Global Perspectives

Past, present and future of medical education in Ireland

Colm Bergin1 & Mary Horgan2,3

1School of Medicine Trinity College Dublin, Ireland; 2Royal College of Physicians of Ireland, Ireland; 3School of Medicine, University College Cork, Ireland

Abstract

Medical education and training has evolved over the centuries. Ireland has a long history of leading on aspects of training that remain relevant today, focussing on the apprenticeship model coupled with a robust modern medical education framework. The practice of medicine is changing rapidly driven by expanding knowledge, advances in technology and use of artificial intelligence, demographic shifts and the expectations of patients and society. Medical training and education need to adapt to ensure that our current knowledge and future medical workforce is prepared for modern-day patient-centric practice. Ireland has emerged as a world leader in medical device technology, pharmaceutical research and development and social media technology support which offer the opportunity for the future of medical training. Knowledge, emotional intelligence, critical thinking, compassion, resilience and leadership are key attributes to which we as a profession aspire. There is an opportunity to leverage Ireland’s global position in technology and finance to train our modern-day medical workforce whilst retaining the attributes of the compassionate practice of the art of medicine. This paper explores the past, present and future of medical education and training in Ireland.

Original Articles

Challenges to student transition through a United Kingdom graduate-entry medicine degree programme

Simon Tso

Department of Dermatology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom

Abstract

Background: The transition experience of graduate-entry medicine degree programme students is less well understood as compared to those from undergraduate-entry medicine degree programmes.

Aim: This thematic analysis study aimed to explore the transition experience of graduate-entry medicine degree programme students at a United Kingdom medical school.

Methods: Twenty-one student volunteers from the University of Warwick 4-year graduate-entry medicine degree programme took part in this study with fourteen participants attended a further follow-up interview. Audio recordings of their semi-structured interviews were transcribed verbatim and analysed thematically.

Results: Results revealed three key transition periods within the University of Warwick Medical School’s graduate-entry medicine degree programme. Learning, professional identity development and managing coping strategies were the three key challenging issues dominating their transition experience. Medical students encountered a range of challenging issues throughout their medical school journey that could be categorised under three conceptual themes: challenges associated with the curriculum, challenges associated with their social role and generic life challenges.

Conclusions: The findings from this study could be useful to educators and medical schools in enhancing their student support services. It could also be useful to prospective and existing medical students in understanding the realities of undertaking a graduate-entry medicine degree programme.

Keywords:        Transition, Graduate-entry, Medical Student, Experience, Challenges, Identity

How psychiatry residents perceive clinical teaching effectiveness with or without direct supervision

Lay Ling Tan & Carmen Jia Wen Kam

Department of Psychological Medicine, Changi General Hospital, Singapore; Clinical Trials and Research Unit, Changi General Hospital, Singapore

Abstract

Aims: Psychiatry residents’ outpatient clinic supervision may be with direct observation of clinical cases (D), without direct observation (WDO) or a mixture of both (M). This study explored residents’ perceptions of clinical teaching effectiveness under these supervision frameworks.

Methods: A survey was conducted amongst residents who completed their third-year training. Cleveland Clinic’s Teaching Effectiveness Instrument (CCTEI) was used to capture their perception of various domains of clinical teaching effectiveness. Content analysis of their qualitative feedback was used to establish the major categories of supervision perception.

Results: 42 out of 60 residents responded. Fewer residents received DO and M compared to WDO. More residents preferred DO. There was no statistical difference in the total CCTEI scores for the three supervision formats. Qualitative content analysis revealed categories surrounding strengths of DO and WDO as well as weaknesses of DO. Although DO allowed timely feedback, addressed patient safety and increased residents’ confidence, it was perceived to be stressful, requiring more resources and inhibited independent learning. WDO was commended for its support of autonomous learning, less anxiety-provoking and contributed to better patient rapport.

Conclusion: There was no statistical difference in clinical teaching effectiveness of the three supervisory frameworks. Previous studies showed DO to be anxiety-provoking with concerns of compromised autonomous learning. This study uncovered similar themes, but residents still preferred DO. It highlighted the residents’ perception of the importance of timely feedback, patient safety and instilling confidence with DO.

