), the higher would be parent-child overall value similarity. Findings from two studies of families - Study 1: 261 Swiss families, children aged 7-9 years; Study 2: 157 German families, children aged 6-11 years - confirmed this hypothesis. The effect was even stronger after controlling for values that prevail in the Swiss and German society, respectively. We integrate evidence from this study of values in families with young children with existing findings from studies with adolescent and adult children, and we discuss potential pathways from parents' educational goals to parent-child value similarity.

Are There Detrimental Effects From Proficiency-Based Training in Fundamentals of Laparoscopic Surgery Among Novices? An Exploration of Goal Theory.

INTRODUCTION: Goal theory states that novices may experience unintended, detrimental learning effects, with decreased performance, when given performance goals on complex tasks. In these situations, it may be more appropriate to give novices learning goals to help avoid these negative consequences. The purpose of this study was to see whether this tenant of goal theory applied to novices learning 2 tasks of fundamentals of laparoscopic surgery (FLS). MATERIALS AND METHODS: Medical and physician assistant students were randomized to a performance goals group and a learning goals group. The performance goals consisted of the published proficiency standards of FLS. Both groups were pretested on perception of surgery, self-efficacy, and general affect. Each group underwent a practice session for the peg transfer task. They were tested and scored per the published standards of FLS. The participants completed NASA Task Load Index, task complexity, and postaffect questionnaires related to the peg transfer task. This was repeated with the suture with intracorporeal knot task. Posttest perception of surgery and self-efficacy questionnaires were completed. RESULTS: In total, 48 students participated in the study: 23 in the performance goals group and 25 in the learning goals group. Most of the participants (n = 40) were first-year medical and physician assistant students. There were no significant differences between the groups in perception of surgery, affect, goal commitment, subjective task complexity, subjective workload, and self-efficacy. There were no differences between the groups concerning overall FLS score for both the peg transfer and suturing tasks. Both groups exhibited significant increases in self-efficacy and perception of surgery (p < 0.05). CONCLUSION: FLS skills can be given to novice learners without concern for detrimental effects as might be expected by other work on goal theory. Given that performance was the same for both groups, surgical educators may have multiple pathways to educational success when incorporating goals into training programs for basic surgical skills.

Educational Goals Extracted from Homepages of Pharmacy Schools in Korea

BACKGROUND: The current educational goals and missions of pharmacy schools in Korea were analyzed to examine the current orientation and future direction of pharmaceutical education. METHODS: Educational mission statements were obtained from the homepages of 35 pharmacy schools and subjected to convert into codes. Themes and categories were induced using qualitative content-analysis from the codes and compared according to location of school (capital area versus province), public versus private, and date of initial enrollment (before versus in 2011). The themes and categories were compared with “the eight-star pharmacist” suggested by World Health Organization (WHO) and International Pharmaceutical Federation (FIP). RESULTS: Twelve themes, 44 categories, and 496 codes were identified. Themes included pharmaceutical expertise, professionalism, contribution to society, basic educational ideology, sphere of activity, leadership, research, dealing with future change, problem-solving ability, self-management and development, cooperation, and respect for life. Mission statements of schools that initially enrolled in 2011 cited humankind level contribution (p=0.011), patient-centered care (p=0.026), and globalization (p=0.018) more frequently than those enrolled before 2011. Most schools mentioned about care-giver, researcher, and decision-maker which were stated in “the eight-star pharmacist”. CONCLUSION: To meet the growing social requirements of a pharmacist's roles, wide-ranging active discussion on establishing educational goals should be made.

[What is the current orientation of undergraduate medical education in Korea?].

