Medical Education during COVID-19: Response at one medical school.

INTRODUCTION: The COVID-19 pandemic has caused a significant toll on healthcare across the globe. The pandemic caused many other consequences, including economic implications and teaching consequences, notably in higher education throughout the world. COVID-19 and the resulting closure of university campuses have had many impacts on Health Professions Education (HPEd), affecting all aspects, including teaching methods, assessment methods, curricula, student-teacher relationships, student selection processes, and student well-being. It has had significant effects on the setting in which students are required to learn more skills such as psychomotor skills. This manuscript aims to investigate the changes implemented in medical education during the pandemic and describe one medical school's response to medical education changes during the pandemic. METHODS: This study was a combination of a case study done by in-depth investigation of the current context at one medical school during the pandemic and action research done by gathering information to change a condition in a particular place. RESULTS: Many changes were implemented in medical education, including online teaching for basic science courses (first two years of the program) and online assessments (video-based remote proctoring) in the program's first two years. Such courses as Clinical Skills are using telemedicine/telehealth concepts in training. There were changes such as video-based remote proctoring of NBME shelf-examinations even in the assessments of clerkships/clinical rotations. CONCLUSIONS: Adaptations of medical education during this pandemic is highly dependent on technology. Most of the changes will be practiced until the campuses are open. We need to understand that these changes were made over this unprecedented period, i.e. the pandemic as an emergency rather than as a normal change process.

Lack of Patient Knowledge Regarding the Adverse Effects of Analgesics With High Doses Leading to Elevation of Creatinine and Major Consequences - A Case Report.

We present a case of a 49-year-old male with complaints of back pain and not being able to urinate. The patient was suffering from back pain for the last four days and followed up with the chiropractor, but the pain persisted. The patient took eight ibuprofen tablets (1600 mg) within those four days to relieve the pain. Lab workup showed a blood urea nitrogen (BUN) of 175 mg/dL, creatinine level of 32.87mg/dL, and an anion gap metabolic acidosis. With close monitoring and dialysis in the hospital, the creatinine came down to 11.92mg/dL. Ultrasound-guided renal biopsy showed that the patient developed acute interstitial nephritis. The patient was treated with prednisone and later discharged with a creatinine level of 8.60mg/dL. Before he was discharged, he was declared to have end-stage renal disease and placed on outpatient dialysis. Only a few case reports are recorded in the literature with such a high elevation of creatinine levels.

The systematic approach to faculty development activities for biomedical educators.

INTRODUCTION: The term continuing professional development encompasses competencies required to practice the high quality medicine, including medical, managerial, ethical, social, and personal skills, whereas continuing medical education refers only to expanding the knowledge and skills required by physicians. The competencies for basic science faculty identified are management and administration, teaching, assessments, curriculum development, and research. This study aimed to evaluate the outcomes of faculty development initiatives at Avalon University School of Medicine and examine the optimal approach to faculty development activities. METHODS: This is a survey-based quantitative study. A cross-sectional survey was conducted after implementing the faculty development activities. We took thirteen basic science faculty members as a unit and recruited them for different faculty development activities from 2015. Faculty members were involved in various faculty development courses, workshops, and training sessions. A survey was conducted among faculty members using a questionnaire on the Likert scale to identify if there are any increased knowledge or skills on teaching and assessment methods, educational scholarship, and scholarly activities after implementing faculty development initiatives. The faculty responses were tabulated and quantified in the Excel sheet and analyzed by SPSS software. RESULTS: All thirteen faculty members responded to the questionnaire (100% response rate). There was an increased self-reported knowledge and skills of faculty members. 70% of the faculty agreed that they are able to get involved in designing their course learning objectives. 100% of the faculty were aware of different teaching methods, and 93% of them were implementing different types of teaching methods, including small group discussions, flipped classrooms, standardized patient-based teaching, and problem-based learning. 100% of the faculty were aware of different assessment methods and implementing them. There were self-reported and observed behavioral changes. CONCLUSIONS: Faculty development activities at Avalon University School of Medicine have shown to be effective. At larger institutions, the department chair can lead the faculty development activities.

Understanding the health risks in basic science medical students: a cross sectional survey.

This article was migrated. The article was marked as recommended. Background Medical students are usually subjected to a high workload environment and stress is one of the most important health risks that medical students encounter. The negative impact of stress on the student's mental and general health in basic science has often been under reported. Methods and Materials A cross-sectional questionnaire survey was performed in Avalon University School of Medicine (AUSOM), Curacao, amongst the first to fourth semester basic science students with an objective to explore and understand their perspectives on different health risks. ResultsMore than ⅔ of the students (79.61%, n=82) were feeling stressed out during their basic sciences. The mean stress level among the basic science students was 7.42 ± 2.13 (scale:1-10). Common health issues encountered by the students were: sleep problems, impaired concentration, low mood, mood swings, difficulty in making decisions, emotional distress, anxiety, substance abuse, and abnormal weight gain. Conclusion Although lack of sleep and behavioral problems are the most common health issues encountered by the pre-clinical medical students. There is an urgent need to implement health promotion strategies in medical curriculum for mental and physical well-being of the students.

