Women in Thoracic Surgery Scholarship: Impact on Career Path and Interest in Cardiothoracic Surgery.

BACKGROUND: Women remain underrepresented in cardiothoracic surgery (CTS). In 2005, Women in Thoracic Surgery (WTS) began offering scholarships to promote engagement of women in CTS careers. This study explores the effect of WTS scholarships on CTS career milestones. METHODS: We assessed career development using the number of awardees matching into CTS residency/fellowship, American Board of Thoracic Surgery (ABTS) certification, and academic CTS appointment. Scholarship awardee data were obtained from our WTS database. Comparison data were gathered from the National Residency Match Program and ABTS. Details of the current roles of ABTS-certified women were determined from public resources. Qualitative results were gathered from post-scholarship surveys. RESULTS: A total of 106 WTS scholarships have been awarded to 38 medical students (36%), 41 general surgery residents (39%), and 27 CTS residents/fellows (25%). Among medical students, 26% of awardees entered integrated CTS residency (vs <0.1% for medical students, P < .001), and 37% entered general surgery residency (vs 4.8% for medical students, P < .001). Of general surgery awardees, 59% entered CTS fellowships (vs 7.7% for general surgery residents, P < .001), and of CTS resident/fellow awardees, 100% earned ABTS certification (vs 73% ABTS pass rate, P = .01). Of ABTS-certified awardees, 44% are practicing cardiothoracic surgeons at US academic training institutions (vs 33% of non-awardee ABTS-certified women, P = .419). All awardees reported that their scholarship was valuable in their development. CONCLUSIONS: Receipt of a WTS scholarship is associated with successful pursuit of CTS career milestones at significantly higher rates than contemporaries. These scholarships foster a supportive community for women trainees in CTS.

Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

An early introduction to surgical skills: Validating a low-cost laparoscopic skill training program purpose built for undergraduate medical education.

BACKGROUND: Medical student exposure to laparoscopy is limited to observation despite the prevalence of minimally invasive techniques in practice. The high cost of laparoscopic simulation equipment, commonly called "box trainers", limits undergraduate exposure to skill training. METHODS: Students at a Midwestern medical school were recruited to participate in an experimental laparoscopic skill training program. One cohort (n = 17) used a DIY box trainer design freely available on MedEdPORTAL. A second cohort (n = 17) used a commercially available equivalent. Pre- and post-training attempts for four tasks were scored and the difference was calculated. The average differences for each cohort were then contrasted statistically. RESULTS: Significant performance improvements (pre- and post-training) were demonstrated regardless of group allocation. The difference in performance between the cohorts was not significant for any task (p > 0.05). CONCLUSIONS: This low-cost training program using DIY box trainers is as effective as commercially available equivalent box trainers for introducing laparoscopic skills to medical students.

An Approach to Economic Evaluation in Undergraduate Anatomy Education.

Medical education research is becoming increasingly concerned with the value (defined as "educational outcomes per dollar spent") of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners.

Modelagem de custeio para mensuração de custos na graduação médica com base em um projeto político-pedagógico de uma instituição pública: estudo metodológico / Cost modeling for cost measurement in medical graduation based on a political-pedagogical project of a public institution: a methodological study

