Leveraging Telehealth and Medical Student Volunteers to Bridge Gaps in Education Access for Providers in Limited-Resource Settings.

PROBLEM: High-quality training opportunities for providers in limited-resource settings are often scarce or nonexistent. This can lead to a dearth of boots-on-the-ground workers capable of translating knowledge into effective action. The tested telehealth education model of Project ECHO (Extension for Community Healthcare Outcomes) can help address this disparity. However, the planning and logistical coordination required can be limiting. APPROACH: Medical student volunteers interested in health disparities and global health can be leveraged to reduce the costs of administration for Project ECHO programs. From mid-2018 to present (2020), student organizations have been formed at Vanderbilt University School of Medicine, University of California, San Francisco, School of Medicine, and Albert Einstein College of Medicine. These organizations have recruited and trained volunteers, who play an active role in assessing the needs of local clinics and providers, developing curricula, and coordinating the logistical aspects of programs. OUTCOMES: In the first 4 student-coordinated Project ECHO cohorts (2019-2020), 25 clinics in 14 countries participated, with a potential impact on over 20,000 cancer patients annually. Satisfaction with the telehealth education programs was high among local clinicians and expert educators. Students' perceived ability to conduct activities important to successfully orchestrating a telehealth education program was significantly greater among students who had coordinated one or more Project ECHO programs than among students who had yet to participate for 7 of 9 competencies. There also appears to be an additive effect of participating in additional Project ECHO programs on perceived confidence and career path intentions. NEXT STEPS: The student-led model of coordinating telehealth education programs described here can be readily expanded to medical schools across the nation and beyond. With continued expansion, efforts are needed to develop assessments that provide insights into participants' learning, track changes in patient outcomes, and provide continuing medical education credits to local clinicians.

Avaliação das atitudes de colaboração entre estudantes de graduação dos cursos de Farmácia e Medicina na Universidade de São Paulo / Evaluation of collaboration attitudes among undergraduate students of Pharmacy and Medicine courses at the University of São Paulo

A prática farmacêutica vem, ao longo dos anos, mudando o seu foco, uma vez que as mudanças de perfil epidemiológico, como a elevação da expectativa de vida, a diversidade de enfermidades crônicas, bem como a morbimortalidade associada ao uso de medicamentos e o aumento dos gastos com saúde, requerem acompanhamento prolongado de pacientes e abordagem integral que contemple as múltiplas dimensões da assistência à saúde dos usuários e da população em geral, com ênfase em prevenção e educação em saúde. Atributos importantes dos profissionais de saúde incluem, mas não estão limitados, à empatia cognitiva, a colaboração interprofissional e as orientações centradas no paciente. Instrumentos de pesquisa para medir cada um desses atributos foram projetados e validados em diferentes graus. O objetivo deste trabalho foi avaliar o grau de cooperação entre estudantes de graduação dos cursos de Farmácia e de Medicina da Universidade de São Paulo, Campus da Capital. Trata-se de um estudo do tipo transversal, quantitativo, com aplicação de questionário online construído e validado especificamente para avaliar o grau de cooperação entre estudantes de todos os anos de graduação dos cursos de Farmácia e de Medicina. Os dados foram coletados por meio do envio do questionário aos estudantes dos dois cursos, o qual contempla dados sócio-demográficos, contato prévio com a prática interprofissional e a versão validada para o português do instrumento "Scale of Attitudes Toward Pharmacist-Physician Collaboration". Foi realizada análise estatística empregandose métodos descritivos (média, mediana e desvio padrão) e inferenciais (Software R - teste t de Student e ANOVA). Com o presente estudo, observou-se que, de maneira geral, os estudantes dos dois cursos são favoráveis às práticas interprofissionais, porém, os dados apontam que os estudantes de Farmácia se mostram mais favoráveis a estas práticas quando comparados aos de Medicina. São necessários mais estudos para aprofundar as causas das diferenças encontradas entre os dois grupos e no que diz respeito à relação das atividades de educação interprofissional e a percepção dos estudantes quanto à colaboração médicofarmacêutico

