"The patient as teacher" - thematic analysis of undergraduate medical students' experiences with an experiential learning project in palliative care.

BACKGROUND: Experiential learning holds high potential for medical students' education in palliative care. At RWTH Aachen University in Germany, medical students can participate in the course "The Patient as Teacher" offering a one-to-one exchange with a terminally ill patient over a period of several weeks complemented with four supervision sessions and writing of a reflective essay. The course had run from 2005 to 2020 before it was paused due to the Covid-19 pandemic. This study aimed to assess the course's value as a palliative care teaching tool by investigating students' motivation and experiences over the years 2005-2020. METHODS: A stratified sample of 24 essays was taken from all submitted essays (n = 78), eight essays from the years 2005-2009, 2010-2014, and 2015-2020. Subsequently, a thematic analysis of the selected essays was conducted. RESULTS: The students felt motivated by the opportunity to gain more experience in palliative care, to improve their communication skills and to decrease insecurities in interaction with terminally ill patients. They learned about the patient's biography and medical history, and encountered physical, psychological, social, and spiritual dimensions of living with a life-limiting disease. Moreover, they experienced relationship building and communication with a terminally ill patient outside their role as future doctors. Ultimately, they considered their participation as a beneficial experience on both a personal and professional level. CONCLUSIONS: The course "The Patient as Teacher" presents a valuable tool for experiential learning in palliative care, which has elicited an unceasingly positive response among the students who participated over the years. It has facilitated medical students in overcoming insecurities in dealing with terminally ill patients and supported them in further developing their professional identity.

Impostor phenomenon and its association with resilience in medical education - a questionnaire study among Swedish medical students.

BACKGROUND: Concern over medical students' well-being is a global issue, with studies showing high psychological distress rates. Impostor Phenomenon (IP), i.e., underestimating one's abilities, attributing success to external factors, and feeling like a fraud, has been implicated as one reason behind these troubling findings. Meanwhile, resilience has been suggested to protect against psychological distress. This study aimed to investigate the prevalence of IP and its association with resilience among undergraduate medical students. METHODS: The Clance Impostor Phenomenon Scale (CIPS), the Brief Resilience Scale (BRS), and sociodemographic questions were completed by 457 medical students registered in their 2-10th semester at a Swedish university. Of the respondents, 62.6% identified as women, 36.1% as men, and 1.3% as others. RESULTS: The prevalence of IP was 58.4% (defined as CIPS score ≥ 62). According to the CIPS scoring guidelines, 10.3% of participants had low IP, 29.5% moderate, 41.6% frequent, and 18.6% intense IP. Of all participants, almost 90% experienced at least moderate and 60.2% frequent to intense IP. Women had significantly higher CIPS scores and lower BRS scores than men. In contrast, neither attending semester nor age group significantly impacted CIPS scores. Finally, there was a moderate inverse correlation between the level of resilience and the prevalence of IP. CONCLUSIONS: Our findings suggest that the majority of Swedish medical students feels like an impostor, and of these students, most do so frequently. Furthermore, IP is more prevalent among female students - who also show lower levels of resilience. Moreover, our results indicated that IP could hinder achieving higher resilience. Future longitudinal studies should investigate how gender norms may contribute to IP feelings and explore the potential advantages of counteracting IP and strengthening resilience among medical students. However, targeted interventions addressing individual students' IP and resilience are insufficient. There is also a need to address structural aspects of the educational environment, such as gender stereotypes, that may contribute to IP.

Satisfaction of lecturers and undergraduate students of medical faculties in Indonesia towards online anatomy learning during COVID-19 pandemic.