A Constituição da República Federativa do Brasil, de 1988, tem entre seus direitos fundamentais a educação e a saúde, temas sociais que são assegurados às pessoas que se encontram dentro do território nacional. Os tópicos são inseridos no ordenamento jurídico brasileiro através das leis infraconstitucionais, ao longo da sua história. A educação está amparada pelas Diretrizes e Bases da Educação Nacional, que legalizaram o tema em três níveis, entre os quais o nível superior, que se baseia nas Diretrizes Curriculares Nacionais direcionadas às instituições de ensino superior. A promulgação da Lei nº 8.080/1990 criou o Sistema Único de Saúde brasileiro, assegurando a todos o acesso universal e igualitário. A importância dos enunciados requer recursos públicos humanos, materiais, físicos e financeiros na prestação do serviço, alinhados aos elementos básicos necessários ao estudo de custo, o qual se volta para eficiência, eficácia e economicidade, ancorados pelas prerrogativas legais de cunho econômico, financeiro e fiscal. Assim, com a perspectiva de unir os temas educação, saúde e custo, este trabalho teve como questionamento central mensurar o custo da formação em medicina, com base no projeto político-pedagógico de uma instituição de ensino superior. Para responder a essa indagação, a pesquisa objetivou criar uma modelagem de custeio para mensurar o custo da formação acadêmica, através da lógica acadêmica. O trabalho teve características descritivas; qualitativa; de estudo de caso; empírica e dedutiva. A metodologia empregada levantou os instrumentos pedagógicos das escolas públicas federais e algumas estaduais das capitais brasileiras, visando identificar elementos mensuráveis pelo método de custo. Entre os projetos que apresentaram elementos necessários, os dados encontrados no projeto pedagógico da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro foram utilizados no estudo proposto. A modelagem sugerida quantificou o custo da formação médica de forma lógica segundo as características acadêmicas, dentro do Plano de Periodização da instituição. Concluiu-se que é possível mensurar os custos da formação médica com base nos projetos pedagógicos, aglutinando os recursos disponíveis institucionais consumidos na carga horária das disciplinas.

The 1988 Constitution of the Federative Republic of Brazil has among its fundamental rights education and health, social issues that are guaranteed to people within the national territory. The topics are inserted in the Brazilian legal system by infra-constitutional laws throughout its history. Education is supported by the National Education Guidelines and Bases, which legalized the topic at three levels, including the higher level, is based on the National Curriculum Guidelines aimed at higher education institutions. The enactment of Law no. 8.080/1990 created the Brazilian Unified Health System, ensuring universal and equal access to all. The importance of the statements requires public human, material, physical and financial resources in the provision of the service, which are aligned with the basic elements necessary for the cost study, focusing on efficiency, effectiveness, and economy, anchored by legal prerogatives of an economic, financial, and fiscal nature. Thus, with the perspective of uniting the themes of education, health and cost, the central issue of this work is measuring the cost of training in medicine, based on the political-pedagogical project of a higher education institution. To answer this question, the research aimed to create a costing model to measure the cost of academic training, through academic logic. The work had descriptive; qualitative; case study; empirical and deductive characteristics. The methodology used surveyed the pedagogical instruments of federal public schools and some state schools in Brazilian capitals, aiming to identify measurable elements using the cost method. Among the projects that presented necessary elements, the data found in the pedagogical project of the School of Medical Sciences of Rio de Janeiro State University were used in this study. The suggested modeling quantified the cost of medical training in a logical way according to academic characteristics, following the institution's Periodization Plan. It was concluded that it is possible to measure the costs of medical training based on pedagogical projects, bringing together the available institutional resources consumed in the course load.

Lack of pocket money impacts Ethiopian undergraduate health science students learning activities.

BACKGROUND: The cost of university presents various challenges with regards to students' daily learning activities. This is particularly evident in developing countries, where higher education students face acute financial problems that greatly affect their daily educational activities. In Ethiopia, public university students do benefit from governmental cost-sharing programs. Moreover, health sciences students have additional costs during their clinical placements that are above the common expenses for university students. OBJECTIVES: Authors aim to explore the challenges that undergraduate health sciences students in their clinical year face with limited pocket money, as well as how students perceive these limited funds affecting their learning activities and their ability to meet challenges. METHODS: This descriptive qualitative study was conducted at the Department of Medical Radiologic Technology, College of Health Sciences, at Addis Ababa University in Ethiopia. Interviews were conducted between January 28, 2019 and February 1, 2019 with twelve students; and only ten participants were included in the study. The semi-structured questions explored participants' experiences and perceptions regarding the challenges of a lack of pocket money and its impacts on their learning activities. Their reaction to financial challenges was assessed. RESULTS: Four themes that are related to the impact of a lack of money on learning activities emerged from our interviews. First, students believed that their difficulty in obtaining pocket money from family or other funding sources contributed to their financial stress, which negatively impacted their learning. Moreover, their difficulty in affording the basic needs for a student greatly affected their learning abilities in the classroom as well as in their clinical placements. The ability to self-manage was also a significant concern for students, with the pressure to use self-control and proper money management adding to their financial stress. Lastly, students observed that the lack of pocket money affected their ability to make social connections at university, which they saw as negatively impacting their learning abilities. CONCLUSION: Ethiopian undergraduate health sciences students faced many challenges due to the lack of pocket money and these challenges affected student learning both directly or indirectly. Based on our data, we believe that the underlying causes of student financial hardship can be addressed by increasing public awareness of university expenses, clarifying the cost-sharing system to the public, redesigning the cost-sharing policy, and improving university services. Additionally, teaching students self-management skills is also another area that could increase student success.