PURPOSE: The educational purpose of a medical school is important, because it guides educational decisions in an individual organization and projects the image of the doctors that we are generating. By analyzing the educational goals of entire medical schools, this study aimed to examine the current orientation and future direction of undergraduate medical education in Korea. METHODS: Educational goals were collected from the website of each medical school and subjected to inductive content analysis. After identifying categories and themes, we examined the differences between medical school subgroups and compared the categories with competencies that have been suggested by the "Korean Doctor's Role." RESULTS: Thirteen themes were identified: medical expertise, professionalism, contribution to various levels of society, self-management and development, basic educational ideology, research ability, cooperation, leadership, dealing with future change, respect for life, creativity, problem-solving ability, and ability to educate. There was a significant difference in educational goals between medical schools when grouped by geographic location and affiliation of research-driven hospitals. Of the 16 competencies that are suggested by the Korean Doctor's Role, 12 had one or more corresponding categories. CONCLUSION: Per their current educational purposes, Korean medical schools pursue a broad variety of competencies that need cultivating during the course of undergraduate medical education. Further research is needed to determine how best to apply these educational purposes in actual institutions and ultimately lead them to become part of the competency of a graduate.

What is the current orientation of undergraduate medical education in Korea? / 한국의학교육

PURPOSE: The educational purpose of a medical school is important, because it guides educational decisions in an individual organization and projects the image of the doctors that we are generating. By analyzing the educational goals of entire medical schools, this study aimed to examine the current orientation and future direction of undergraduate medical education in Korea. METHODS: Educational goals were collected from the website of each medical school and subjected to inductive content analysis. After identifying categories and themes, we examined the differences between medical school subgroups and compared the categories with competencies that have been suggested by the "Korean Doctor's Role." RESULTS: Thirteen themes were identified: medical expertise, professionalism, contribution to various levels of society, self-management and development, basic educational ideology, research ability, cooperation, leadership, dealing with future change, respect for life, creativity, problem-solving ability, and ability to educate. There was a significant difference in educational goals between medical schools when grouped by geographic location and affiliation of research-driven hospitals. Of the 16 competencies that are suggested by the Korean Doctor's Role, 12 had one or more corresponding categories. CONCLUSION: Per their current educational purposes, Korean medical schools pursue a broad variety of competencies that need cultivating during the course of undergraduate medical education. Further research is needed to determine how best to apply these educational purposes in actual institutions and ultimately lead them to become part of the competency of a graduate.

Metas e estratégias de socialização que mães de crianças surdas valorizam para seus filhos / Socialization Goals and strategies for deaf children that their mothers value for their children

Estudos sobre desenvolvimento infantil destacam não apenas o papel do ambiente físico e social da criança, como também das cognições parentais, compartilhadas em determinado contexto e momento histórico. Pesquisas no Brasil apontam a prevalência de modelos de criação distintos, em virtude do contexto cultural, são eles: interdependente, independente e autônomorelacional. Sendo assim, objetivou-se conhecer as metas de socialização e expectativas de mães de crianças surdas sobre o futuro dos seus filhos. Foram entrevistadas 13 mães de crianças surdas matriculadas em uma unidade especializada na educação de surdos, no município de Belém, a partir da aplicação de um roteiro semiestruturado, composto por questões, validadas no Brasil, sobre metas e estratégias de socialização. O grupo entrevistado caracterizou-se por: mães residentes em contexto urbano, em sua maioria de baixa renda, com pouca escolaridade, na fixa etária entre 31 e 40 anos. Foram relatadas 20 metas de socialização, concentradas nas seguintes categorias, expectativas sociais, bom comportamento e autoaperfeiçoamento, em ordem decrescente, indicando uma tendência à dimensão sociocêntrica. O modelo de criação predominante foi o interdependente. Em relação às estratégias de socialização, foram descritas 37, entre elas a categoria centrada em si obteve maior escore, com destaque para o aspecto cognitivo. Compreende-se que embora o modelo de criação seja interdependente, as estratégias concentraram-se na figura da mãe. Uma análise possível é a barreira linguística decorrente da surdez que impede que a criança e o contexto sejam considerados pelas mães como mediadores de qualidades para seus filhos.