The changing of education activities (offline into online) to reduce coronavirus transmission during COVID-19 pandemi has influence on the learning strategies, which ultimately might impact the achievement of learning objectives. Therefore, we conducted a cross-sectional study using a valid (p < 0.01; two-tailed Pearson correlation) and reliable (r = 0.878 and r = 0.849; Cronbach Alpha) online questionnaire to evaluate the perspectives of human anatomy lecturers and undergraduate medical students in Indonesia in implementing the online anatomy learning. We also explored their expectations and preferred learning methods after COVID-19 pandemic. Using purposive sampling, 467 respondents, which consisted of 66 lecturers from 41 universities in six islands (Java, Sumatera, Kalimantan, Sulawesi, Nusa Tenggara and Papua) and 401 students from 19 universities in four islands (Java, Sumatera, Kalimantan, Papua) were recruited. A Chi-square test was used to analyze the differences in categorical variables. The lecturers (74.2%) and students (63.1%) agreed that online learning effectively delivered the course material (p = 0.095). They (69.7% lecturers and 57.9% students) also agreed that learning time allocation was sufficient (p = 0.079); moreover, lecturers (53%) and students (56.1%) had good interaction (p = 0.689). Nevertheless, 56.1% lecturers and 63.3% students had problem during online practical sessions. They had different perspectives about issues during online classes (69.7% vs 36.4%; p < 0.01), motivation improvement (72.7% vs 37.4%; p < 0.01), and time management (87.9% vs 58.4%; p < 0.01). According to the location of the university, especially in the student's side, students in Java had higher proportion in the two aspects, i.e. learning material (p < 0.01) and lecturer-student interaction (p < 0.01), and had lower proportion in the problems during online class (p = 0.003) and practical sessions (p = 0.008). Majority of the respondents (62,2% lecturers in Java, 71.4% lecturers outside Java, 79.6% Students in Java, and 76.6% students outside Java) preferred the use of blended learning after the pandemic (new normal era) and expected to continue the cadaveric practical sessions (82.2% lecturers in Java, 81.0% lecturers outside Java, 91.1% students in Java, and 78.3% students outside Java). In conclusion, the study showed that the satisfaction toward online anatomy learning related to the subject's role (lecturer or student) and the university region in some aspects.

Interprofessional collaboration skills and motivation one year after an interprofessional educational intervention for undergraduate medical and nursing students.

BACKGROUND: The increasingly complex patient care in the twenty-first century is delivered by interprofessional health care teams. Interprofessional collaboration can be taught during interprofessional education. However, whether a long-term change in collaborative competencies can be achieved by interprofessional education has not been studied sufficiently. Our research questions were: How does motivation for interprofessional collaboration and interprofessional collaborative skills change up to one year after an interprofessional educational intervention? How are they related to each other? METHODS: During a one-year period, undergraduate medical and nursing students attended four interprofessional (intervention) or uniprofessional (control group) education sessions. Self-determination Theory was used as the theoretical framework. Autonomous and controlled motivation scores for interprofessional collaboration were calculated using the Academic Self-Regulation Questionnaire, before (T1), directly after (T2) and one year post-intervention (T3). At T3, the students also filled out the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), which measured the perceived attainment of collaborative competencies by a retrospective pre-test/post-test design. We used linear mixed effects models to analyse the motivation scores and linear regression for the relation between motivation and competence. RESULTS: In the interprofessional group, autonomous motivation scores of the participants were significantly lower at T2 vs. T1. Controlled motivation scores were significantly higher at T3 vs. T1. Controlled motivation scores for T2 were significantly higher in the uniprofessional group than in the interprofessional group. Perceived competence was related to higher autonomous motivation scores. At T3 the interprofessional collaborative competencies seemed to have grown more among students in the interprofessional group. CONCLUSIONS: The perceived growth in interprofessional collaboration competence lasted at least up to one year after the intervention, and was measurable with the ICCAS. The growth was significantly more in the IPE students than in the UPE students. The few differences found in motivation scores for interprofessional collaboration were probably caused by an imbalance of nursing versus medical students over the different time points. This finding indicates that classroom based IPE can contribute to interprofessional collaboration skills of nursing and medical students at least up to one year after an intervention.

Ripple effects of COVID-19 lockdown pertaining to clinical skills among undergraduate medical students of Karachi.

OBJECTIVE: To determine the outcomes of coronavirus disease-2019 lockdown pertaining to clinical skills among undergraduate medical students. METHODS: The cross-sectional questionnaire-based study was conducted after approval from the Jinnah Sindh Medical University, Karachi, at 6 public and private medical education institutions in Karachi from July 3 to August 3, 2021, and comprised undergraduate students from the 3rd, 4th and final academic years. Data was collected using a pre-designed questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 383 subjects, 260(67.9%) were females and 123(32.1%) were males. The overall age range was 20-25 years. There were 145(37.9%) students from the 3rd year, 154(40.2%) from 4th and 84(21.9%) from the final year. Among them, 251(84.2%) accepted having decreased efficiency in clinical skills because they were not being able to train in person, 157(41%) claimed that certain topics related to clinical study were given in exams even though they were not taught, and 164(72.6%) faced difficulty in exams related to clinical skills. CONCLUSIONS: Coronavirus disease-2019 caused disruption in routine life, and medical education was not an exception. E-learning modality was found to be insufficient, and patient exposure elevates confidence, eliminates hesitation, and improves clinical skills.

