Learning clinical reasoning in the workplace: a student perspective

Introduction Clinical reasoning is a core competency for every physician, as well as one of the most complex skills to learn. This study aims to provide insight into the perspective of learners by asking students about their own experiences with learning clinical reasoning throughout the medical Master’s curriculum. Methods We adopted a constructivist approach to organise three semi-structured focus groups within the Master’s curriculum at the medical school of the Radboud University Medical Center in Nijmegen (Netherlands) between August and December 2019. Analysis was performed through template analysis. Results The study included 18 participants who (1) defined and interpreted clinical reasoning, (2) assessed the teaching methods and (3) discussed how they used their context in order to learn and perform clinical reasoning during their clinical rotations. They referred to a variety of contexts, including the clinical environment and various actors within it (e.g. supervisors, peers and patients). Conclusion With regard to the process by which medical students learn clinical reasoning in practice, this study stresses the importance of integrating context into the clinical reasoning process and the manner in which it is learnt. The full incorporation of the benefits of dialogue with the practice of clinical reasoning will require additional attention to educational interventions that empower students to (1) start conversations with their supervisors; (2) increase their engagement in peer and patient learning; (3) recognise bias and copy patterns in their learning process; and (4) embrace and propagate their role as boundary crossers.

Current Trends in Removable Partial Prosthodontics Teaching in Undergraduate Dental Colleges of Sindh, Pakistan

Objective: To explore current trends in removable partial prosthodontics teaching in undergraduate dental colleges of Sindh, Pakistan. Study Design: Descriptive Cross-sectional. Place and Duration of the Study: Department of prosthodontics in dental colleges of Sindh in September 2019. Methodology: A descriptive cross-sectional study was done in which a questionnaire was sent by email to head of Prosthodontics department of 16 dental institutes of Sindh, Pakistan. The survey included different questions regarding current trends in removable partial prosthodontics education in undergraduate dental colleges. Results: Out of sixteen questionnaires, fourteen were completely filled and returned. Majority (69.2%) of the institutes teach fabrication of removable partial dentures (RPDs) in third year of dental college. Students of only one dental college fabricate 10-12 RPDs in their clinical rotation. All dental colleges teach acrylic RPD construction in their preclinical years. Faculty in 12 (85.7%) dental colleges always give clinical demonstrations to students before their clinical rotations. Eleven out of the fourteen colleges teach cast partial dentures (CPDs) theoretically, but no CPDs are fabricated by the students during their clinical rotation. About 70% dental schools do not have in-house facility to fabricate cast partial dentures. Conclusion: This study describes current trends of removable prosthodontics teaching in undergraduate colleges of Sindh. A large majority of undergraduate dental students are not fabricating the minimum number of partial dentures as per PMC requirement. Although theoretically cast partial dentures are taught in lectures but students do not construct them in their undergraduate years. Efforts should therefore be made to improve teaching practices and clinical skills of undergraduates, for them to be able to treat partially dentate patients after graduation.

Are we teaching health science students in the United States what they need to know about death and dying coping strategies?

Purpose: This investigation aimed to answer the following questions: Are health science students provided with death and dying education before attending clinical rotations, and if so, do the students receiving this type of education perceive it as effective?Methods: In this descriptive cross-sectional survey, 96 Midwestern State University health science students were surveyed to determine the percentage of students who had received death and dying education before clinical rotations, as well as the students’ perception of educational effectiveness for those who had received end-of-life training. A self-report questionnaire presented nursing, radiologic sciences, and respiratory care students with a series of questions pertaining to the education they had received concerning the death and dying process of patients.Results: Of the 93 students who had already started their clinical rotations, 55 stated they had not received death and dying education before starting clinical courses. Of the 38 who had received death and dying education, only 17 students believed the training was effective.Conclusion: It is imperative that health science educational programs implement death and dying education and training into the curriculum, and that criteria for evaluating effectiveness be an essential part of death and dying education and training in order to ensure effectiveness.

The effects of Covid-19 on Medical Education

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods. doi: https://doi.org/10.12669/pjms.38.1.5269 How to cite this:Karim Z, Javed A, Azeem MW. The effects of Covid-19 on Medical Education. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.5269 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Attitudes of Medical Students toward COVID-19 Vaccination: Who Is Willing to Receive a Third Dose of the Vaccine?