The pharmaceutical practice has, over the years, changing its focus, since the epidemiological profile changes, such as increased life expectancy, the diversity of chronic diseases, as well as the morbidity and mortality associated with the use of drugs and the increase in health spending, require prolonged follow-up of patients and require comprehensive approach that addresses the multiple dimensions of health care users and the general population, with emphasis on prevention and health education. Important health professionals attributes include, but are not limited to cognitive empathy, interprofessional collaboration, and guidance centered on the patient. Research tools to measure each of these attributes have been designed and validated to varying degrees. The objective of this study is to measure and evaluate the level of cooperation among undergraduate students of Pharmacy and Medicine courses at the University of São Paulo, Campus Capital. It is a transversal, quantitative study with online application of online questionnaire developed and validated specifically to evaluate the level of cooperation between students from all undergraduate years of Pharmacy and Medicine courses. Data will be collected by sending the questionnaire to students from both courses. The questionnaire will be prepared on the basis of the Federal University of Sergipe tool and every student can respond to even just once. It will be performed the statistical analysis employing descriptive methods (mean, median and standard deviation) and inferential (Software R - Student's t-test and ANOVA). With the present study, it was observed that, in general, the students of the two courses are favorable to interprofessional practices, however the data indicate that the students of pharmacy are more favorable when compared to those of medicine. Further studies are necessary to look into the causes of the differences found between the two groups and also regarding the relation of the activities of interprofessional education and the students' perception regarding the physician-pharmacist collaboration

Health behaviors, care needs and attitudes towards self-prescription: a cross-sectional survey among Dutch medical students.

PURPOSE: There is a growing awareness of the potent ways in which the wellbeing of physicians impacts the health of their patients. The purpose of this study was to investigate the health behaviors, care needs and attitudes towards self-prescription of Dutch medical students, and any differences between junior preclinical and senior clinically active students. METHODS: All students (n = 2695) of a major Dutch medical school were invited for an online survey. Physical activity, eating habits, alcohol consumption, smoking, Body Mass Index, substance use and amount of sleep per night were inquired, as well as their need for different forms of care and their attitude towards self-prescription. RESULTS: Data of 902 students were used. Physical activity levels (90% sufficient) and smoking prevalence (94% non-smokers) were satisfying. Healthy eating habits (51% insufficient) and alcohol consumption (46% excessive) were worrying. Body Mass Indexes were acceptable (20% unhealthy). We found no significant differences in health behaviors between preclinical and clinically active students. Care needs were significantly lower among clinically active students. (p<0.05) Student acceptance of self-prescription was significantly higher among clinically active students. (p<0.001) CONCLUSIONS: Unhealthy behaviors are prevalent among medical students, but are no more prevalent during the clinical study phase. The need for specific forms of care appears lower with study progression. This could be worrying as the acceptance of self-care and self-prescription is higher among senior clinical students. Medical faculties need to address students' unhealthy behaviors and meet their care needs for the benefit of both the future physicians as well as their patients.

Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience / Doze anos de experiência em Educação Médica da Liga de Cirurgia Cardiotorácica da Universidade de São Paulo

INTRODUCTION: Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica - LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field. OBJECTIVE: To evaluate the experience gained through LCCT implementation. METHODS: Current students and former members of LCCT were submitted to a specific evaluation form, delivered personally or by email, which provided data on the general opinion regarding LCCT's activities, the reasons for answers provided and choice of medical specialties. Furthermore, LCCT's total scientific production was evaluated. Results: Most undergraduate medical students 51/65 (78.5 percent) and former members 94/121 (77.7 percent) completed the form. The interest in Cardiothoracic Surgery was the most common reason for joining LCCT 44/161 (27.3 percent). Most students 32/51 (62.7 percent) - reported their initial expectations were partially met. Almost every member would recommend a fellow medical student to join LCCT 50/51 (98 percent) and 25/51 (49 percent) of them participated in a scientific project linked to LCCT. In total, 47 scientific papers were published having LCCT's medical students as authors or co-authors during the existence of the league. Of the former members who chose a surgical career, 7/52 (13.4 percent) chose thoracic or cardiovascular surgery. CONCLUSION: LCCT has met its goals, since most current and former members recognized its role in their medical training, besides it is a good way to produce scientific initiation.

