Global Perspectives

Global perspective on continuing professional development

Lawrence T. Sherman & Kathy B. Chappell


Healthcare professionals worldwide participate in continuing professional development (CPD) to remain competent in practice, and to ensure they provide high-quality care to patients. Globally, CPD systems have evolved at different rates resulting in significant variation in structure, requirements, and oversight. In some countries, CPD has moved from single profession educational designs and formal didactic methods of delivery to educational models that are innovative, dynamic, and learner-centric. In other countries, CPD is a neglected part of the healthcare education continuum. This article provides a global perspective on the evolution of CPD over the past 20 years, and identifies opportunities for the future.

Original Articles

STarDom study – Applying systems theory framework for Internal Medicine senior residency career development in a Singapore ACGMEI Residency Programme

Joanne Kua, Mark Chan, Jolene See Su Chen, David Ng & Wee Shiong Lim


Aims: Career counselling is a complex process. Traditional career counselling is unidirectional in approach and ignores the impact and interactions of other factors. The Systems Theory Framework (STF) is an emerging framework that illustrates the dynamic and complex nature of career development. Our study aims to i) explore factors affecting senior residency (SR) subspecialty choices, and ii) determine the suitable utility of the STF in career counselling.

Methods: A prospective observational cohort study of internal medicine residents was done. Surveys were collected at three time points. The Specialty Indecision Scale (SIS) assesses the individual components and expert consensus group derived the questions for the contextual components. We measured burnout using the Mashlach Burnout Inventory. Process influences were assessed via thematic analysis of open-ended question at the 3rd survey.

Results: 82 responses were collected. There was a trend towards older residents being ready to commit albeit not statistically significant. At year 1, overseas graduands (OR = 6.87, p= 0.02), lifestyle factors (t(29)=2.31, p=0.03, d= 0.91), individual factors of readiness (t(29) = -2.74, p=0.01, d= 1.08), indecisiveness (t(27)= -0.57, p=0.02, d= 0.99) and self- doubt (t(29)= -4.02, p=0.00, d= 1.54) predicted the resident’s ability to commit to SR. These factors change and being married (OR 4.49, p= 0.03) was the only factor by the 3rd survey. Male residents are more resolute in their choice (OR= 5.17, p= 0.02).

Conclusion: The resident’s choice of SR changes over time. The STF helps in understanding decision-making about subspecialty choices. Potential applications include: i) initiation of career counselling at year 1 and ii) reviewing unpopular SR subspecialties to increase their attractiveness.

Keywords:         Internal Medicine Residents, Career Counselling, Senior Residency

The process of developing a rubric to assess the cognitive complexity of student-generated multiple choice questions in medical education

Rebecca Grainger, Emma Osborne, Wei Dai & Diane Kenwright


Cognitively complex assessments encourage students to prepare using deep learning strategies rather than surface learning, recall-based ones. In order to prepare such assessment tasks, it is necessary to have some way of measuring cognitive complexity. In the context of a student-generated MCQ writing task, we developed a rubric for assessing the cognitive complexity of MCQs based on Bloom’s taxonomy. We simplified the six-level taxonomy into a three-level rubric. Three rounds of moderation and rubric development were conducted, in which 10, 15 and 100 randomly selected student-generated MCQs were independently rated by three academic staff. After each round of marking, inter-rater reliability was calculated, qualitative analysis of areas of agreement and disagreement was conducted, and the markers discussed the cognitive processes required to answer the MCQs. Inter-rater reliability, defined by the intra-class correlation coefficient, increased from 0.63 to 0.94, indicating the markers rated the MCQs consistently. The three-level rubric was found to be effective for evaluating the cognitive complexity of MCQs generated by medical students.

Keywords:            Student-generated Multiple-choice Questions, Cognitive Complexity, Bloom’s Taxonomy, Marking Criteria, Moderation of Assessment

Effect of smartphone overuse on sleep problems in medical students

Pairoj Boonluksiri


Background: Smartphones are used worldwide. Consequently, it does seem to be having an impact on health-related problems if overused. However, it is uncertain whether it is associated with sleep problems or poor learning.

Objective: To determine the association between smartphone overuse and sleep problems in medical students as primary outcome and poor learning as secondary outcome.

Methods: A cross-sectional study was conducted in 89 students having their own smartphones, at Hatyai Medical Education Centre, Thailand. The habits of using smartphone were obtained. Smartphone overuse during bedtime was defined as using longer than 1 hour according to Smartphone Addiction Scale (SAS). The primary outcome was napping in a classroom that was defined as a problem if it happened more than 20% of the time attending class. Sleep problems using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were obtained by self-assessment. Learning outcome measured by grade point average was the secondary outcome. Multivariable analysis was performed for the association between smartphone overuse and sleep problems.

Results: Of all students, 77.5% had sleep problems and 43.6% had napped in the classroom No personal characteristics, daily life behaviours, and physical environments were associated with sleep problems. 70.8% of all students found to over use smartphones during bedtime. The Facebook website was the most popular. Smartphone overuse was significantly associated with poor sleep quality (odds ratio= 3.46) and napping in the classroom (odds ratio=4.09) but not grade point average.

Conclusion: Smartphone overuse during bedtime in medical students is associated with sleep problems but not learning achievement.