Effectiveness of Small Group Discussions for Teaching Specific Pharmacology Concepts.

Small group discussions are used in medical education to reinforce learning and to promote the application of knowledge. Small group discussions can involve a variety of tasks, such as critical thinking, self-directed learning, problem-solving, and brainstorming. The objective of this study is to find out if small group discussions can improve students' learning of specific pharmacology topics and students' performance on assessments. In the present study, small group discussions were utilized for six unique topics in the pharmacology course, and knowledge-based tests were administered before and after small group discussions to examine their efficacy. Statistically significant improvement in knowledge gains was observed for antimicrobials and neuropharmacology topics, but not for anticancer agents. Students' performance in topics that had group discussions was better on summative assessments compared with the overall performance on the summative assessment in the pharmacology (study group; summer 2018). Students' (study group; summer 2018) overall grade on the summative assessment of the pharmacology course was better than overall pharmacology grade on the summative assessment of students who had no group discussions (control group; winter 2018). Students' perceptions of the small group discussions were satisfactory, suggesting group discussions may be an enjoyable way to improve students' performance in some pharmacology topics.

The hybrid model of clinical skills teaching and the learning theories behind it.

INTRODUCTION: There are two popular methods of clinical skills teaching. One is Peyton's method, and the other one is Robert Gagne's method. A hybrid model which is a combination of both teaching methods is developed and implemented at Avalon University School of Medicine in Clinical Skills. The aim of the study was to evaluate the hybrid model of clinical skills teaching. METHODS: This is a quasi-experimental study where a control group with a sample size of 26 was compared with two study groups; one group included 24 participants, and as the other one consisting of 16 subjects selected without randomization. All students in the class were included in the study, except for those withdrew voluntarily. The quantitative data were gathered in the form of a questionnaire on the Likert scale which was collected as the end of course evaluations. The quantitative data for the responses on the Likert scale was analyzed for descriptive statistics: Mean, Median, and Mode. The quantitative data also included the students' performance on assessments of clinical skills which was analyzed using ANOVA test. The qualitative data were gathered in the form of open-ended questions in the end of course evaluations. The qualitative data were also collected from the faculty members who were the examiners for the clinical skills course as the feedback taken from them. RESULTS: There was a significant improvement in the feedback of students (end of course evaluations) after implementing the hybrid model of clinical skills teaching which was shown by increased Mean, Median, Mode for the most pointers on the Likert scale. Also, there was a notable improvement in the performance of students with a significant p-value (p<0.05) on ANOVA test. CONCLUSION: The hybrid model is very effective in teaching clinical skills. This teaching method can be evaluated by replicating this study at larger institutions with more number of students.

Implementation of standardized patient program using local resources in Avalon School of Medicine.

INTRODUCTION: The standardized Patient Program (SPP) is a standard educational training method which provides the pre-clinical students a better clinical foundation by linking the realm of clinical medicine to basic sciences. It incorporates a modern simulation technique and enhances the ability of the students wherein they can practice, apply and learn the basics of patient encounter. The main objective of this study was to analyze the implementation and efficiency of the SPP in Avalon University School of Medicine (AUSOM). METHODS: A quasi-experimental "before-and-after" study design was conducted among the 3rd Semester (MD3) medical students at AUSOM. 24 students voluntarily participated in the study. The effectiveness of the program was evaluated after comparing the summative examination scores before and after implementation of the SPP (graded in 100 points system). Mean scores were calculated and a comparison of the change in scores was made, using a paired t-test in Stata (ÓStata corp). RESULTS: The mean final summative clinical skills examination scores of the students before and after the introduction of the SPP were 78.46 ± 6.62 (SEM: 1.35, range: 89-70) and 86.54±6.41 (SEM: 1.31, range: 98-65), respectively. There was a statistically significant increment (t=5.5058, p=0.0001) in the scores of the students after the introduction of the SPP. CONCLUSION: Introduction and implementation of SPP at AUSOM at preclinical years increased the overall students' performance in clinical skills. It is necessary that medical schools implement SPP early in preclinical years to strengthen learning and inoculate necessary clinical skills in medical students.

Implementation of formative assessment and its effectiveness in undergraduate medical education: an experience at a Caribbean Medical School.