Medical students may come in contact with individuals infected with COVID-19 in their clinical rotations. A high level of acceptance of vaccination is needed for them to protect their health and the health of patients from this disease. The objectives of this study were to (1) obtain information on medical students’ attitudes toward COVID-19 vaccination, (2) assess factors associated with students’ attitudes, and (3) identify predictors of their willingness to receive a third dose of the COVID-19 vaccine. Using a cross-sectional design, we conducted a questionnaire survey of medical students in July 2021. For this survey, we employed a 15-item questionnaire specifically developed to assess the students’ attitudes toward COVID-19 vaccination. Of the 742 distributed questionnaires, 496 (294 males and 202 females) were completed. Among all the participants, 89.1% (442/496) received the second dose of the vaccine, and 90.7% (450/496) indicated that they would hypothetically receive the COVID-19 vaccine in the future. Furthermore, 84.5% (419/496) of all the participants were willing to receive a third dose of the vaccine. Regarding willingness to receive a third dose of the COVID-19 vaccine, multiple logistic regression models showed that students’ grade and their responses to Q1 (positive attitude toward vaccination), Q9 (belief in the protection offered by COVID-19 vaccination), Q10 (concern about the excessively rapid development of COVID-19 vaccines), Q12 (need for aspects of pre-pandemic life), and Q14 (concern about the sustainability of immunity) had significant associations with this outcome. Confidence in vaccines, relaxation of mobility restrictions, and concern about the sustainability of immunity motivate willingness to receive a third dose of the COVID-19 vaccine in medical students.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument

Background Medical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students’ perceptions of their clinical skill growth. Methods A self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year. The instrument consisted of questions on 5 clinical skill categories where students rated their performance as “below”, “at” or “above” expected, and open-ended questions on strengths and challenges. We evaluated changes in self-ratings between the first (n=136) and third (n=118) quarters by matched-pair analysis of the shift in responses between time points using a Sign Test. We also identified the main themes from the students’ responses to open-ended questions. Results We found 22.4 % and 13.3 % of students increased their self-assessment ratings on “Oral Presentation Skills” and on “Differential Diagnosis”, respectively. In contrast, perceived ability to communicate with patients saw the largest negative shifts. “Patient Interaction” was the most commonly identified area of strength and “Knowledge and Organization” was most frequently cited as a barrier. Conclusions Students demonstrated a positive shift in perceived competence in some core clinical skills that are not strongly emphasized in the preclinical curriculum, likely reflecting increased exposure over time. However, their perceived competence in communication skills declined. This may reflect initial over-estimation or true decline due to competing needs/interests. These patterns of change can inform the design of longitudinal curricula that anticipate and address students’ needs during clinical rotations, such as placing increased emphasis on presentation skills and differential diagnosis earlier in the curriculum, and adding more emphasis to communication skills in later phases.

Rapid Development, Training, and Implementation of a Remote Health Profession’s Student Volunteer Corps During the COVID-19 Pandemic

Public health in the United States has long been challenged by budget cuts and a declining workforce. The COVID-19 pandemic exposed the vulnerabilities left by years of neglecting this crucial frontline defense against emerging infectious diseases. In the early days of the pandemic, the University of Texas Medical Branch and the Galveston County Health District (GCHD) partnered to bolster Galveston County’s public health response. We mobilized interprofessional teams of students and provided training to implement projects identified by GCHD as necessary for responding to the pandemic. We provided a safe outlet for students to contribute to their community by creating remote volunteer opportunities when students faced displacement from clinical rotations and in-person didactics converted to virtual formats. As students gradually returned to clinical rotations and didactic demands increased, it became necessary to expand volunteer efforts beyond what had initially been mostly hand-selected student teams. We have passed the initial emergency response phase of COVID-19 in Galveston County and are transitioning into more long-term opportunities as COVID-19 moves from pandemic to endemic. In this case study, we describe our successes and lessons learned.

Anxiety, Uncertainty, and Resilience of Medical Students Worldwide during the COVID-19 Pandemic

The COVID-19 pandemic significantly impacted medical education worldwide. While healthcare professionals labored to ensure proper care for COVID-19 patients, medical students suffered from high rates of anxiety, uncertainty, burnout, and depressive symptoms. Whilst students in the pre-clinical phase of education faced disruption of didactic lectures and laboratory training, senior medical students faced uncertainty regarding their clinical rotations and internships, which are vital for practical exposure to healthcare. Several studies across the world demonstrated that clinical learning was significantly affected, with students in many countries completely cut off from in-person rotations. The disruption of the clinical curriculum coupled with a sense of failure to contribute at a time of significant need often led to despair. Reforms proposed and/or implemented by governments, medical advisory boards, medical schools, and other administrative bodies were felt to be insufficient by the medical student fraternity at large. Consequently, these students continue to face high rates of anxiety, depression, and a general sense of cynicism. In this student-authored perspective, we highlight the challenges faced by and the psychological impact on medical students directly or indirectly from the pandemic.