Assessment of sleep knowledge among medical and dental students in a Nigerian tertiary institution: a cross-sectional study.

PURPOSE: Sleep medicine is a rapidly growing field of Medicine globally. However, studies are lacking on the knowledge of Nigerian medical and dental students on sleep and the different types of sleep disorders. Thus, we assessed the knowledge, interest and awareness of Nigerian medical and dental students about sleep medicine. We also determined the factors associated with sleep knowledge among the medical and dental students. METHODS: We conducted this cross-sectional study from June to September 2021, among medical students at the Obafemi Awolowo University, Ile-Ife, Nigeria. The students' knowledge of sleep was assessed with the Assessment of Sleep Knowledge in Medical Education (ASKME) survey. The participants were classified as having low or high scores based on the proportion who gave a correct answer to 60% of the questions. RESULTS: Among the 488 students who completed the questionnaire, there was a male preponderance (55%). About three-quarters of the respondents (376, 77%) had a low sleep knowledge score. Age, year of study, and awareness about sleep medicine were the predictors of sleep knowledge. CONCLUSION: A significant proportion of the medical students had poor sleep knowledge scores. There is a need to incorporate teaching sleep medicine in the curriculum of medical students early in their training.

Flipped classroom for undergraduate medical students in India: are we ready for it?

The teaching-learning environment has undergone a paradigm shift with the recent implementation of a Competency-Based Medical Curriculum in India. Despite this, the concept of flipped classrooms for medical students is still in its infancy in our country. We conducted an experimental randomized crossover study to find if a flipped teaching model improves learning for first-year medical undergraduate students. Students' perceptions of this novel method were also obtained and analyzed. In the first period (first part of the study), one group of students underwent the flipped model teaching (flipped teaching group), and the second group (traditional teaching group) was taught by the conventional method. A crossover was done with a second topic in the second period. A written test was conducted at the end of each period. Student feedback was also obtained. There was no statistically significant difference in students' performance on comparing traditional and flipped teaching methods. Reasons for this could be the level of the learner, prior exposure to active learning strategies, learner readiness/motivation for active learning, and timing of the study. Out of the participants, 80% of students preferred the flipped model classroom teaching, especially the interactive discussion, and expressed their desire for more frequent similar learning activities. We conclude that there was no difference in marks obtained by students in the two groups, yet they preferred the flipped classroom method, which indicates that it is feasible to adopt this method in the Indian medical undergraduate classroom.NEW & NOTEWORTHY We conducted a study to find if flipped teaching model improves the learning of medical undergraduate students and assess students' perceptions. There was no difference in marks obtained by students taught with either flipped or traditional methods. The reasons for this could be differences in the level of learner, prior exposure, or learner readiness for active learning. Since students prefer the flipped method of classroom teaching, it is feasible to adopt it in the Indian classroom.

The impact of an integrated PBL curriculum on clinical thinking in undergraduate medical students prior to clinical practice.

BACKGROUND: Problem-based learning (PBL) is a widely adopted educational approach in medical education that aims to promote critical thinking and problem-solving in authentic learning situations. However, the impact of PBL educational mode on undergraduate medical students' clinical thinking ability has been limitedly investigated. This study aimed to assess the influence of an integrated PBL curriculum on clinical thinking ability of medical students prior to clinical practice. METHODS: Two hundred and sixty-seven third-year undergraduate medical students at Nantong University were recruited in this study and were independently assigned to either the PBL or control group. The Chinese version of the Clinical Thinking Ability Evaluation Scale was used to assess clinical thinking ability, and the students' performance in the PBL tutorials was assessed by tutors. All participants in both groups were required to complete the pre-test and post-test questionnaires to self-report their clinical thinking ability. A paired sample t-test, independent sample t-test and one-way analysis of variance test (ANOVA) were used to compare the difference in clinical thinking scores among different groups. Multiple linear regression was conducted to analyze the influencing factors correlated with clinical thinking ability. RESULTS: The clinical thinking ability of most third-year undergraduate medical students at Nantong University was at a high level. The PBL group had a higher proportion of students with high-level clinical thinking ability in the post-test compared to the control group. The pre-test scores of clinical thinking ability were similar between the PBL and control groups, but the post-test scores of clinical thinking ability in the PBL group were significantly higher than those in the control group. Additionally, there was a significant difference in clinical thinking ability between the pre-test and post-test in the PBL group. The post-test scores of sub-scales of critical thinking ability were significantly higher than the pre-test in the PBL group. Furthermore, the frequency of reading literature, time of PBL self-directed learning, and PBL performance score ranking were influencing factors on the clinical thinking ability of medical students in the PBL group. Moreover, there was a positive correlation between clinical thinking ability and the frequency of reading literature, as well as the scores of the PBL performance. CONCLUSIONS: The integrated PBL curriculum model has an active impact on improving undergraduate medical students' clinical thinking ability. This improvement in clinical thinking ability may be correlated with the frequency of reading literature, as well as the performance of the PBL curriculum.

Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review.

BACKGROUND: Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022. METHODS: Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations). RESULTS: Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect. CONCLUSIONS: Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure.

BACKGROUND: The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students' perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM). METHODS: 76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion. RESULTS: 38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥ 4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤ 3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1-3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥ 4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p = 0.008), preparedness for student entry (p = 0.003), and overarching dimension of social participation (p = 0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p = 0.000 and p = 0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p = 0.000). DISCUSSION: The students' CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.

What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study.

BACKGROUND: The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient's first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools. METHODS: A qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4-6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software. RESULTS: Four themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient's first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC. CONCLUSIONS: Medical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.

Deconstructing forearm casting task by videos with step-by-step simulation teaching improved performance of medical students: is making working student's memory work better similar to a process of artificial intelligence or just an improvement of the prefrontal cortex homunculus?

PURPOSE: To compare two teaching methods of a forearm cast in medical students through simulation, the traditional method (Trad) based on a continuous demonstration of the procedure and the task deconstruction method (Decon) with the procedure fragmenting into its constituent parts using videos. METHODS: During simulation training of the below elbow casting technique, 64 medical students were randomized in two groups. Trad group demonstrated the entire procedure without pausing. Decon group received step-wise teaching with educational videos emphasizing key components of the procedure. Direct and video evaluations were performed immediately after training (day 0) and at six months. Performance in casting was assessed using a 25-item checklist, a seven item global rating scale (GRS Performance), and a one item GRS (GRS Final Product). RESULTS: Fifty-two students (Trad n = 24; Decon n = 28) underwent both day zero and six month assessments. At day zero, the Decon group showed higher performance via video evaluation for OSATS (p = 0.035); GRS performance (p < 0.001); GRS final product (p < 0.001), and for GRS performance (p < 0.001) and GRS final product (p = 0.011) via direct evaluation. After six months, performance was decreased in both groups with ultimately no difference in performance between groups via both direct and video evaluation. Having done a rotation in orthopaedic surgery was the only independent factor associated to higher performance. CONCLUSIONS: The modified video-based version simulation led to a higher performance than the traditional method immediately after the course and could be the preferred method for teaching complex skills.

Undergraduate Medical Students' Perceptions of Nutrition Education at the Northern Ontario School of Medicine.

The objective of this evaluation was to determine Northern Ontario School of Medicine (NOSM) undergraduate medical education (UME) students' perceptions of the curriculum related to their nutrition knowledge, attitudes, and counseling self-efficacy/confidence. A 16-item electronic survey (Qualtrics©) was developed, and it included nutrition competency statements, adult and pediatric nutrition assessment and counseling confidence, and nutrition curriculum satisfaction. Students in Years 2, 3, and 4 (n = 192, 66%-73% female) were invited to answer the survey. Of the 61 respondents, 50.8% were Year 2, 34.9% Year 3, and 10.6% Year 4. Overall, 72.1% of the respondents were dissatisfied. Respondents perceived they were least competent in strategies to prevent and treat disease (72.1%), in applying basic dietary strategies (65.6%), and in ethics and nutrition management (62.3%), whereas 52.5% felt competent in the team approach to nutrition care. Respondents reported lowest confidence (less than 10%-15%) in specialized nutrition support, cancer care, renal nutrition, and mental health/eating disorders for both populations. NOSM medical learners reported curriculum dissatisfaction, nutrition incompetence, and poor levels of perceived confidence in nutrition management. Results will be used to inform nutrition curriculum enhancements and future outcome evaluations. Current and future physicians with enhanced nutrition knowledge, awareness of the Registered Dietitian (RD) roles, and an understanding of when to refer patients to an RD can provide better patient-centred care.

