Original Articles

Current status of medical education research in Japan: A meta-epidemiological investigation

Yuki Kataoka1,2, Hiraku Tsujimoto2, Yasushi Tsujimoto3, Yuka Urushibara-Miyachi4, Yuda Miyamoto5, Hideto Yasuda6, Hiromitsu Yamashita5, Ryohei Yamamoto6 & Hiroshi Nishigori7

1Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Japan; 2Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Japan; 3Department of Nephrology and Dialysis, Kyoritsu Hospital, Japan; 4Science and Religion, School of Divinity, University of Edinburgh, Scotland; 5Outpatient Facility Kameda Clinic, Japan; 6Department of Intensive Care Unit, Kameda General Hospital, Japan; 7Center for Medical Education, Kyoto University, Japan

Abstract

Background: The representation of Japan in science has been decreasing. No data is available on the current status of medical education research in Japan.

Aim: The present study aims to describe the current status of medical education research in Japan.

Methods: We conducted a meta-epidemiological investigation of the conference abstracts from Japan for the Japan Society for Medical Education (JSME), the Association for Medical Education in Europe (AMEE) Conference, and Asia Pacific Medical Education Conference (APMEC) published between April 2012 and March 2017.

Results: A total of 1399 JSME conference abstracts and 193 AMEE conference and APMEC conference abstracts were published. From a total of 382 abstracts, 37 abstracts (10%) presented at the JSME 2014 conference were published as full papers. From a total of 39 abstracts, four (10%) abstracts presented at the AMEE Conference 2014 and APMEC 2014 from Japan were published, respectively. Exploratory analysis showed that the characteristics of abstracts were not related significantly with subsequent publication. Of the original articles, 0.46% (31/6727) from Japan were presented in 7 international medical education journals.

Conclusion: We found a low subsequent publication rate for Japanese conference abstracts and low representativeness in medical education journals. Further investigation to improve the number of publications is required.

Keywords:            Medical Education Research, Postgraduate Education, Continuous Medical Education

The University of the East-Ramon Magsaysay Memorial Medical Center, Inc. medical students’ perception of the objective structured examination in pharmacology as an assessment tool

Chiara Marie Miranda Dimla, Maria Paz S. Garcia, Maria Petrina S. Zotomayor, Alfaretta Luisa T. Reyes, Ma. Angeles G. Marbella & Carolynn Pia Jerez-Bagain

Department of Pharmacology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center, Inc., Philippines

Abstract

The teaching of pharmacology prepares the medical sophomore to prescribe drugs on a rational basis. In small group discussions (SGDs), the evaluation of individual competence poses a challenge. Hence, the Objective Structured Examination in Pharmacology (OSEP) was initiated, to provide an additional, objective means of assessing individual performance. The OSEP is an oral, time-bound, one-on-one examination given at the end of the course, designed with a rubric for scoring. The aim of this study was to determine the students’ perceptions of the OSEP as an assessment tool. A survey was conducted on all pharmacology students of School Year 2016-17 as a post-activity evaluation for curricular improvement. After the approval of the institutional ethics review board was obtained, the data was collected retrospectively. The responses of participants who gave their informed consent were included in the study. The students’ perceptions were based on the level of agreement to sixteen statements, using a Likert Scale. The median score for each statement and the proportion with positive perception were computed. The positive perception was operationally defined based on a pre-determined median score. A total of 414 students participated in the study. The mean response rate was 99% and the median score for all statements revealed that 88%, 93% and 94% have a positive perception of the effectiveness, content and conduct of the OSEP, respectively. In conclusion, the medical students perceived the OSEP as an effective assessment tool that can provide an additional, objective means of evaluating individual performance in the course.

Keywords:            Assessment Tool, Rubric, Rational Use of Medicines, Objective Structured Examination, Pharmacology, Oral Examination, Outcome-based Education, Small Group Discussion, Biomedical Science, Medical Education

Evaluation of a developmental paediatrics teaching programme for medical students

Yeleswarapu S. Padmini, Pratibha K. Agarwal & Lourdes M. Daniel

Department of Child Development, KK Women’s and Children’s Hospital (KKH), Singapore

Abstract

Introduction: The aim of the study was to evaluate the efficacy of the developmental paediatrics teaching programme for undergraduate medical students posted to the Department of Child Development (DCD), in a tertiary children’s hospital in Singapore.

Methods: Efficacy of the teaching program was evaluated objectively using multiple-choice questions (MCQs) and subjectively using a self-assessment evaluation form developed in-house. Feedback was obtained from the students and tutors at the end of the posting.

Results: 36 students participated in this evaluation. There was a significant positive difference in the pre and end of posting MCQ scores (p < 0.001). The difference in the students’ self-assessment of their knowledge and skills of child development before and at the end of their DCD posting was similarly positively significant (p < 0.001). Feedback from the students using a series of open-ended questions indicated that they had a very positive learning experience and this included learning beyond their stated learning objectives. Feedback from the tutors was reflective of some of the challenges they faced while teaching.

