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Design, Implementation, and Evaluation of a Simulation-Based Clinical Correlation Curriculum as an Adjunctive Pedagogy in an Anatomy Course

Coombs CM, Shields RY, Hunt EA, Lum YW, Sosnay PR, Perretta JS, et al.

Acad Med, 2017 04;92(4):494-500.
PMID: 27680320 DOI: 10.1097/ACM.0000000000001387

PROBLEM: Because reported use of simulation in preclinical basic science courses is limited, the authors describe the design, implementation, and preliminary evaluation of a simulation-based clinical correlation curriculum in an anatomy course for first-year medical students at Perdana University Graduate School of Medicine (in collaboration with Johns Hopkins University School of Medicine).
APPROACH: The simulation curriculum, with five weekly modules, was a component of a noncadaveric human anatomy course for three classes (n = 81 students) from September 2011 to November 2013. The modules were designed around major anatomical regions (thorax; abdomen and pelvis; lower extremities and back; upper extremities; and head and neck) and used various types of simulation (standardized patients, high-fidelity simulators, and task trainers). Several methods were used to evaluate the curriculum's efficacy, including comparing pre- versus posttest scores and comparing posttest scores against the score on 15 clinical correlation final exam questions.
OUTCOMES: A total of 81 students (response rate: 100%) completed all pre- and posttests and consented to participate. Posttest scores suggest significant knowledge acquisition and better consistency of performance after participation in the curriculum. The comparison of performance on the posttests and final exam suggests that using simulation as an adjunctive pedagogy can lead to excellent short-term knowledge retention.
NEXT STEPS: Simulation-based medical education may prove useful in preclinical basic science curricula. Next steps should be to validate the use of this approach, demonstrate cost-efficacy or the "return on investment" for educational and institutional leadership, and examine longer-term knowledge retention.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Effects of brief psychoeducational program on stigma in Malaysian pre-clinical medical students: a randomized controlled trial

Fernandez A, Tan KA, Knaak S, Chew BH, Ghazali SS

Acad Psychiatry, 2016 Dec;40(6):905-911.
PMID: 27527730

OBJECTIVE:
If presented with serious mental illness (SMI), individuals' low help-seeking behaviors and poor adherence to treatment are associated with negative stereotypes and attitudes of healthcare providers. In this study, we examined the effects of a brief psychoeducational program on reducing stigma in pre-clinical medical students.

METHODS: One hundred and two pre-clinical medical students (20-23 years old) were randomly assigned to face-to-face contact + educational lecture (n = 51) condition or video-based contact + educational lecture (n = 51) condition. Measures of pre-clinical medical students' mental illness-related stigma using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) were administered at pre-, post-treatment, and 1-month follow-up.
RESULTS: A 2 (condition: face-to-face contact + educational lecture, video-based contact + educational lecture) by 3 (time: pre-treatment, post-treatment, and 1-month follow-up) mixed model MANOVA was conducted on the Attitudes, Disclosure and Help-Seeking, and Social Distance OMS-HC subscales. Participants' scores on all subscales changed significantly across time, regardless of conditions. To determine how participants' scores changed significantly over time on each subscale, Bonferroni follow-up comparisons were performed to access pairwise differences for the main effect of time. Specifically, pairwise comparisons produced a significant reduction in Social Distance subscale between pre-treatment and post-treatment and between pre-treatment and 1-month follow-up, and a significant increase between post-treatment and 1-month follow-up, regardless of conditions. With respect to the Attitudes and Disclosure and Help-Seeking subscales, pairwise comparisons produced a significant reduction in scores between pre-treatment and post-treatment and a significant increase between post-treatment and 1-month follow-up.
CONCLUSIONS: Our findings provide additional evidence that educational lecture on mental illness, coupled with either face-to-face contact or video-based contact, is predictive of positive outcomes in anti-stigma programs targeting future healthcare providers.
KEYWORDS: Face-to-face contact; Stigma; Video-based contact

