Editorial

Educational value of Curiosity

Dujeepa D. Samarasekera & Matthew C.E. Gwee

“Curiosity… is the spark that can lead to breakthrough innovation. … it helps
produce more than new ideas.” (A. Ignatius, 2018).

We believe that curiosity is vital to learning. Many studies have shown that if a student is curious or the subject matter generates learners’ curiosity, then the student learning is deeper and that they remember better (Dyche & Epstein, 2011; Yuhas, 2014).

Global Perspectives

FAIMER fellowship programs: An international, project-centered approach to improving health through health professions education

Julie Drendall & John J. Norcini

I. INTRODUCTION

The Foundation for Advancement of International Medical Education and Research (FAIMER®) is a non-profit foundation committed to improving the health of communities by enhancing the quality of health professions education. This article highlights several of FAIMER’s international efforts, with particular emphasis on the fellowship programs developed in partnership with institutions in the Asia-Pacific region.

The odyssey of medical education in Indonesia

Rita Mustika, Hiroshi Nishigori, Sjamsuhidajat Ronokusumo & Albert Scherpbier

Abstract

Medical education in Indonesia has undergone a long journey. It began with the establishment of medical training for native youth in a military hospital in Jakarta during the Dutch colonial period in 1849. Since then, the number of medical schools has increased according to socio-political needs. Currently, there are 83 medical schools, public and private, which generate approximately 8000 graduates per year. The explosion in the number of medical schools challenged quality of medical education. Indeed, several curriculum changes and improvements applied to elevate the quality. Undergraduate program was initially implementing Dutch curriculum, but was then changed into American curriculum. The improvement continued by implementing the first and the second national curriculum. Since 2005 a national level competency-based curriculum (CBC) was carried out for undergraduate programs, while for postgraduate clinical training the CBC began later on. Moreover, Medical Internship Program and the National Competency-based Examination were introduced following the CBC. Nevertheless, some problems with advancement of medical schools were identified, including lack of staff and facilities, existing learning cultures and limitation of experts. Accordingly, many efforts have been made, including enactment of law on medical education and national accreditation. In the future, support from international organizations in terms of financial, consultation, faculty development and accreditation should be optimized. In addition, collaboration with medical education community elsewhere would be beneficial to overcome the challenges and promote the quality of medical education.

Keywords:            Medical Schools, Curriculum Changes, Medical Education, Indonesia

Lessons learnt in Sri Lanka as elective students

Klara E. Fransson, Ingrid E. J. Lundahl, Heidi K. Pasma, Mohamed R. M. Rishard & Maduka de Lanerolle-Dias

Abstract

Annually, a number of final year medical students from Lund University in Sweden travel to various healthcare facilities globally. We chose to go to the island of Sri Lanka, spending our elective at the department of Obstetrics and Gynaecology in Colombo. The dissimilarity between healthcare in Sweden and in Sri Lanka was evident throughout our stay. The design of healthcare facilities in Sri Lanka focused less on patient privacy and more on efficiency. The workload for doctors in Colombo was heavier than their Swedish counterparts. In general, outcome for Swedish patients is favourable when compared to Sri Lankan. We believe the difference in outcome is due to the unequal financial situations of the countries. Teaching approach in Sri Lanka diverted from Swedish practice by being more authoritarian but also exceedingly efficient. The large number of patients in wards and outpatient clinics allowed for us to experience a wide range of patient cases, offering important insights in medicine. It has been questioned whether the tradition of international electives is ethically justifiable. We therefore believe it important to stress that throughout our stay we were participating as observing students, not practicing doctors. We regard our elective a valuable experience, providing us with knowledge we will use in our future profession. Time spent observing Sri Lankan healthcare will also serve as a reminder to remain humble towards different cultures. We are now aware of the privileges we have, practicing medicine in a socioeconomically strong country.

Original Articles

Can digital media affect the learning approach of medical students?

Sonali Prashant Chonkar, Hester Lau Chang Qi, Tam Cam Ha, Melissa Lim, Mor Jack Ng & Kok Hian Tan

Abstract

Background: Students’ learning approaches have revealed that deep learning approach has a positive impact on academic performance. There are suggestions of a waning interest in deep learning to surface learning.