INTRODUÇÃO: Ligas acadêmicas são entidades pertencentes a faculdades de Medicina e seus hospitais. Compartilham os objetivos: pesquisa, ensino e assistência à saúde. Há doze anos, fundou-se a Liga de Cirurgia Cardiotorácica (LCCT) pela Faculdade de Medicina da USP, com o objetivo de fornecer aos estudantes de Medicina a oportunidade de ter conhecimento mais profundo em Cirurgia Cardiovascular e para participar de iniciação científica nesse campo. OBJETIVO: Avaliar a experiência adquirida nos 12 anos de existência da LCCT. Métodos: Membros atuais e antigos da LCCT responderam a um formulário entregue pessoalmente ou por e-mail, fornecendo opinião geral (e suas razões) sobre atividades da LCCT e escolha de especialidades médicas. O total de produção científica da LCCT foi também contabilizado. RESULTADOS: A maioria dos atuais estudantes 51/65 (78,5 por cento) e ex-membros 94/121 (77,7 por cento) respondeu ao formulário. O interesse em Cirurgia Cardiovascular foi o motivo mais apontado para ingressar na LCCT, representrando 44/161 (27,3 por cento). A maioria dos estudantes - 32/51 (62,7 por cento) - relatou que suas perspectivas iniciais foram parcialmente preenchidas. Quase todos os membros recomendariam a um colega participar da liga 50/51 (98 por cento) e 25/51 (49 por cento) deles participaram de uma iniciação científica vinculada à LCCT. No total, 47 trabalhos científicos com alunos da LCCT como autores ou coautores foram publicados. Dentre os exmembros que optaram por uma carreira cirúrgica, 7/52 (13,4 por cento) deles escolheram Cirurgia Torácica ou Cardiovascular. CONCLUSÃO: LCCT cumpriu seus objetivos, os alunos reconheceram a colaboração da LCCT na sua formação médica, além de ter se mostrado um bom meio de realizar iniciação científica.

Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience.

INTRODUCTION: Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica--LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field. OBJECTIVE: To evaluate the experience gained through LCCT implementation. METHODS: Current students and former members of LCCT were submitted to a specific evaluation form, delivered personally or by email, which provided data on the general opinion regarding LCCT's activities, the reasons for answers provided and choice of medical specialties. Furthermore, LCCT's total scientific production was evaluated. RESULTS: Most undergraduate medical students 51/65 (78.5%) and former members 94/121 (77.7%) completed the form. The interest in Cardiothoracic Surgery was the most common reason for joining LCCT 44/161 (27.3%). Most students 32/51 (62.7%)--reported their initial expectations were partially met. Almost every member would recommend a fellow medical student to join LCCT 50/51 (98%) and 25/51 (49%) of them participated in a scientific project linked to LCCT. In total, 47 scientific papers were published having LCCT's medical students as authors or co-authors during the existence of the league. Of the former members who chose a surgical career, 7/52 (13.4%) chose thoracic or cardiovascular surgery. CONCLUSION: LCCT has met its goals, since most current and former members recognized its role in their medical training, besides it is a good way to produce scientific initiation.

Characteristics of medical students with rural origin: implications for selective admission policies.

OBJECTIVES: Selective admission policies of medical schools favoring students of rural origin have been implemented in many countries in hope of increasing rural physicians. This study evaluated the characteristics of medical students from rural origins and their choice of future practice location. METHODS: Personal, familial, and academic information of 1929 graduates of Jichi Medical University (JMU), a Japanese medical school with a special mission to produce rural doctors, was collected on admission and graduation between 1972 and 1997, and follow-up information on workplace addresses were collected in 2000, 2004, and 2006. Jichi Medical University has a unique contract system under which all the graduates have the obligation to work in rural areas in exchange for having their tuition fee during their 6 years of undergraduate medical education waived. RESULTS: Subjects with rural origin were more likely to have parents with lower academic background, improve their academic standing throughout undergraduate medical education, and engage in rural practice than those from urban origins. Positive linear relationships between places of upbringing and workplaces were recognized in various geographic/demographic indicators. CONCLUSIONS: The selective admission policy seems to be a reasonable way of increasing the number of rural physicians without placing an undue burden on medical schools.

Nonsurgical skills do not predict baseline scores in inanimate box or virtual-reality trainers.

INTRODUCTION: Laparoscopic basic skills are best trained in the nonclinical setting. Box trainers and virtual-reality trainers have been shown to be useful in training laparoscopic skills. Certain nonsurgical skills may predict baseline skills in these trainers. This study tested the hypothesis that baseline scores could be predicted in inanimate box trainers and virtual-reality trainers by nonsurgical skills. METHODS: Only preclinical medical students were included in the study. All students were given a survey ascertaining if they played computer games, typed, sew, played a musical instrument, and utilized chopsticks. Students utilized a box trainer (BT) and/or virtual-reality trainer (VR). Nonparametric two-tailed Mann-Whitney tests were utilized to compare students that possessed certain nonsurgical skills versus those who did not. RESULTS: There were 18 students in the VR group and 33 students in the BT group. In the VR group, students who played computer games, typed, utilized chopsticks, or played a musical instrument had better scores and fewer errors than those who did not but this did not reach statistical significance in any comparison (p = NS). In the BT group, none of the nonsurgical skills predicted times or errors. Males performed better than females in the VR group (p < 0.001); but this gender discrepancy was not seen in the BT group. CONCLUSIONS: Nonsurgical skills do not predict baseline scores in either trainer. The gender differences in VR training need to be further explored.