Designing a Massive Open Online Course (MOOC) in face-to-face sessions. A blended design to teach practical histology.

Teaching histology, through virtual microscopy in educational strategies, undeniably moved towards the digitization and distancing of teaching. The setting up of the Massive Open Online Course (MOOC) entitled "Introduction to Histology: exploring the tissues of the human body" made it possible to exploit the potential to share digital resources with a wider audience while being integrated into the teaching on-campus students. This article described the pedagogical choices prevailing during the design of the MOOC and its combination with face-to-face sessions to achieve specific learning outcomes. The pedagogical alignment of learning outcomes described according to their cognitive levels, with online and face-to-face learning activities and evaluation methods has been demonstrated. The impact of such a blended design into an academic program has been ascertained using perception and performance data. Student satisfaction and engagement as well as motivational cues were identified. The level of performance was maintained in the educational strategy implemented and made it possible to achieve the objectives expected by the teachers. The benefits of integrating a MOOC with classroom-based teaching were highlighted, as well as barriers that could hinder the successful implementation.

A cross-sectional study on anxiety due to COVID-19 and its predictors among undergraduate medical students in a tertiary care teaching hospital of Kolkata, West Bengal.

Background: Medical education is recognized as stressful globally. COVID-19 pandemic is an additional source of anxiety to the medical students. Objectives: This study was conducted to assess the prevalence and to identify the factors associated with anxiety due to COVID-19 among undergraduate medical students in a teaching hospital of Kolkata, West Bengal. . Methods: An observational cross-sectional study was conducted among 363 undergraduate medical students using the stratified random sampling of a medical college from June to July 2021. Data were collected using a predesigned, pretested, and structured online questionnaire, including "Coronavirus Anxiety Scale." Descriptive statistics were used to estimate the prevalence of anxiety. Pearson's Chi-square test was performed to find out the factors associated with anxiety due to COVID-19. Results: About 25.6% of the medical students were found to have anxiety due to COVID-19. About 28.9% of them reported COVID-19 infection in family in recent past and 11.0% had themselves tested positive. Nearly 20% reported loss of family members, relatives, and close friends due to COVID-19. The factors associated with anxiety due to pandemic were socioeconomic status, social stigma, sleep disturbances, history of COVID-19 in family, loss of job. and vaccination status of family members missing practical classes and exam-related anxiety. Conclusion: The study found that one-fourth of the medical students had anxiety due to COVID-19. Social stigma due to COVID-19 and loss of job of parents were the most significant predictors. It is recommended that targeted psychological and clinical interventions need to be taken to alleviate students' anxiety due to COVID.

Statistics for undergraduate medical students in Sudan: associated factors for using statistical analysis software and attitude toward statistics among undergraduate medical students in Sudan.

INTRODUCTION: Statistics helps medical students understand research. Without understanding statistics, students can't choose the proper analysis in their research. We aimed to assess the attitude toward statistics, usage of statical software and associated factors for using statistical analysis software in Sudan. METHOD: A cross-sectional online survey was distributed among undergraduate medical students across ten Sudanese universities. The study aimed to measure their attitude towards statistics using Survey of Attitudes Toward Statistics (SATS-36) scale. RESULTS: In total, 489 students were participated with a mean age of 21.94 ± 1.61 and a slight female preponderance (52%, n = 256). The overall attitude towards statistics was 4.64 ± 0.91. The mean attitude scores for the components of SATS-36 scale was higher for students who were using statistical analysis software demonstrating significant difference in affect (p = 0.002), cognitive competence (p = 0.002), value (p = 0.002), Interest (p = 0.004) and Effort (p = 0.029). Almost half of the students (47%) had attended a biostatistics workshop with only 26% of them reported using statistical analysis software. Of the latter group, 72% (n = 91) used SPSS while 50% (n = 64) used excel. Univariate logistic regression showed students who had previously used an statistical software were more likely to be studying in their sixth year compared with second year (OR: 12.652, CI 95% 4.803- 33.332; p < 0.001), older age (OR: 1.224, CI 95% 1.079- 1.388; p = 0.002), attended a course in research methodology (OR: 3.383, CI 95% 2.120- 5.398; p < 0.001) or biostatistics (OR: 1.886, CI 95% 1.252- 2.841; p = 0.002), initiated or participated in a research project (OR:4.349, CI 95% 2.839 - 6.661;p < 0.001) or published a paper (OR: 8.271, CI 95% 3.542 - 19.312; p < 0.001). CONCLUSIONS: The study showed an average attitude towards statistics among medical students. Being at higher years, participating or publishing research and attending research workshop are associated with the usage of statistical software. Also, few students were using statistical software.