Delivering medical education for future healthcare needs: a community-focused challenge.

Medical schools are required to train the workforce needed to care for the population they serve. In the UK, we are expected to produce more graduates choosing to be general practitioners and to equip all graduates with the ability to care for an ageing population with increasingly complex care needs. These doctors need to be effective members of multi-professional teams, possessing generalist skills including an understanding of uncertainty and risk. Curricula where a significant proportion of clinical learning is based in general practice are best placed to address this pedagogic need. The authors evaluate the sociocultural factors which impede the expansion of undergraduate medical education in general practice. These include historic cultural divides between secondary and primary care, medical school leadership, funding, contractual arrangements and capacity in general practice to deliver increasing education of medical students alongside other established and emerging health professions. The piece concludes with two recommendations: undergraduate student teaching should be incorporated into contract negotiations and there must be urgent UK-wide investment in appropriate placement tariff for students. Furthemore, there is an imperative to pilot and evaluate novel collaborative approaches to the education of undergraduate medical and other health professions students.

Cost-effective innovation of locally assembled mannequins for undergraduate skill development in parenteral drug administration.

INTRODUCTION: The new competencybased curriculum for undergraduate medical education by the Medical Council of India mandates simulation using mannequins for teaching parenteral drug administration. Traditional education tends to focus on textbook learning, whereas competencybased education concentrates on the outcomes that directly guide the assessment of learners. OBJECTIVE: To introduce a module for the development of the core competency of parenteral drug administration using costeffective locally assembled mannequins for handson skill development in administering injections to be assessed using objective structured practical examination (OSPE). MATERIALS AND METHODS: Costeffective and durable fiberglass arms from mannequins used for fashion display were prepared for parenteral drug administration. The padding is easily done with wadding and gauze/crepe bandages, and the assembling requires only 15 minutes per arm. The training can be conducted in the department, giving students adequate opportunity for handson learning on individual arms during the practical sessions. As initial investment and recurring costs are low, it is possible for the department to obtain enough number of mannequins for each student to practice individually on an injection arm. RESULTS: Students practice injection technique freely, without fear of damaging the mannequin or having to do it on a patient. This helps them to assimilate the steps and sub-steps of doing the task in a much more realistic way and builds their confidence. Assessment of the performance of injection technique, infection control practices, and drug delivery are possible. CONCLUSION: We have observed a greater trend toward selflearning and selfefficacy and better adherence to the protocol of injection technique because of the handson training the students receive.

Student Volunteering as a Solution for Undergraduate Health Professions Education: Lessons From the COVID-19 Pandemic.

In response to the COVID-19 pandemic, many medical universities worldwide, including the Poznan University of Medical Sciences, launched student volunteering projects (SVPs). We examined our student volunteers' perceptions on the conditions, safety, costs and benefits of their participation in the SVP. Using this information, we attempted to assess the viability of SVPs as a solution for health professions education during and after the pandemic. The main research tool was a questionnaire on students' perceptions of their participation in the SVP. As a complementary qualitative method, we used semi-structured interviews with the volunteers. Our respondents (n = 158) perceived conditions and safety generally positively: most reported having personal protective equipment (89.24%), technical support (88.61%), and induction training (79.11%). Only 38.61% said they had access to psychological support. In our view, benefits (e.g., an opportunity to make new contacts or receiving positive reactions from patients and staff) seemed to outweigh costs. 65.82% of the respondents agreed that they learnt new interesting things. A majority noticed the development of their soft skills (social 86.08%; organisational 78.48%; stress management 68.99%), while 40.51% - the development of their medical skills. The interviews pointed to additional benefits for students such as gaining insight of the healthcare system, and costs such as distress caused by some patient interactions. We conclude that student volunteering could become a viable solution for health professions education. To maximise its educational potential, volunteers' needs must be explored, psychological support ensured, and opportunities for mentoring and reflection provided. The organisational framework of a SVP should be culturally sensitive.