Political self-characterization of U.S. medical students.

BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians' political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training. METHODS: All medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year). RESULTS: Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal." Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P < or = .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, "I'm glad I chose to become a physician" and "Access to care is a fundamental human right," were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions. CONCLUSIONS: U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes.

[The assessment of health behaviours among Warsaw Medical University students]. / Zachowania zdrowotne studentów warszawskiej akademii medycznej.

Some health behaviours among 228 students of Warsaw Medical University (130 women and 98 men) using anonymous questionnaire were examined. Percentage of smokers among female and male students was similar (13.1% and 14.3% respectively). Among respondents the greatest frequency of drinking alcohol was from a few times weekly to a few times monthly. Male students drunk alcohol more often than female ones. Beer was prefered by men, wine and beer--by women. Only male students (10.2%) used drugs (amphetamine, marihuana). About 1/3 of respondents did not do any sports. Female students had better knowledge about objective factors of their health status (blood pressure, blood glucose and cholesterol level) compared to males ones.

Senior medical students' perceptions of the adequacy of education on end-of-life issues.

CONTEXT: It is unclear how well prepared U.S. senior medical students are to handle end-of-life issues as they reach the end of medical school. Additionally, the most optimal way of providing medical student end-of-life education has not been adequately defined. OBJECTIVE: This study aims to determine the preparedness of senior medical students at U.S. medical schools regarding end-of-life issues. DESIGN: A self-administered survey. SETTING: Six medical schools throughout the United States, two of which have a formal curriculum on end-of-life issues, and four of which do not. PARTICIPANTS: Fourth-year medical students during November through February of their senior year. MAIN OUTCOME MEASURE: Self-reported preparation on a number of end-of-life competencies. RESULTS: Of the 757 surveys sent out, 262 responses were received (34.6%). Only 22% to 53% of students (varying by topic) felt prepared by their education in the selected end-of-life competencies. Students attending medical schools with a formal end-of-life curriculum were more likely to feel prepared than students with no formal curriculum to address psychosocial issues (21% higher, p = 0.008), cultural/spiritual issues (21% higher, p = 0.005), technical aspects of end-of-life care (18% higher, p = 0.001), and treatment of common symptoms (34% higher, p = 0.001). Students who had more clinical experiences in palliative care were more likely to feel prepared to discuss end-of-life issues with patients (p = 0.013) and to treat common symptoms (p = 0.011). CONCLUSIONS: This study demonstrates support for development of formal curriculum on end-of-life issues, and emphasizes the importance of clinical exposure to terminally ill patients to prepare medical students to provide quality end-of-life care.

Semiologia pediatrica: experiencia de ensino e aprendizagem segundo uma nova proposta de curso medico / Pediatric semiology: new approaches of teaching and learning of a recent medical school

O artigo apresenta a experiencia dos professores responsaveis pelo Curso de Semiologia Pediatrica, oferecido aos alunos da quinta etapa do Curso de Medicina da Universidade de Ribeirao Preto, destacando as suas prioridades, com enfase na Saude, Estado Nutricional e aprendizado fora da estrutura hospitalar.

Relación entre el promedio de la enseñanza media superior y el rendimiento obtenido en el curso de bioquímica en medicina / Relation between average college marks and performance in biochemistry in medical school

Se relacionaron los promedios obtenidos en bioquímica por los alumnos de seis grupos correspondientes a seis generaciones (91-92 a 96-97) de la Facultad de Medicina de la UNAM con los promedios alcanzados por los mismos alumnos en la enseñanza media superior y provenientes principalmente de la Escuela Nacional Preparatoria y el Colegio de Ciencias y Humanidades. Se encontró una baja correlación entre las dos variables mencionadas. Los resultados de este estudio sugieren que en el desempeño de los alumnos durante el curso de bioquímica influyen otros factores además del promedio alcanzado en la enseñanza media superior que sería muy importante reconocer y analizar. Los alumnos provenientes de la Escuela Nacional Preparatoria tuvieron mejor rendimiento en el curso de bioquímica. Las diferencias observadas entre los dos sistemas de bachillerato permiten suponer que el de la Escuela Nacional Preparatoria es superior al del Colegio de Ciencias y Humanidades