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Teaching of pharmacology in Universiti Malaya and the other medical schools in Malaysia -- a historical perspective

Sim SM

Acta Pharmacol Sin, 2004 Sep;25(9):1209-19.
PMID: 15339399

Traditional pharmacology teaching has focused more on drug instead of therapeutics, such that although pharmacological knowledge is acquired, practical skills in prescribing remain weak. In Malaysia many new medical schools (both public and private) have been set up in the last 12 years due to a change in government policy, resulting in a wide spectrum of medical curricula. Universiti Malaya (UM) being the oldest medical school in Malaysia was deep set in its traditional way of teaching-learning, since its inception in 1962, until a visit from the General Medical Council of the United Kingdom in 1984 triggered off a change of tide. Since then the medical curriculum in UM has undergone two major revisions. The first revised curriculum (1988) aimed to inject more clinical relevance into basic science teaching, through introducing clinical lectures and skills in the paraclinical year. Professional behaviour was also addressed. The second revised curriculum (1998) sought to improve further the integration of knowledge as well as to produce a holistic doctor, viewing the patient as a person instead of a clinical entity. The teaching-learning of pharmacology has gradually moved from factual regurgitation to more clinical reasoning, from lab-based to more patient-oriented approach. As more new medical schools are being set up in Malaysia, exchange of experience in this area of learning will hopefully help us find a happy medium between "the old is best" and "the new is better" type approach so that a pedagogically sound and yet logistically practical curriculum can be found in our local setting, to help produce doctors with good prescribing practice.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial

Perera J, Mohamadou G, Kaur S

Adv Health Sci Educ Theory Pract, 2010 May;15(2):185-93.
PMID: 19757129 DOI: 10.1007/s10459-009-9191-1

Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Integrating an open-source course management system (Moodle) into the teaching of a first-year medical physiology course: a case study

Seluakumaran K, Jusof FF, Ismail R, Husain R

Adv Physiol Educ, 2011 Dec;35(4):369-77.
PMID: 22139773 DOI: 10.1152/advan.00008.2011

Educators in medical schools around the world are presently experimenting with innovative ways of using web-based learning to supplement the existing teaching and learning process. We have recently used a popular open-source course management system (CMS) called the modular object-oriented dynamic learning environment (Moodle) to construct an online site (DPhysiol) to facilitate our face-to-face teaching of physiology to a group of first-year students in the Bachelor of Medicine and Bachelor of Surgery program. The integration of the Moodle site into our teaching was assessed using online log activity, student examination marks, and feedback from students. The freely available Moodle platform was simple to use, helped to effectively deliver course materials, and has features that allowed cooperative learning. Students who used the CMS throughout their academic year and commented favorably regarding its use as a complement to the face-to-face classroom sessions. The group of students used the CMS obtained significantly higher scores in the final examination compared with the previous class that did not use the CMS. In addition, there was a significant correlation between student participation and performance in online quizzes and their final examination marks. However, students' overall online usage of the CMS did not correlate with their examination marks. We recommend Moodle as a useful tool for physiology educators who are interested in integrating web-based learning into their existing teaching curriculum.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Student perceptions regarding the usefulness of explicit discussion of "Structure of the Observed Learning Outcome" taxonomy

Prakash ES, Narayan KA, Sethuraman KR

Adv Physiol Educ, 2010 Sep;34(3):145-9.
PMID: 20826769 DOI: 10.1152/advan.00026.2010