Conclusion: The integrated approach to teaching developmental paediatrics that includes didactic, reflective, interactive and problem-based learning results in a highly positive learning experience and enhances both the knowledge and skills in child development. This enables delivery of a holistic curriculum that goes beyond teaching mainly routine developmental assessment.

Keywords:            Developmental Assessment, Developmental Paediatrics, Problem-based learning, Didactic Teaching, Medical Students

Learning perceptions of medical students engaged in clinical teaching postings in neonatal intensive care units

Stefan Kutzsche1 & Erwin Jiayuan Khoo2

1Centre for Education, International Medical University, Malaysia; 2Clinical School, International Medical University, Malaysia

Abstract

We are reporting the results of implementing Learning from Observation and Discussions at Clinical Campus International Medical University, Kuala Lumpur, Neonatal Intensive Care Unit (NICU). This initiative was conceived and successfully implemented with the aim to identify medical students’ learning perception from self-reported learning experiences. A total of 80 semester eight medical students were invited to participate in the study. A structured, validated and reliable instrument developed from a work skill development framework was used to assess students’ perception of learning through discussions and observations (Total D&O), input from their experience providing future ideas (Total Ideas) and guided ward rounds as a new learning format (Total Visit). Informed consent was obtained from 42 students who participated over the ten-month period of the study. Data was analysed with ANOVA and structural regression equation modelling. The study showed that both Total Visit and Total Discussion & Observation can predict Total Perception of Learning. According to student evaluations, the Total Visits rating was the best single predictor summarising positive perception of rounds at the neonatal intensive care unit based on the significance values, partial eta squared and power. Students ranked the process of guided rounds at the neonatal intensive care unit as valuable in providing educational experiences and integral to their learning perception.

Keywords:            Perception of Learning, Bedside Teaching, Clinical Neonatology, Observational Learning

Medical education in Lao People’s Democratic Republic: The challenges students face in accessing learning resources

Annie L. Kilpatrick1,2, Ketsomsouk Bouphavanh3, Sourideth Sengchanh3, Vannyda Namvongsa3 & Amy Z. Gray1,2

1Centre for International Child Health, Department of Paediatrics, University of Melbourne, Australia; 2The Royal Children’s Hospital, Australia; 3Education Development Centre, Faculty of Medicine, University of Health Sciences, Lao People’s Democratic Republic

Abstract

Aim: To understand the needs and preferences of students at the University of Health Sciences (UHS) in Vientiane, Lao People’s Democratic Republic (PDR) in relation to access to educational materials in order to develop a strategy for development of educational resources for students at UHS.

Methods: We conducted a cross-sectional semi-structured survey of 507 students, staff and post-graduate residents from a range of faculties at UHS regarding current learning resources, access to educational aids and online learning. Focus groups of survey participants were conducted for in-depth understanding of desired materials and challenges faced.

Results: There was an overwhelming request by students for greater access to learning resources. The main areas of difficulty include English language capacity, limited local language resources alongside poor internet access and limited competence in navigating its use. Students would prefer learning resources in their own language (Lao); many potential study hours are being consumed by students searching for and translating resources.

Conclusions: Students in Lao PDR describe multiple barriers in accessing appropriate resources for their learning. Scoping current access and needs through this research has enabled us to better plan investment of limited resources for educational material development in Lao PDR, as well as highlight issues which may be applicable to other low resource setting countries.

Keywords:            Medical Education, Student Preferences, University, Learning Resources, Low Resource Setting

Short Communications

Harnessing mobile technology to develop a sustainable on the go learning resource for junior doctors

Zhun Wei Mok, Jill Cheng Sim Lee & Manisha Mathur

Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore

Abstract

Introduction: At KK Women’s and Children’s Hospital’s (KKWCH) Department of Obstetrics and Gynaecology (O&G), a junior doctor’s handbook exists to guide safe practice. A challenge remains in ensuring relevant, current, and readily accessible content. The onus of re-editing is left to senior clinicians with heavy clinical and supervisory roles, leading to a lack of sustainability. Mobile applications (apps) can be a sustainable ‘just-in-time’ learning resource for junior doctors as they balance new responsibilities with relative inexperience.

Methods: The app was developed in-house with the Residency’s EduTech Office. A focus group comprising junior doctors identified content deemed useful. The alpha version was launched in August 2017 and trialled amongst the wider junior doctor population. Data on usefulness were collected through serial focus groups and analysed using grounded theory.

Results: An online survey disseminated to all 100 junior doctors showed that 100% owned a smartphone. 97.1% supported this new resource. Consultative discussions recommended inclusion of (i) Procedural and consent information; (ii) Risk calculators; and (iii) Clinical pathways and management algorithms. Mobile learning apps entreat the user to immediately reflect and conceptualise their concrete experiences, and actively experiment with the content to build on his/her current knowledge. Learners become stakeholders in creating their own learning material. Qualitative feedback indicated a continued interest to contribute, underscoring the app’s sustainability potential.

Conclusions: Apps can be a sustainable on the go resource developed by junior doctors, for junior doctors. Learners become stakeholders in creating their own learning material through continued reflection, conceptualisation and active experimentation. This can be scaled for wider clinical use.