Preparadores en anatomía: diseño y evaluación de una estrategia para su labor / Anatomy preparadors: strategy to design and to evaluate

La educación médica moderna se orienta hacia la innovación y el cambio de las estrategias para optimizar la preparación de los egresados; así se han evaluado y mejorado gran parte de los recursos pedagógicos, sin embargo, sorprendentemente existen algunos tópicos que si bien siempre se han considerado importantes, han quedado al margen; tal es el caso de los preparadores. Por ello se plantea diseñar y evaluar una estrategia que permita el adecuado desenvolvimiento de los preparadores durante su labor, buscando establecer lo que los estudiantes esperan de los preparadores. Se encuestaron dos muestras, una de alumnos que cursaban la asignatura y otra de estudiantes que ya la aprobaron. La encuesta contiene las opciones pedagógicas disponibles, buscando conocer las más beneficiosas. Los resultados se confrontaron con los basamentos teóricos la disponibilidad de recursos, estableciéndose las exigencias actuales para un preparador de anatomía y el perfil actual del preparador ideal; planteándose un nuevo plan de trabajo, evaluado por dos años

Niveles de internalidad y necesidad de logro en estudiantes del VI año de medicina / Internality of levels and achievement necessity in students of the VI years of medicine

En la carrera de Medicina de la Universidad Centroccidental "Lisandro Alvarado", han sido poco estudiadas las variables internalidad y necesidad de logro en los estudiantes, inclusive no se conoce ningún trabajo a nivel del VI año, por lo que se procedió a realizar una investigación de tipo descriptivo. Se tomó una muestra al azar de 96 estudiantes del VI año A, en 10 de los ambulatorios docente-asistenciales adscritos al Decanato, durante diciembre 94 mayo 95, a quienes se les aplicaron los instrumentos Escala i-E Levenson internalidad y Escala Mehrabian para necesidad de logro. Se encontró que el grupo etario predominante corresponde a 24-26 años, seguido por el grupo 27-29 años. La mayor parte de los estudiantes investigados pertenece al sexo femenino. El rendimiento académico, expresado en el promedio ponderado, se ubicó en primer lugar en la categoría regular; el promedio general del curso fue 12,74 puntos. Un mayor número de individuos (53,57 por ciento) mostró internalidad alta, lo cual se relacionó con un mejor rendimiento académico. La necesidad de logro baja se encontró en un mayor número de individuos (56,33 por ciento). Se evidenció una relación directamente proporcional entre bajo y un menor rendimiento académico; cuando el logro es alto se encuentra un mejor rendimiento académico

Resultados da escala de sonolencia Epworth em 480 alunos de graduacao da Faculdade de Medicina da Universidade de Sao Paulo / Epworth sleepiness scale outcome in 480 Brazilian medical students

Este estudo relata os resultados da aplicacao da Escala de Sonolencia de Epworth (ESE) em 480 alunos da FMUSP, o resultado da correlacao do valor obtido da ESE com o numero declarado de horas de sono por noite e a comparacao com um estudo semelhante com alunos de medicina da Australia. A ESE e um questionario auto-aplicado de 8 itens usado para se avaliar sonolencia subjetiva em adultos. Os valores da ESE variam de 0 ate o maximo de 24 pontos. Os questionarios foram aplicados no final de 1994. Total de respostas = 480 sendo que 293 masculino, 185 feminino. Idade media = 20,55 + ou - 2,15 (DP). Etnia branca = 3346; amarela = 96; negra = 3; outros = 10; nao declarados = 25...

Perfil do academico da Faculdade de Medicina, UFRGS: semestre 93/1 e 93/2 / Medical student sociodemographic profile from UFRGS: class semester 93/1 and 93/2

Atraves da implantacao do Nucleo de Acompanhamento do Aluno (NAA), a Direcao da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), visa aprimorar a integracao entre alunos e tutores. Nesta etapa inicial de atividades, o NAA buscou descrever o perfil do academico de medicina, das turmas de ingresso 93/1 e 93/2, quanto a suas caracteristicas socio demograficas, educacionais e expectativas quanto a profissao medica. Dos 140 calouros de 1993, distribuidos em dois semestres, 107 (77.5 por cento ) responderam aos 52 itens do questionario aplicado na primeira atividade de recepcao aos mesmos. Os dados apontam para um calouro jovem, solteiro, habitualmente com familiar medico e sem restricoes a dedicacao integral ao curso. Os respondentes demonstraram alguma percepcao das oportunidades atuais do mercado de trabalho medico e da necessidade de zelarem por sua educacao continuada