Keywords:        Psychiatry, Residents, Supervision, Direct Observation, Ambulatory, Outpatient

Deeper conversations: Palliative care education for pharmacists makes a difference

Andrea Thompson1, Tanisha Jowsey1, Helen Butler1, Augusta Connor2, Emma Griffiths2, Hadley Brown2 & Marcus Henning1

1University of Auckland, New Zealand; 2Mercy Hospice, Auckland, New Zealand

Abstract

Objective: The aim of this study was to identify the impact of a series of palliative care educational packages on pharmacists’ practice for improved service delivery. We asked, what are the educator and learner experiences of a short course comprised of workshops and a series of palliative care learning packages, and how have learners changed their practice as a result of the course?

Method: Semi-structured interviews were conducted and transcribed verbatim. Interpretive thematic analysis was undertaken.

Results: Eight people participated in this study; five pharmacists who had completed learning packages in palliative care and three educators who facilitated teaching sessions for the learning packages. The teaching and assessment approaches were applied and transferable to the clinical setting. The teaching strategies stimulated engagement, enabling participants to share their ideas and personal experiences. Participants’ understanding of palliative care was improved and they developed confidence to engage in deeper conversations with patients and/or their families and carers. Although the completion of assessment for the learning packages enabled credit for continuing professional development, their impact on the long-term practice of pharmacists was not established.

Conclusions: The findings of this study suggest that interactive teaching methods assisted the interviewed pharmacists to further develop their understanding of palliative care, and communication skills for palliative care patients and/or their families/carers. Pharmacists were better equipped and felt more comfortable about having these potentially difficult conversations. We recommend educators to place more emphasis on reflective activities within learning packages to encourage learners to develop more meaning from their experiences.

Keywords:        Palliative Care Education, Pharmacist, Hospice, Interactive Learning, Communication, Learning Packages

Distance education in improving knowledge, attitudes and skills of public health inspectors

Suriyakumar Mahendra Arnold1, Sepali Wickrematilake2, Dinusha Fernando3, Roshan Sampath1, Palitha Karunapema4 & Pasyodun Koralage Buddhika Mahesh5

1Quarantine Unit, Ministry of Health Sri Lanka; 2Regional Director of Health Services Office, Matale, Sri Lanka; 3Regional Director of Health Services Office, Puttalam, Sri Lanka; 4Health Promotion Bureau, Ministry of Health, Sri Lanka; 5Ministry of Health, Sri Lanka

Abstract

Background: The duties of Public Health Inspectors (PHI) includes those related to food legislation. Effective methods are being explored in providing refresher training for them amidst the constraints of resources.

Objective: To assess the knowledge, attitudes and skills of the PHI on food legislation and to evaluate the effectiveness of a Distance Education (DE) programme in improving these.

Methodology: The study included quasi-experimental educational intervention with a pre- and post- assessments. 105and 109 PHI were recruited for the intervention and control groups. Pre and post interventional assessments on the knowledge, attitudes, self-assessed competencies and performance were done with a self-administered questionnaire and observational checklist. Intervention group was exposed to an educational intervention through a distance education programme. Post-assessments were done following four months of the intervention.

Results: The pre interventional knowledge and performance was poor. PHI had unfavorable views. Post intervention mean knowledge and performance scores revealed that a statistically significant improvement (P<0.001) has occurred in the intervention group. Change in the opinions on usefulness of in-service training on food safety to develop knowledge and skills, was statistically significant (P<0.01) in the intervention group.

Conclusion: The DE method used in the present study was feasible to implement and was effective in significantly improving the knowledge and performance of the PHI.

Keywords:        Distance Education, Continuing Education, Public Health Inspector, Food Legislation

Short Communications

Eight tips for inclusion of persons with disabilities as standardised patients

Sok Mui May Lim1,2, Zi An Galvyn Goh2 & Bhing Leet Tan1

1Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore; 2Centre for Learning Environment and Assessment Development (CoLEAD), Singapore Institute of Technology, Singapore

Abstract

The use of standardised patients has become integral in the contemporary healthcare and medical education sector, with ongoing discussion on exploring ways to improve existing standardised patient programs. One potentially untapped group in society that may contribute to such programs are persons with disabilities. Persons with disabilities have journeyed through the healthcare system, from injury to post-rehabilitation, and can provide inputs based on their experiences beyond their conditions. This paper draws on our experiences gained from a two-phase experiential learning research project that involved occupational therapy students learning from persons with disabilities. This paper aims to provide eight highly feasible, systematic tips to involve persons with disabilities as standardised patients for assessments and practical lessons. We highlight the importance of considering persons with disabilities when they are in their role of standardised patients as paid co-workers rather than volunteers or patients. This partnership between persons with disabilities and educators should be viewed as a reciprocally beneficial one whereby the university and the disability community learn from one another.