Aim: To assess if digital media can reduce the incidence of surface learning approach among medical students

Method: A digital video introducing three predominant learning approaches (deep, strategic, surface) was shown to medical students between March 2015 and January 2017. The Approaches and Study Skills Inventory for Students (ASSIST), was administered at the beginning and end of their clinical attachment, to determine if there were any changes to the predominant learning approaches. A survey was conducted using a 5-point Likert scale to assess if video resulted in change.

Results: Of 351 students, 191 (54.4%) adopted deep, 118 (33.6%) adopted strategic and 42 (12.0%) adopted surface as their predominant learning approach at the beginning of their clinical attachment. At the end of their clinical attachment, 171 (49.6%) adopted deep, 143 (41.4%) adopted strategic and 31 (9.0%) adopted surface learning as their predominant learning approach. The incidence of students predominantly using surface approach decreased from 42 (12.0%) to 31 (9.0%), although not statistically significant. Qualitative feedback from students stated that they were more likely to adopt non-surface learning approaches after viewing the video.

Conclusion: This evaluation highlighted the potential of digital media as an educational tool to help medical students reflect on their individual learning approaches and reduce the incidence of surface learning approach.

Keywords:            Learning Approaches, ASSIST, Digital Media, Video, Deep Learning, Surface Learning

Trends of clarification purpose of medical education research in the Asia-Pacific region: A scoping review

Wee Shiong Lim, Kar Mun Tham, Fadzli Baharom Adzahar, Han Yee Neo, Wei Chin Wong, Issac Lim, Charlotte Ringsted & Dujeepa D. Samarasekera

Abstract

Background: In recent years, the Asia-Pacific region has become a hotbed of activity in medical education. Little is known about the progress in advancing the field through clarification research studies situated within a strong conceptual framework vis-a-vis descriptive (“What was done?”) and justification (“Did it work?”) research purposes. We aimed to determine the trend in clarification as opposed to descriptive and justification research purposes in the Asia-Pacific region over a 5-year period.

Methods: We conducted a scoping review of original research abstracts presented at the 2008, 2010 and 2012 Asia Pacific Medical Education Conferences. All eligible abstracts were classified as descriptive, justification or clarification using the modified Cook (2008) research purpose framework. All abstracts were reviewed by two researchers, with disagreement resolved by consensus. We performed trended Chi-square tests followed by logistic regression adjusted for covariates, to determine the longitudinal trend in clarification studies.

Results: Our sample comprised 517 abstracts (2008:136; 2010:195; 2012:186). There was a significant trend towards an increase in clarification studies from 2008 to 2012 (4.4% vs 8.7% vs 12.9%, p=.001), even after excluding submissions from non-Asian countries. When adjusted for covariates, abstracts in 2012 significantly predicted a clarification research purpose compared to 2008 (OR 2.74, 95% CI 1.04-7.23). A non-descriptive study design also significantly predicted clarification studies (OR 7.07, 95% CI 3.17-15.75).

Conclusions: Our results of a trend towards increased clarification research purpose affirm the longitudinal progress in quality of medical education research in the Asia-Pacific region. Efforts should be made to promote non-descriptive study designs that are undergirded in clarification research purpose.

Keywords:            Medical Education Research, Clarification Research Purpose, Asia-Pacific, Scoping Review

What drives attrition amongst obstetrics and gynaecology residents in Singapore?

Jill Cheng Sim Lee, Xiang Lee Jamie Kee, Sharon Wiener-Ogilvie, Bernard Su Min Chern & Chee Yang Chin

Abstract

Background: Resident attrition is costly but literature studying the motivations behind it in obstetrics and gynaecology (OBGYN) is lacking.

Objectives: We aimed to study the relationship between prior specialty-appropriate work experience and risk of attrition amongst OBGYN residents in Singapore, and identify factors placing residents at greater risk of attrition.

Methods: This nationwide mixed methods case control study studied all OBGYN residents in Singapore for the 2011 and 2012 intakes. A pre-piloted questionnaire was used to identify work experience and risk factors related to resident attrition. Structured interviews were conducted with a subgroup of participants chosen for diversity of educational background, work experience, and position towards residency.

Results: 28 of 33 (84.8%) eligible residents participated in this study. Female (40.9% vs. 0%), married (50.0% vs. 22.2%) and Singaporean (38.1% vs.14.3%) residents more often considered attrition from training. Those accepted into residency after graduation were 33% less likely to have considered leaving. No statistical difference was observed between residents with prior work experience and those without (38.9% vs. 20.0%, p=0.417). All interviewees believed that prior experience informs expectations and eases initial learning. Low job satisfaction related to mismatched expectations was the most quoted reason for considering attrition. 85.7% of interviewed residents were concerned about competing work and family demands.