One method of grading responses of the descriptive type is by using Structure of Observed Learning Outcomes (SOLO) taxonomy. The basis of this study was the expectation that if students were oriented to SOLO taxonomy, it would provide them an opportunity to understand some of the factors that teachers consider while grading descriptive responses and possibly develop strategies to improve scores. We first sampled the perceptions of 68 second-year undergraduate medical students doing the Respiratory System course regarding the usefulness of explicit discussion of SOLO taxonomy. Subsequently, in a distinct cohort of 20 second-year medical students doing the Central Nervous System course, we sought to determine whether explicit illustration of SOLO taxonomy combined with some advice on better answering descriptive test questions (to an experimental group) resulted in better student scores in a continuous assessment test compared with providing advice for better answering test questions but without any reference to SOLO taxonomy (the control group). Student ratings of the clarity of the presentation on SOLO taxonomy appeared satisfactory to the authors, as was student understanding of our presentation. The majority of participants indicated that knowledge of SOLO taxonomy would help them study and prepare better answers for questions of the descriptive type. Although scores in the experimental and control group were comparable, this experience nonetheless provided us with the motivation to orient students to SOLO taxonomy early on in the medical program and further research factors that affect students' development of strategies based on knowledge of SOLO taxonomy.

Matched MeSH terms: Education, Medical, Undergraduate/methods
Fulltext Explicit constructivism: a missing link in ineffective lectures?

Prakash ES

Adv Physiol Educ, 2010 Jun;34(2):93-6.
PMID: 20522904 DOI: 10.1152/advan.00025.2010

This study tested the possibility that interactive lectures explicitly based on activating learners' prior knowledge and driven by a series of logical questions might enhance the effectiveness of lectures. A class of 54 students doing the respiratory system course in the second year of the Bachelor of Medicine and Bachelor of Surgery program in my university was randomized to two groups to receive one of two types of lectures, "typical" lectures (n = 28, 18 women and 10 men) or "constructivist" lectures (n = 26, 19 women and 7 men), on the same topic: the regulation of respiration. Student pretest scores in the two groups were comparable (P > 0.1). Students that received the constructivist lectures did much better in the posttest conducted immediately after the lectures (6.8 +/- 3.4 for constructivist lectures vs. 4.2 +/- 2.3 for typical lectures, means +/- SD, P = 0.004). Although both types of lectures were well received, students that received the constructivist lectures appeared to have been more satisfied with their learning experience. However, on a posttest conducted 4 mo later, scores obtained by students in the two groups were not any different (6.9 +/- 3 for constructivist lectures vs. 6.9 +/- 3.7 for typical lectures, P = 0.94). This study adds to the increasing body of evidence that there is a case for the use of interactive lectures that make the construction of knowledge and understanding explicit, easy, and enjoyable to learners.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Stimulating student interest in physiology: the intermedical school physiology quiz

Cheng HM

Adv Physiol Educ, 2010 Mar;34(1):20-1.
PMID: 20237230 DOI: 10.1152/advan.00096.2009
Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext A simple model to demonstrate the movements and the axes of the eyeball

Nayak S, Soumya KV

Adv Physiol Educ, 2009 Dec;33(4):356-7.
PMID: 19948688 DOI: 10.1152/advan.00047.2009
Matched MeSH terms: Education, Medical, Undergraduate/methods*
Peer-guided cooperative learning enhances the performance of refresher students

Torke S, Abraham RR, Ramnarayan K, Upadhya S

Adv Physiol Educ, 2007 Mar;31(1):118.
PMID: 17327594
Matched MeSH terms: Education, Medical, Undergraduate/methods*
Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students

Abraham RR, Upadhya S, Torke S, Ramnarayan K

Adv Physiol Educ, 2004 Dec;28(1-4):102-4.
PMID: 15319191

Medicine is an applied science, interpreting evidence and applying it to real life by using clinical reasoning skills and experience. COPT (clinically oriented physiology teaching) was incorporated in physiology instruction aiming to relate the study of physiology to real-life problems, to generate enthusiasm and motivation for learning, and to demonstrate the vocational relevance of physiology among students by integrating clinical experience with teaching. COPT consisted of two elements: 1) critical-thinking questions (CTQ) and 2) clinical case studies. After a few topics were taught, CTQ and case studies were given as an assignment. Answers were discussed in the next class. Two exams, each of which contained CTQ and recall questions, were conducted, one before (exam 1) and one after (exam 2) the implementation of COPT. Analysis of student performance in the examinations revealed that the students did better in exam 2 (P < 0.0001). Feedback from students indicated that this method was useful and challenging.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Self-directed learning