Keywords:            Sustainable Mobile Learning, Mobile Applications, On the Go Resource, Junior Doctors, Obstetrics and Gynaecology

Residents’ expectations and perceptions of clinical teaching activities in National Dental Centre Singapore

Marianne Meng Ann Ong1 & Sandy Cook2

1Department of Restorative Dentistry, National Dental Centre, Singapore; 2Academic Medicine Education Institute, Duke-NUS Medical School, Singapore

Abstract

Aim: To describe residents’ expectations of faculty using the One-Minute Preceptor (OMP) in microskills and their ratings of faculty performing them during clinical sessions.

Methods: Prior to the start of residency, residents were invited to participate in a survey on residents’ expectations of faculty performing the OMP microskills in clinical teaching activities using a 4-point Likert scale. At the end of Year 1, they rated faculty on their use of the OMP microskills using a 4-point Likert scale using a second survey.

Results: Sixteen Year 1 residents completed the first survey and 15 residents completed the second survey. Prior to residency, correcting mistakes with feedback was the highest rated microskill (3.78) and obtaining a commitment was the lowest rated (3.15). At the end of Year 1, residents rated faculty performing getting a commitment as the highest (3.63) and giving feedback the lowest (3.17).

Conclusion: In this small cohort of residents, expectations were high around the OMP microskills. Residents felt faculty performed them well in their first year of residency. However, residents view of the importance of the five OMP microskills by faculty differed from their perception of how well the faculty demonstrated them. Future studies could explore if residents’ perceptions of importance changed over time or were related to their view on the quality of performance by faculty. Faculty will be further encouraged to employ the five OMP microskills to maximise their teaching moments with residents managing patients in busy outpatient clinics in National Dental Centre Singapore.

Keywords:            Learner Perception, Expectation, Evaluation, Clinical Teaching

Case Study

Our journey through the Medical Grand Challenge 2017

Wenqi Chiew1, Zi Qiang Glen Liau2, Wen Guang Benson Ang1, Jolyn Moh3 & Wilson Wang1,2

1Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Department of Orthopaedic Surgery, National University Hospital, Singapore; 3NUS Business School, National University of Singapore, Singapore

I. INTRODUCTION

Medical Grand Challenge (MGC) 2017 was the inaugural student-led medical innovation competition hosted by the Yong Loo Lin School of Medicine (YLLSOM) in National University of Singapore (NUS) which provided a platform for students from different faculties to come together to brainstorm for innovative solutions to real healthcare problems.

Personal View

Research in Anaesthesia – The PEGASUS Journey

Sophia Tsong Huey Chew1,2,3 & Lian Kah Ti2,4,5

1Department of Anaesthesiology, Singapore General Hospital, Singapore; 2Yong Loo Lin School of Medicine, National University of Singapore; 3Duke-NUS Graduate Medical School, Singapore; 4Department of Anaesthesia, National University Hospital, 5National University Health System, Singapore

I. INTRODUCTION

We never quite know how a scientific journey pans out, or any journey for that matter. What started for us as a scientific quest to better understand local clinical data and practice in cardiac surgery is yielding answers of value locally and beyond. But the high hanging (and greater) fruit that is already coming of age is the formation of a growing community of younger researchers who not only share success with us in publication, but beyond this are actively expanding the research community through their own networks in research and mentorship.

Caribbean offshore medical schools – Accreditation and financial challenges

Pathiyil Ravi Shankar

Department of Medical Education, American International Medical University, Saint Lucia

I. INTRODUCTION

A. Why This is an Issue of Global Importance

Offshore Caribbean medical schools (OCMS) were first established in the late 1970s. In 2013 more than three-quarters of the United States (US) International Medical Graduates (IMGs) graduated from OCMS (Eckhert & van Zanten, 2015). Many also admit students from Asia (predominantly from South Asia) with many graduates returning home to practice medicine (Morgan, 2017). Students from the Middle East and West Africa, especially Nigeria and Ghana are also admitted. There has been no published study on these proportions but at the medical school where the author works over 70% of students are from South Asia and over 15% from Nigeria. The proportion at other medical schools varies and a comprehensive study may be required.

Letter to Editor

Response to: The Ownership Cycle and self-regulated learning

Ching-Hui Sia

Department of Cardiology, National University Heart Centre Singapore, Singapore

Abstract

Dear Editor,

I read with great interest the case study on “The Ownership Cycle and self-regulated learning” published by Jian Yi Soh in The Asia-Pacific Scholar (Soh, 2019) and congratulate the author for the development of this framework. The author describes how the teacher may encounter 2 different types of learners in the educational setting and how the ownership cycle may play a role in explaining difficult teaching encounters. He also proposes a 6-step intervention on how to help learners with difficulty.

The Author’s reply: The Ownership Cycle and self-regulated learning

Soh Jian Yi

Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore

Synopsis

Dear Sir/Madam,

Thank you for pointing out the similarities between the two Cycles and Professor Carol Dweck’s studies on Mindsets.

Professor Dweck’s mindsets are, in fact, part of the two Cycles. I agree with the need to provide more practical examples – the limitation here being the number of words I could pen in a journal article, plus the existence of the 200-page book of the same name, that does illustrate the exact examples you have asked for.