Research in Brazil has drawn attention to the prevalence of distinct models for creativity that arise from the social background, which are as follows: interdependent, independent and autonomous-relational. In light of this, the purpose of this study is to uncover the socialization goals and expectations of mothers of deaf children with regard to the future of their children. Interviews were conducted with 13 mothers of deaf children enrolled in a deaf public school; the study was carried out using a semi-structured questionnaire (officially recognized in Brazil) comprising questions about the goals and strategies of socialization. The group of participants consisted of the following: low-income mothers residing in an urban environment, with little formal education and aged between 31 and 40. The study reported 20 socialization goals that were divided into the following categories: social expectations, good behavior and self-improvement-in descending order-which suggests a tendency towards a 'sociocentric' dimension. The interdependent category was the predominant model of creativity. With regard to strategies of socialization, 37 were described, one of which (the category centered on itself) obtained the highest score with stress being laid on its cognitive features. It should be understood that although the model of creativity is independent, the strategies were concentrated on the figure of the mother. One possible analytical approach is to examine the linguistic barriers that are caused by deafness and which prevent the child and the environment from being taken into account by mothers as mediators of the children.

Kampo Medical Education for University Students of Health Education / 日本東洋医学雑誌

Many of the students belonging to the School of Health and Social Services will be responsible for health education in the future, and it is important that they have an understanding of the importance of Kampo medicine and the ability to give appropriate guidance in the field. But their educational goals need discussing. We conducted lectures on Kampo medicine with medical school students towards this end, and conducted before and after questionnaire surveys to gauge their effect. Students with a desirable degree of awareness toward Kampo medicine in Japanese society increased from 58.0 ± 15.4% to 88.5 ± 10.2%, and students judging Kampo as either useful or extremely useful rose from 58.4% to 95.9%. It is our hope that, with the raised awareness from these lectures as a base, these students will go on to engage in suitable medical educational activities in the future.

The Attempt to Develop a "Model Program" on the Basis of the Objectives Established by the Ministry of Health, Labour and Welfare in the New Postgraduate Clinical Training System / 医学教育

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.

The Changes in the Educational Goals and Objectives of Medical Schools in Korea / 한국의학교육

We reviewed the educational goals and objectives of the 32 medical schools in Korea, which is based on the 1992's, 1994's, and 1996's edition of the Directory of Korea Medical Education. The purpose of this study is to find trend of their changes and to help revise them. Among the 32 medical schools in Korea, 31(96.9%) described goals and objectives separately on 1996's edition, while 26(81.3%), 19(59.4%) on 1994's, 1992's, respectively. The medical ethics and morality was becoming more important; 30(93.8%) medical schools on 1996's and 1994's edition, while 26(81.3%) on 1992's. There were more emphases on the promotion of the ability of community services in health and of self study. For the promotion of the ability of community services in health; 26(81.3%) medical schools on 1996's edition, while 23(71.9%), 19(59.4%) on 1994's, 1992's, respectively. For the promotion of the ability of self study; 25(78.1%) medical schools on 1996's edition, while 21(65.6%), 15(46.9%) on 1994's, 1992's, respectively. The cultivation of primary care physician was becoming the primary goal of medical schools; 23(71.9%) medical schools on 1996's edition, while 12(37.5%), 9(28.1%) on 1994's, 1992's respectively. Teaching medical knowledge and clinical skills were still regarded as important; 21(65.6%) medical schools on 1996's edition, while 20(62.5%), 23(71.9%) on 1994's, 1992's, respectively. The inclusion of medical scientists in the possible job lists was also eminent; 14(43.8%) medical schools on 1996's edition, while 11(34.4%), 6(18.8%) on 1994's, 1992's, respectively. The ultimate educational goal of university was becoming prominent; 21(65.6%) medical schools on 1996's edition, while 15(46.9%), 11(34.4%) on 1994's, 1992's, respectively.