Optimizing resource utilization during proficiency-based training of suturing skills in medical students: a randomized controlled trial of faculty-led, peer tutor-led, and holography-augmented methods of teaching.

BACKGROUND: Suturing is a fundamental skill in undergraduate medical education. It can be taught by faculty-led, peer tutor-led, and holography-augmented methods; however, the most educationally effective and cost-efficient method for proficiency-based teaching of suturing is yet to be determined. METHODS: We conducted a randomized controlled trial comparing faculty-led, peer tutor-led, and holography-augmented proficiency-based suturing training in pre-clerkship medical students. Holography-augmented training provided holographic, voice-controlled instructional material. Technical skill was assessed using hand motion analysis every ten sutures and used to construct learning curves. Proficiency was defined by one standard deviation within average faculty surgeon performance. Intervention arms were compared using one-way ANOVA of the number of sutures placed, full-length sutures used, time to proficiency, and incremental costs incurred. Surveys were used to evaluate participant preferences. RESULTS: Forty-four students were randomized to the faculty-led (n = 16), peer tutor-led (n = 14), and holography-augmented (n = 14) intervention arms. At proficiency, there were no differences between groups in the number of sutures placed, full-length sutures used, and time to achieve proficiency. The incremental costs of the holography-augmented method were greater than faculty-led and peer tutor-led instruction ($247.00 ± $12.05, p < 0.001) due to the high cost of the equipment. Faculty-led teaching was the most preferred method (78.0%), while holography-augmented was the least preferred (0%). 90.6% of students reported high confidence in performing simple interrupted sutures, which did not differ between intervention arms (faculty-led 100.0%, peer tutor-led 90.0%, holography-augmented 83.3%, p = 0.409). 93.8% of students felt the program should be offered in the future. CONCLUSION: Faculty-led and peer tutor-led instructional methods of proficiency-based suturing teaching were superior to holography-augmented method with respect to costs and participants' preferences despite being educationally equivalent.

On Step 1 Mania, USMLE Score Reporting, and Financial Conflict of Interest at the National Board of Medical Examiners.

Though intended to inform a binary decision on initial medical licensure, the United States Medical Licensing Examination (USMLE) is frequently used for screening candidates for residency positions. Some have argued that reporting results as pass/fail would honor the test's purpose while preventing inappropriate use. To date, the USMLE's sponsor organizations have declined to make such a change. In this Perspective, the authors examine the history and mission of the National Board of Medical Examiners (NBME), trace the rise of "Step 1 mania," and consider the current financial incentives for the NBME in implementing a pass/fail score-reporting policy.The NBME was founded in 1915 to address the lack of interstate reciprocity in medical licensure examination. With the creation of the USMLE in 1992, a single pathway for licensure was established, and the organization's original mission was achieved. Yet even after fulfilling its primary purpose, the NBME-classified as a nonprofit organization-has seen its revenues rise dramatically over the past 2 decades. Much of the increased revenue is derived from test products and services not required for medical licensure, with sales driven by the increasing importance of Step 1 scores in residency selection. Revenue from these products and services would likely decline if the NBME reported Step 1 results as pass/fail.A financial conflict of interest occurs when a judgment concerning a primary interest may be influenced by a secondary interest, such as financial gain. The data presented here demonstrate that the NBME has a conflict of interest in its current score-reporting policy. Possible remedies, such as disclosure, recusal, divestiture, and restructuring, are considered.

The real costs of teaching medical students in general practice: a cost-collection survey of teaching practices across England.