Keywords:        Standardised Patients, Objective Structured Clinical Examination (OSCE), Persons with Disabilities, Inclusion, Role-play, Script, Practical Lessons

Personal View

“Booster Shots” of Humanism at Bedside Teaching

Chi-Wan Lai

Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

I. INTRODUCTION

Most medical education programmes in Taiwan accept students upon high school graduation. Medical education used to consist of seven years with the last year being an internship. Since 2013, medical students have graduated at the end of six years, and the internship has been moved to a postgraduate year. In both formats, students have been offered medical humanities courses in the “pre-med” phase, i.e. the first two years of medical school. From the third year onward, however, students rarely have exposure to subjects related to humanism, other than courses on medical ethics and some problem-based learning case discussions. Moreover, medical students have had very little exposure to humanities in high school. Such limited exposure to humanities during medical school can have detrimental effects on cultivating humanistic physicians in Taiwan.

Clinician engineers – Re-injecting the thinking into medicine

Neel Sharma1, Mads S. Bergholt2, Rosalia Moreddu3 & Ali K. Yetisen3

1Queen Elizabeth Hospital Birmingham, United Kingdom; 2Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, United Kingdom; 3Department of Chemical Engineering, Imperial College London, United Kingdom

I. INTRODUCTION

Medicine historically relied on astute history and examination skills. As technology was lacking, ward rounds focused on debate and discussion of diagnoses and possible differential diagnoses based on the history and physical examination. The technology movement into healthcare was never truly predicted. With its occurrence, came the ability to scan a patient from top to toe via computed tomography and magnetic resonance imaging. Technology now serves as our main diagnostic tool (Patel, 2013).

Big data in medical education – Are we ready?

Heng-Wai Yuen1,2,3 & Abhilash Balakrishnan2,3,4

1Department of Otolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore; 2Duke-NUS Medical School, Singapore; 3National University of Singapore, Yong Loo Lin School of Medicine, Singapore; 4Department of Otolaryngology, Singapore General Hospital, Singapore

I. INTRODUCTION

Big data (BD) involves aggregating and melding large and heterogeneous datasets, allowing searches and cross-referencing, and deriving insights and meaning from them. It has tremendous potential for application in medical education (ME) where the massive amounts of data that are generated and collected about learners, their learning, and the organisation of their learning can be analysed and interpreted to provide meaning and insights into various aspects of ME. This article briefly introduces BD, potential areas of application, and highlights the pitfalls and challenges surrounding the use of BD in ME (BDME) from the authors’ perspectives.

Case Study

Reflections on an interdisciplinary curriculum and pedagogical approaches in a public health course

Julian Azfar & Rayner Kay Jin Tan

Saw Swee Hock School of Public Health, National University of Singapore, Singapore

I. INTRODUCTION

The notion of interdisciplinary health(care) education is an emerging, though not novel concept (Allen, Penn, & Nora, 2006). The module Social Determinants of Health was introduced in the Saw Swee Hock School of Public Health in 2018. The module covered important foundational concepts in the study of social determinants of health and explored examples of such determinants over 13 weeks. The module adopted an interdisciplinary approach to public health, drawing from biomedical, psychological and sociocultural perspectives informed by both the natural and social science disciplines. Coursework took the form of student-led seminars, opinion editorial (Op-Ed) and reflective essays, and a fieldwork project involving a chosen group in the community. While the adoption of such an interdisciplinary approach, or the use of the chosen pedagogical approaches are not novel, we present our reflections on the implementation of a novel, interdisciplinary course in public health for undergraduates in Singapore who do not have prior knowledge or expertise in the subject area.

Letter to Editor

Organisational Grit Trumps Individual Grit Response to: Grit in healthcare education and practice

Muhammad Raihan Jumat

Office of Education, Duke-NUS Medical School

Abstract

I read with great interest Samarasekera and Gwee’s article in TAPS (January, 2020) entitled: “Grit in healthcare education practice”. The authors cited Duckworth’s seminal studies on grit and its strong correlation with success. The authors suggested that grit be used to select for medical students and for healthcare systems to adopt organisational grit. I applaud the authors’ call for implementing organisational grit in healthcare. This is a step forward in working out the multiple issues plaguing healthcare. Interestingly, the call to implement organisational grit might not make it necessary to select for grit upon medical school admission.