Conclusions: Lack of specialty-appropriate work experience contributes to misinformed training expectations and increased attrition risk. Residents who have considered attrition may still desire career longevity in their specialty. Reduction in mismatched expectations promises to improve job satisfaction and translate to career longevity.

Keywords:            Resident Attrition, Obstetrics and Gynaecology, Work Experience

Depression and stressful life events among medical students during undergraduate career: Findings from a medical school in South Asia

Dakshitha P. Wickramasinghe, Isuru S. Almeida & Dharmabandhu N. Samarasekera

Abstract

Purpose: Medical students face significant psychological stress and adverse life events throughout their student career. The aim of this study was to assess the prevalence of depression among medical undergraduates in a medical faculty in Sri Lanka.

Methods: A cross-sectional study using a self-administrated, validated questionnaire was conducted among 300 undergraduate medical students of the University of Colombo, Sri Lanka. Prevalence of depression was assessed using Beck Depression Inventory (BDI). The data were analysed by the Mann-Witney U-test. P values less than 0.05 were considered statistically significant.

Results: Three hundred students participated in the study (male: female: 111: 189). Overall, 19% (male: female: 25:32) of students were identified as depressed. Depression was most common among 1st year (25%) students followed by final year (20%) and 3rd year (12%) students respectively. Depression was more common in students who were living in rented rooms compared to those residing in hostels and home (22%, 19.1% and 13.3%, respectively). Depression was less prevalent in students who participated in extracurricular activities than those who did not (11.9% vs 23.6%, P<0.05, Mann-Whitney U-test). There were 2 students with extreme depression.

Multivariate analysis identified residency outside the city and adverse life events to be associated with a higher risk of depression and extracurricular activities to be associated with a lower risk.

Conclusions: 1st year and female medical students had a higher prevalence of depression while those who participated in extracurricular activities had lower rates. A system should be established to identify students with depressive features early.

 

Keywords:            Medical students, Depression, Stress, Sri Lanka

Short Communications

Health promotion campaign from student approach – The lesson learned for the upcoming medical doctor; The effects of a campaign to reduce consumption of sugar-sweetened beverages in medical students

Nattabborn Bunplook, Mechita Kongphiromchuen, Priyapat Phatinawin & Panadda Rojpibulstit

Abstract

Aim: To encourage first year medical students to have better health by drinking more water and being role models in health promoting lifestyle.

Methods: The campaign was launched in February 2016 with seven main activities, convinced via social networking apps (Line and Facebook). The pre and post questionnaires were launched via Google Forms regarding the effective activities and participants’ drinking behaviour. Data were analysed by descriptive statistics and dependent t-test.

Results: Response rate for the questionnaire was 74.71% (127/170). After 4 weeks of the campaign, the average water intake was significantly increased (t = 6.359, p < 0.05). The average consumption of sugar-sweetened beverages was significantly decreased (t = -8.256, p < 0.05). Additionally, when comparing from the seven activities, the most top three preference activities are ‘Info & suggestions’, ‘Sugar Hunt’ and ‘Sugar Free Be Rich’.

Conclusions: Nowadays, people are preferring to consume sugary drinks instead of regular water and many may assume that computer games and social media are prevalent issues. But in reality if we use technology wisely, it would even provide us with a much more efficient method to reach the target group. Our study, thereby, then brings upon the appropriate aspect of games and social media in order to resolve the current issues. However, some activities have to be improve to attract more of the target group and the duration of the campaign should be increased for better long-term behavioural change.

Keywords:            Health Promotion, Medical Students, Obesity, Lifestyle

Clickers: Enhancing the residency selection process

Jill Cheng Sim Lee, Muhammad Fairuz Abdul Rahman, Weng Yan Ho, Mor Jack Ng, Kok Hian Tan & Bernard Su Min Chern

Abstract

Background: Residency selection panels commonly use time consuming manual voting processes which are easily subjected to bias and influence of others to select successful candidates. We explored the use of an electronic audience response system (ARS) or ‘clickers’ in obstetrics and gynaecology resident selection; studying the voting process and examiner feedback on confidentiality and efficiency.

Methods: All 10 interviewers were provided with clickers to vote for each of the 25 candidates at the end of the residency selection interview. Votes were cast using a 5-point Likert scale. The number of clickers provided to each interviewer was weighted according to the rank of the interviewer. Voting scores and time for each candidate was recorded by the ARS and interviewers completed a questionnaire evaluating their experience of using clickers for resident selection.