This article was migrated. The article was marked as recommended. BACKGROUND: Two types of assessments used in the medical education are summative and formative assessments. Summative assessments evaluate a student's learning progress and typically provide concrete grades or pass/fail decisions. The main purpose of the formative assessments is to provide the feedback and improve the learning behavior of the students. However, it is less known about the impact of the formative assessments on overall student's performance in summative assessments. This study is intended to study the effects after the implementation of formal formative assessments on students overall performance in summative assessments or any changes in the total grade point average in a Caribbean Medical School which is a low resource context. MATERIALS AND METHODS: A longitudinal cohort study was conducted among the basic sciences students at AUSOM in May 2017. The study was supported by quantitative data, quantitative and qualitative questionnaires to address the objectives of the study. Data collected and analyzed with Stata (Stata 15). RESULTS: 58, among 67 total students took part in the study. The mean grade point average (GPA) with and without formative assessment was 2.83 (SD±.624745) and 2.29 (SD±.76575) respectively. There was a significant improvement in the overall GPA after the introduction of the formative assessments t (58) = 0.000567, p < .001. CONCLUSION: There was a significant improvement in the student's academic performance after the implementation of formative assessments. Formative assessments consolidate the learning and reinforce the learning behavior. It is necessary that formative assessments should be incorporated into the regular assessment system for the optimal educational output.

Students' perceptions on community-based education at Avalon University School of Medicine during the first two years of the program.

This article was migrated. The article was marked as recommended. Objectives The socio-cultural learning theory can be divided into a social and cultural process. Learner's learning occurs within the context rather than anticipating and preparing for the future context. It may happen in the workplace through apprenticeship, experiential learning, or community-based learning. Community-based education and community services have always been part of the students' volunteer services at Avalon University School of Medicine. The importance of community-based education has led to its recent integration into the curriculum. The objective of this study is to observe the community services in the field and to record the perceptions of students regarding community-based education at Avalon University School of Medicine. Methods This is a qualitative study. The research was conducted in the form of an observational study and framework analysis was done. The community-based education and community services were observed and recorded along with individual interviews. Students from different semesters were selected randomly for the interviews. The interviews were audio-recorded and transcribed. Results All interviewed students (100%) reported that they are involved in community services. 53.8% of students were not able to recognize the health issues of Curacao. 84.6% of students recognized and acknowledged the local health issues after reminding them of the activities conducted in the community services. 84.6% of students believed community services enhanced their clinical skills and increased their confidence in communication skills. Conclusion Community-based education enhances the competency of future physicians in clinical and communication skills.

Time, Temperature, and Cationic Dependence of Alkali Activation of Slag: Insights from Fourier Transform Infrared Spectroscopy and Spectral Deconvolution.

The use of waste/by-product materials, such as slag or fly ash, activated using alkaline agents to create binding materials for construction applications (in lieu of portland cement) is on the rise. The influence of activation parameters (SiO2 to Na2O ratio or Ms of the activator, Na2O to slag ratio or n, cation type K+ or Na+) on the process and extent of alkali activation of slag under ambient and elevated temperature curing, evaluated through spectroscopic techniques, is reported in this paper. Fourier transform infrared spectroscopy along with a Fourier self-deconvolution method is used. The major spectral band of interest lies in the wavenumber range of ∼950 cm-1, corresponding to the antisymmetric stretching vibration of Si-O-T (T = Si or Al) bonds. The variation in the spectra with time from 6 h to 28 days is attributed to the incorporation of Al in the gel structure and the enhancement in degree of polymerization of the gel. 29Si nuclear magnetic resonance spectroscopy is used to quantify the Al incorporation with time, which is found to be higher when Na silicate is used as the activator. The Si-O-T bond wavenumbers are also generally lower for the Na silicate activated systems.

Incidence of new cardiovascular events in patients with and without peripheral arterial disease seen in a vascular surgery clinic.

BACKGROUND: To investigate the incidence of death and of new cardiovascular events at long-term follow-up of patients with and without PAD seen in a vascular surgery clinic. MATERIAL/METHODS: We investigated the incidence of death, new stroke/transient ischemic attack, new myocardial infarction, new coronary revascularization, new carotid endarterectomy, new peripheral arterial disease (PAD) revascularization, or at least one of the above outcomes at long-term follow-up of patients with and without PAD followed in a vascular surgery clinic. RESULTS: At least one of the above outcomes occurred in 259 of 414 patients (63%) with PAD at 33-month follow-up and in 21 of 89 patients (24%) without PAD at 48-month follow-up (p<0.0001). Death occurred in 112 of 414 patients (27%) with PAD and in 10 of 89 patients (11%) without PAD (p=0.002). Stepwise Cox regression analysis for the time to at least one of the 6 outcomes showed that significant independent risk factors were men (hazard ratio =1.394; 95% CI, 1.072-1.813; p=0.013), estimated glomerular filtration rate (hazard ratio =0.992; 95% CI, 0.987-0.997; p=0.003), and PAD (hazard ratio =3.520; 95% CI, 2.196-5.641; p<0.0001). Stepwise Cox regression analysis for the time to death showed that significant independent risk factors were age (hazard ratio =1.024; 95% CI, 1.000-1.049; p=0.048), estimated glomerular filtration rate (hazard ratio =0.985; 95% CI, 0.974-0.996; p=0.007), and PAD (hazard ratio =2.157; 95% CI, 1.118-4.160; p=0.022). CONCLUSIONS: Patients with PAD have a significantly higher incidence of cardiovascular outcomes, especially death, new PAD revascularization, and new carotid endarterectomy, than patients without PAD followed in a vascular surgery clinic.