Keywords:            Napping in Classroom, Sleep Problems, Smartphone Overuse

The development of clinical confidence during the PGY-1 year in a sample of PGY-1 doctors at a District Health Board (DHB) in New Zealand

Wayne A. de Beer & Helen E. Clark


The New Zealand Curriculum Framework (NZCF) for Prevocational Medical Training identifies a number of procedural skills that prevocational doctors should achieve during their first two years following graduation from medical school. This study aimed to identify the clinical confidence of graduate doctors in performing the list of procedures outlined in the NZCF at two points in time; following completion of undergraduate studies, and the first year of prevocational, preregistration training. An anonymous paper-based survey, consisting of 59 items, was completed by a cohort of PGY-1 doctors (n = 30) twice during 2015, with the first 48 items of the survey rating PGY-1s perceptions of their clinical confidence in performing procedures that fall under the 12 competencies identified in the Procedures and Interventions section of the NZCF. 70.8% of the procedures were rated above 2.0 at the start of the PGY-1 year, indicating that respondents had received teaching in, or viewed the procedure being performed, during undergraduate training. By year-end, procedural skills performance rated above 3.0 (i.e., confident in performing said procedure independently) was achieved in 52% of the listed skills. Low scores occurred in procedures listed under the categories ENT, Ophthalmology, Surgery and Trauma. While ratings of clinical confidence improved in many areas as expected during the PGY-1 tenure, some areas remained low. This highlights an issue that PGY-1 doctors may not be receiving adequate training in certain procedural skills listed as core NZCF competencies during the PGY-1 year.

Keywords:        Prevocational Doctors, Core Competencies, Procedural Skills, Clinical Confidence

Analysis of the perceptions of medical students applying contextual relevance to literature

Kun Hwang, Ae Yang Kim & Hun Kim


In the current healthcare environment, team-based models in the teaching and practice of medicine have become more a norm than a preference.  Renewed focus on team-based practice discloses the effect that poorly functioning teams may have on successful outcomes in team-based delivery of patient care. Team incompetence compromises learning and work performance for all members; an outcome often rooted in poor communication and understanding of role responsibilities within the team. Business schools have been innovative and proactive in recognizing this problem and have instituted team charters to align team expectations and norms through discussion and consensus. Team charters were introduced in Block 2 Microscopic Anatomy and Block 3 Human Structure courses at Mayo Medical School in the first year curriculum. Teams were oriented on the concept of the team-charter and given the opportunity to create individual team charters to suit each team’s work ethos.  Teams were encouraged to revisit their charters midway through the course to maintain a dynamic contract.  Students took time to reflect on and adapt their strategy in order to facilitate better team cohesiveness, communication, interaction and ultimate performance.  Qualitative student feedback indicated that the exercise fostered better group dynamic and improved communication within the team. Students were empowered to take responsibility for their own learning, professional identity formation, performance, academic development and their impact on total performance of the team.

Keywords:          Gross anatomy education; Medical education; Team-based learning; Team charters; Assessment

A cross-sectional survey of interprofessional education across 13 healthcare professions in Japan

Michiko Goto, Junji Haruta, Ai Oishi, Kazue Yoshida, Kenji Yoshimi, Yousuke Takemura & Hisashi Yoshimoto


Background: With the rapid aging of the population, collaboration among the various medical professions throughout the country is becoming increasingly indispensable in Japan. To promote collaboration in medical care, it is necessary to introduce the concept of collaboration to students at an early stage of their professional education. Despite this need, there are no core medical, healthcare and welfare education curricula in Japan that include interprofessional education (IPE). Therefore, the status of IPE in Japanese schools of medicine and other healthcare-related services is unclear.

Methods: We sent 3,430 questionnaires to 13 schools of medicine and related healthcare providers: doctors, nurses, physical therapists, registered dieticians, dentists, dental hygienists, social workers, pharmacists, occupational therapists, clinical psychologists, medical administrators, certified care workers, and speech therapists. The items addressed implementation rate of IPE, teaching methods and grading methods.

Results: Of the 3,430 surveys distributed, 572 completed surveys were returned (response rate 17%). Of the completed surveys, 493 qualified as valid, resulting in a final response rate of 14%. Only 19% (n = 93) of the analysed medical educational institutions included IPE instruction in their curricula.

Conclusion: While many educational institutions were conducting IPE, there were important inter-institutional differences with respect to attitudes towards IPE, teaching methods, and evaluation methods. This study was unprecedented in scale, and provides important basic information for the future development of IPE in Japan.

Keywords:        Interprofessional Education, Healthcare Professions, Teaching Methods, Grading Methods, Collaboration

Letter to Editor

Rashomon approach as educational method

Junichi Tanaka


It was interesting to read the letter from Rajesh and Sengodan (2017) published in The Asia Pacific Scholar (TAPS) Volume 2 Number 3 regarding the Kurusowa approach to teaching and learning (Rajesh & Sengodan, 2017). The authors discuss the Rashomon effect in the letter and hence, I would like to elaborate further on the “Rashomon approach.”

Personal View

Medical Education in India

Sethuraman K. Raman


A. Why this is an issue of global relevance

India is the world’s largest exporter of doctors and healthcare workforce to other nations. More than 70,000 medical graduates from India (nearly 10% of the qualified doctors in India) are in the USA, UK, Europe, and the other nations. Therefore, the quality of medical education and the competence level of medical professionals from India acquire global relevance. Over the years, several critiques have been published on Indian Medical Education (Solanki & Kashyap, 2014).

eLearning in medical education – Costs and value add

Poh Sun Goh


This article (and its accompanying and complementary presentation blog []) expands on ideas presented and elaborated on during the pre-conference workshop (, and main conference symposium ( on this topic at the 14th APMEC. It will specifically address the issue of the costs involved, and value add of eLearning. It is presented in two sections, 1) as a series of short conversational style quotes intended to make a case for the use (or not) of eLearning / Technology enhanced learning, which were recently shared in the preamble to a more formal presentation on this topic; and 2) as a single paragraph compact article, augmented by internal keyword links to additional resources, links to the original workshop and symposium presentation blogs, an audio podcast (, video (example1) ( or video (example 1, embedded version below) demonstration, and interactive online bulletin ( board (most updated versions of these media, and multimedia links will be on the blog).