Results: The 10 successful candidates scored a mean of 4.28 (SD 0.27, range 3.86-4.73), compared to 2.99 (SD 0.71, 1.50–3.79) for the 15 unsuccessful candidates (p<0.001). Average voting time was 26 seconds per candidate. Total voting time for all candidates was 650 seconds. All interviewers favoured the use of clickers, for its confidentiality, instantaneous results, and more discerning graduated response.

Conclusion: Clickers provide a rapid and anonymous method of collating interviewer decisions following a rigorous selection process. It was well-received by interviewers and highly recommended for use by other residencies in their selection process.

Keywords:            Resident Selection, Clickers, Electronic Audience Response System

“Modified World Café” workshop for a curriculum reform process

Ikuo Shimizu, Junichiro Mori & Tsuyoshi Tada

Abstract

Consensus formation among faculties is essential to curriculum reform, especially for the clinical curriculum. However, there is limited evidence on the model of workshop that is necessary for curriculum reform. In the current project, we aimed at developing a beneficial workshop method for building consensus and reaching educational goals in curriculum reform. We compared the two types of workshop models. First, we conducted workshops using standard group work model with fixed group members. Then we used a revised workshop model. In the revised model, all but one group member moved their seats after the first round of discussion. In addition, we reserved time for plenary presentations and discussions after each round. We called the model “Modified World Café” workshop named after World Café, a collaborative dialogue method. With this design, not only we were able to achieve significant improvement of appropriate products and better consensus, but also attained several educative goals. Since the model combines characteristics of the standard group work and World Café concept, it might be useful in facilitating the sharing of new knowledge and creating consensus.

Keywords:            Curriculum Reform, Workshop, Consensus Building, World Café

Personal View

Transformation of medical education over the years – A personal view

Oh Moh Chay

I. INTRODUCTION

Over the years, medical education has invariably changed. When faculty meet to discuss the performance and attitude of young doctors, the question of what had happened to medical education often arise, intuitively pointing fingers to changes in medical education as the root cause of the problem.

The impact of graduate-entry medicine degree programme students’ prior academic and professional experience on their medical school journey

Simon Tso

I. GRADUATE-ENTRY MEDICINE DEGREE PROGRAMMES

Graduate-entry medicine degree programmes exist in many countries. In the UK, graduate-entry medicine degree programmes began in 2000 and accounted for approximately 10% of the annual intake into all undergraduate medicine academic programmes (Garrud, 2011). There had been relatively few studies exploring the impact of prior experience on graduate-entry medical students’ medical school journey. Rapport and colleagues (2009) reported prior work and life experience had a significant and positive impact on medical students’ degree programme experience. Their prior experiences had helped them understand complex concepts in professionalism, ethics and reflective learning, as well as how to manage patient encounters (Rapport et al., 2009). On the other hand, the authors noted the nature of medical students’ previous degree subjects had ‘virtually negligible effects’ on their current degree programme experience (Rapport et al., 2009). Gallagher and Hoare (2016) explored the transition experience of New Zealand medical students that were health professionals. The authors reported these medical students retained a number of generic core skills (e.g. patient communication, professionalism, teamwork, familiarity with the health care environment) from their previous health profession role and were able to apply these skills to their medicine degree programme (Gallagher and Hoare, 2016).

Case Study

The Ownership Cycle and self-regulated learning

Jian Yi Soh

I. INTRODUCTION

Teachers in various settings worldwide meet with a variety of learners. Some are adept and master their lessons quickly; some less so; and some have persistent difficulties with their lessons. The difficulties can extend beyond the academic; conduct, professionalism and resilience are all important, especially in undergraduate and postgraduate learners. Inability to accept poor results, to admit failure so as to learn from it, can create learners who become withdrawn and resistant to constructive feedback and sincere attempts to help them. “No insight” and “unmotivated” are common terms used in the hallways and discussion rooms to describe these learners. Based on these twin assumptions, teachers strive to extend more help, more resources and more constructive feedback to these learners, and often find that there is little or no improvement despite the vast amounts of energy and time expended.

Multimedia Article

Tri-Generational Homecare, a student-led inter-professional project

Celine Yi Xin Tham

Abstract

This paper was first published in TAPS Volume 3 Number 1 as an Original Article.