Abraham RR, Upadhya S, Ramnarayan K

Adv Physiol Educ, 2005 Jun;29(2):135-6.
PMID: 15905163
Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Using an integrated teaching approach to facilitate student achievement of the learning outcomes in a preclinical medical curriculum in India

Vashe A, Devi V, Rao R, Abraham RR, Pallath V, Umakanth S

Adv Physiol Educ, 2019 Dec 01;43(4):522-528.
PMID: 31642706 DOI: 10.1152/advan.00067.2019

Today most education institutions around the world have adopted the philosophy of outcome-based education. The emphasis in outcome-based education is achievement of outcomes; hence the curriculum should be designed in a way that it includes the components targeted specifically at achieving these outcomes. A discipline-based approach results in fragmentation of learning and lack of clinical applicability. Integrated teaching could be a solution to achieve required outcomes in a holistic way. Hence, the aim of this study was to develop, implement, and evaluate an integrated teaching module. Temporal coordination of the basic sciences, along with correlation of learned topics to clinical settings, was done in the first year of the undergraduate medical program. The module was evaluated by obtaining qualitative and quantitative feedback from students. Student assessment was conducted with a test that had case vignettes and multiple-choice questions. In addition, students' change in learning approaches and self-directed learning readiness were collected. Students' perception regarding the educational environment was also obtained. Analysis of the data showed positive feedback from the students regarding the integrated teaching. Students' average score in the test was 86%. There was a significant increase in the scores for the deep approach and self-directed learning readiness in the posttest compared with the pretest. Moreover, students were found to be satisfied with the educational environment. Evaluation of integrated teaching revealed that it was well accepted by the students. Moreover, it facilitated the achievement of the students' outcomes.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Ten maxims of formative assessment

Prashanti E, Ramnarayan K

Adv Physiol Educ, 2019 Jun 01;43(2):99-102.
PMID: 30835147 DOI: 10.1152/advan.00173.2018

In an era that is seemingly saturated with standardized tests of all hues and stripes, it is easy to forget that assessments not only measure the performance of students, but also consolidate and enhance their learning. Assessment for learning is best elucidated as a process by which the assessment information can be used by teachers to modify their teaching strategies while students adjust and alter their learning approaches. Effectively implemented, formative assessments can convert classroom culture to one that resonates with the triumph of learning. In this paper, we present 10 maxims that show ways that formative assessments can be better understood, appreciated, and implemented.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia

Dydykin S, Kapitonova M

Anat Sci Educ, 2015 Sep-Oct;8(5):471-7.
PMID: 25688979 DOI: 10.1002/ase.1523

Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Anatomy education environment measurement inventory: A valid tool to measure the anatomy learning environment

Hadie SNH, Hassan A, Ismail ZIM, Asari MA, Khan AA, Kasim F, et al.

Anat Sci Educ, 2017 Sep;10(5):423-432.
PMID: 28135037 DOI: 10.1002/ase.1683

Students' perceptions of the education environment influence their learning. Ever since the major medical curriculum reform, anatomy education has undergone several changes in terms of its curriculum, teaching modalities, learning resources, and assessment methods. By measuring students' perceptions concerning anatomy education environment, valuable information can be obtained to facilitate improvements in teaching and learning. Hence, it is important to use a valid inventory that specifically measures attributes of the anatomy education environment. In this study, a new 11-factor, 132-items Anatomy Education Environment Measurement Inventory (AEEMI) was developed using Delphi technique and was validated in a Malaysian public medical school. The inventory was found to have satisfactory content evidence (scale-level content validity index [total] = 0.646); good response process evidence (scale-level face validity index [total] = 0.867); and acceptable to high internal consistency, with the Raykov composite reliability estimates of the six factors are in the range of 0.604-0.876. The best fit model of the AEEMI is achieved with six domains and 25 items (X2 = 415.67, P