BACKGROUND: Current funding arrangements for undergraduate medical student placements in general practice are widely regarded as outdated, inequitable, and in need of urgent review. AIM: To undertake a detailed costing exercise to inform the setting of a national English tariff for undergraduate medical student placements in general practice. DESIGN AND SETTING: A cost-collection survey in teaching practices across all regions of England between January 2017 and February 2017. METHOD: A cost-collection template was sent to 50 selected teaching practices across all 25 medical schools in England following the development of a cost-collection tool and an initial pilot study. Detailed guidance on completion was provided for practices. Data were analysed by the Department of Health and Social Care. RESULTS: A total of 49 practices submitted data. The mean cost per half-day student placement in general practice was 111 GBP, 95% confidence interval = 100 to 121 (146 USD), with small differences between students in different years of study. Based on 10 sessions per student per week this equated to around 1100 GBP (1460 USD) per student placement week. CONCLUSION: The costs of undergraduate placements in general practice are considerably greater than funding available at time of writing, and broadly comparable with secondary care funding in the same period. The actual cost of placing a medical student full time in general practice for a 37-week academic year is 40 700 GBP (53 640 USD) compared with the average payment rate of only 22 000 GBP (28 990 USD) per year at the time this study was undertaken.

Approaches of anatomy teaching for seriously resource-deprived countries: A literature review.

Background: Teaching anatomy is an important but expensive part of the medical curriculum, potentially more than many countries can afford. In the search for efficient methods, cost-effectiveness is of utmost importance for such countries. The aim of this contribution is to provide a review of the literature on anatomy teaching methods, evaluating these for feasibility in resource-deprived countries. Methods: A literature review was carried out to identify distinct approaches to anatomy teaching published in the period 2000-2014, using the databases of PubMed, Wiley Online Library, Elsevier, HINARI, Springer, and ERIC. The approaches found were compared against their conceptual, operational, technical, and economic feasibility and Mayer's principles of effective instruction. Results: Our search yielded 432 papers that met the inclusion criteria. We identified 14 methods of teaching anatomy. Based on their conceptual feasibility, dissection and technology enhanced learning approaches appeared to have more benefits than others. Dissection has, besides benefits, many specific drawbacks. Lectures and peer teaching showed better technical and economic feasibility. Educational platforms, radiological imaging, and lectures showed the highest operational feasibility. Dissection and surgery were found to be less feasible with regard to operational, technical, and economic characteristics. Discussion: Based on our findings, the most important recommendations for anatomy teaching in seriously resource-deprived countries include a combination of complementary strategies in 3 different moments, lecturing at the beginning, using virtual learning environment (for self-study), and at the end, using demonstration through prosected specimens and radiological imaging. This provides reasonable insights in anatomy through both dead and living human bodies and their virtual representations.

The AUA Curriculum for Medical Students: Current Resources and Developments.

PURPOSE OF REVIEW: To summarize the advancements and offerings of the American Urological Association's (AUA) Medical Student Education Committee (MSEC). RECENT FINDINGS: The AUA MSEC is focused on advocating for urologic education in medical schools by promoting core principles and practices in urology. The origins of the MSEC go back to 2008. With comprehensive support from the AUA Office of Education, the MSEC continues to refine and expand the resources available for medical students through the AUA Medical Student Curriculum website. The AUA Medical Student Curriculum website offers a repository of resources for medical students. This information is meant to serve as a foundational curriculum for undergraduate medical student education in urology.

Does financial support for medical students from low income families make a difference? A qualitative evaluation.

BACKGROUND: The 2015-2020 strategic plan from the Office for Fair Access calls on institutions to provide contemporary assessments of the impact of their financial support for disadvantaged students on retention, progression, success, wellbeing and participation, throughout the student lifecycle. In response to this call, this article describes the first evaluation the authors are aware of, of a financial support scheme for students from lower income backgrounds attending a medical school. METHODS: A qualitative study of a bursary scheme for undergraduate medical students was undertaken at a university in London, England. One-to-one, audio-recorded interviews were conducted, transcribed and thematically analysed in order to ascertain eight recipients' experiences of receiving the bursary and its influence on their financial situation, academic studies and quality of life. RESULTS: The data were best explained by five main themes: impact of the bursary, communication, financial management, support preferences, and administration of the bursary. CONCLUSIONS: The participants, who were in receipt of various bursary amounts, generally regarded it as a good scheme with it providing a financial buffer and enabling them to focus on their studies and extracurricular activities rather than seek paid employment during term time.