Assessment of the relationship between the educational environment and academic performance of undergraduate medical students of Azad Kashmir.

OBJECTIVE: To assess the relationship between the educational environment and academic performance of undergraduate medical students of Azad Jammu and Kashmir. METHODS: The cross-sectional study was conducted from September 2018 to September 2019 at Poonch Medical College, Rawalakot, Azad Jammu and Kashmir, and comprised undergraduate medical students of either gender from first to fifth year of studies. Data was collected using the Dundee Ready Education Environment Measure questionnaire which was distributed electronically to the students. The percentage of scores achieved in the last professional examination was taken as the academic performance, and it was corelated with the questionnaire's subscale scores. Data was analysed using SPSS 23. RESULTS: Of the 500 students approached, 324(64.8%) returned the questionnaire fully completed; 92(28.4%) males and 232(71.6%) females. The largest group was from the third year of studies 108(33.3%). The mean questionnaire score was 96.31±18.47 and it was not significantly correlated with academic performance (p>0.05). The subdomain mean scores were also not significantly correlated with academic performance (p>0.05). Academic performance was significantly higher among females compared to males (p=0.002). CONCLUSIONS: There was found a huge scope for improvement of the educational environment.

'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills.

BACKGROUND: Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills. METHODS: An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed. RESULTS: Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men. CONCLUSION: Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.

Natural frequency trees improve diagnostic efficiency in Bayesian reasoning.

When physicians are asked to determine the positive predictive value from the a priori probability of a disease and the sensitivity and false positive rate of a medical test (Bayesian reasoning), it often comes to misjudgments with serious consequences. In daily clinical practice, however, it is not only important that doctors receive a tool with which they can correctly judge-the speed of these judgments is also a crucial factor. In this study, we analyzed accuracy and efficiency in medical Bayesian inferences. In an empirical study we varied information format (probabilities vs. natural frequencies) and visualization (text only vs. tree only) for four contexts. 111 medical students participated in this study by working on four Bayesian tasks with common medical problems. The correctness of their answers was coded and the time spent on task was recorded. The median time for a correct Bayesian inference is fastest in the version with a frequency tree (2:55 min) compared to the version with a probability tree (5:47 min) or to the text only versions based on natural frequencies (4:13 min) or probabilities (9:59 min).The score diagnostic efficiency (calculated by: median time divided by percentage of correct inferences) is best in the version with a frequency tree (4:53 min). Frequency trees allow more accurate and faster judgments. Improving correctness and efficiency in Bayesian tasks might help to decrease overdiagnosis in daily clinical practice, which on the one hand cause cost and on the other hand might endanger patients' safety.

Pathways to performance in undergraduate medical students: role of conscientiousness and the perceived educational environment.

This study examined conscientiousness and the perceived educational environment as independent and interactive predictors of medical students' performance within Biggs' theoretical model of learning. Conscientiousness, the perceived educational environment, and learning approaches were assessed at the beginning of the third year in 268 medical students at the University of Geneva, Switzerland. Performance was examined at the end of the third year via a computer-based assessment (CBA) and the Objective Structured Clinical Examination (OSCE). Path analysis was used to test the proposed model, whereby conscientiousness and the perceived educational environment predicted performance directly and indirectly via students' learning approaches. A second model included interaction effects. The proposed model provided the best fit and explained 45% of the variance in CBA performance, and 23% of the variance in OSCE performance. Conscientiousness positively predicted CBA performance directly (ß = 0.19, p < 0.001) and indirectly via a deep learning approach (ß = 0.05, p = 0.012). The perceived educational environment positively predicted CBA performance indirectly only (ß = 0.02, p = 0.011). Neither conscientiousness nor the perceived educational environment predicted OSCE performance. Model 2 had acceptable, but less optimal fit. In this model, there was a significant cross-over interaction effect (ß = 0.16, p < 0.01): conscientiousness positively predicted OSCE performance when perceptions of the educational environment were the most positive, but negatively predicted performance when perceptions were the least positive. The findings suggest that both conscientiousness and perceptions of the educational environment predict CBA performance. Research should further examine interactions between personality traits and the medical school environment to inform strategies aimed at improving OSCE performance.