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Peer-Assisted Learning Activities During Undergraduate Ophthalmology Training: How the Medical Students of Asia Pacific Region Perceive

Sahoo S, Venkatesan P, Myint KT, Moe S

Asia Pac J Ophthalmol (Phila), 2015;4(2):76-9.
PMID: 26065348 DOI: 10.1097/APO.0000000000000094

OBJECTIVES: The aims of this study were to identify the attitude of peer tutors (PTs) toward peer-assisted learning (PAL) and to explore the perceived benefits of PAL by PTs and peer learners (PLs).
DESIGN: A qualitative and quantitative research study.
METHODS: This study involved fourth-year medical undergraduates during their clinical posting in ophthalmology. One PAL session was conducted in each of the 4-week clinical postings. Peer tutors were selected during the first week and were briefed on PAL. Premultiple and postmultiple choice questions were distributed to PLs before and after each PAL session. One focus group discussion was conducted with PLs to explore their perception. Peer tutors were requested to give feedback in the form of structured Likert scale statements with 2 open-ended questions.
RESULTS: A total of 104 students, 6 PTs and 98 PLs, participated in this study. Both tutor and learner groups expressed positive attitudes toward PAL. Peer learners preferred having PAL in a clinical setting. There were some issues related with PAL that emerged from both groups. Success in PAL depends on the teaching ability of PTs.
CONCLUSIONS: Students have positive perceptions toward PAL. Most of the students believed PAL was beneficial to them.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Dysfunctional problem-based learning curricula: resolving the problem

Lim WK

BMC Med Educ, 2012;12:89.
PMID: 23009729 DOI: 10.1186/1472-6920-12-89

Problem-based learning (PBL) has become the most significant innovation in medical education of the past 40 years. In contrast to exam-centered, lecture-based conventional curricula, PBL is a comprehensive curricular strategy that fosters student-centred learning and the skills desired in physicians. The rapid spread of PBL has produced many variants. One of the most common is 'hybrid PBL' where conventional teaching methods are implemented alongside PBL. This paper contends that the mixing of these two opposing educational philosophies can undermine PBL and nullify its positive benefits. Schools using hybrid PBL and lacking medical education expertise may end up with a dysfunctional curriculum worse off than the traditional approach.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine

Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E

BMC Med Educ, 2015;15:39.
PMID: 25884717 DOI: 10.1186/s12909-015-0321-6

BACKGROUND: Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.
METHODS: A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.
RESULTS: A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.
CONCLUSIONS: BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.

Matched MeSH terms: Education, Medical, Undergraduate/methods*
Fulltext Using Kahoot! as a formative assessment tool in medical education: a phenomenological study

Ismail MA, Ahmad A, Mohammad JA, Fakri NMRM, Nor MZM, Pa MNM

BMC Med Educ, 2019 Jun 25;19(1):230.
PMID: 31238926 DOI: 10.1186/s12909-019-1658-z

BACKGROUND: Gamification is an increasingly common phenomenon in education. It is a technique to facilitate formative assessment and to promote student learning. It has been shown to be more effective than traditional methods. This phenomenological study was conducted to explore the advantages of gamification through the use of the Kahoot! platform for formative assessment in medical education.
METHODS: This study employed a phenomenological design. Five focus groups were conducted with medical students who had participated in several Kahoot! sessions.
RESULTS: Thirty-six categories and nine sub-themes emerged from the focus group discussions. They were grouped into three themes: attractive learning tool, learning guidance and source of motivation.
CONCLUSIONS: The results suggest that Kahoot! sessions motivate students to study, to determine the subject matter that needs to be studied and to be aware of what they have learned. Thus, the platform is a promising tool for formative assessment in medical education.

Matched MeSH terms: Education, Medical, Undergraduate/methods*

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