Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study.

OBJECTIVE: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets. METHODS: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical. RESULTS: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05. CONCLUSIONS: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Surgical Residents as Clerkship Scholars May Improve Student Perception of the Surgery Clerkship.

INTRODUCTION: The surgical clerkship is a formative experience in the medical school curriculum and can leave a lasting impression on students' perception of surgery. Given the historical negative stereotypes of surgeons, the clerkship represents an opportunity to impact students in a meaningful way. METHODS: Our institution developed a program in which research residents can serve as junior clerkship coordinators and educators; working closely with medical students on their surgery clerkship. At the end of their clerkship, students were administered a survey with Likert-scale and free text responses regarding satisfaction with the rotation, lectures, feedback, and value of the clerkship. Student survey results were compared before (2015-2016) and after (2017-2019) the implementation of the scholar program with nonparametric statistical analysis and qualitative text analysis. RESULTS: A total of 413 students responded to the survey with no significant difference in response rate by term (P = 0.88). We found no statistical difference with respect to overall course perception (92.3% versus 91.2%, P = 0.84), but a statistically significant difference was noted for the clarity of the provided written clerkship materials (80.3% versus 91.3%, P = 0.02) and usefulness of the feedback (57.5% versus 78.7%, P = 0.01). Qualitative analysis demonstrated an overall positive shift in perception of the clerkship, improvement in the course materials, and organization. CONCLUSIONS: The scholar program was overall well received by the students with improvements in certain aspects of the clerkship: organization, feedback, and course materials. This program represents a potential strategy to improve certain portions of the medical school clerkship experience.

Preclinical Immersion Experiences Improve Medical Student Perceptions of Surgery.

INTRODUCTION: Medical students historically receive little to no preclinical exposure to surgery and surgical subspecialties. As a result, by the time they reach their clinical clerkship time, students often have already found interest in other specialties. The goal of this study is to utilize the knowledge to action (KTA) implementation framework to design and refine a clinical immersion experience during the second year of medical school. METHODS: A total of 94 second-year Harvard Medical School students underwent the surgical immersion experience between 2019 and 2022 (the program was postponed in 2020 due to COVID). The development and refinement of the curriculum were nicely modeled by the KTA implementation framework. We identified a gap in medical student preclinical education, adapted a curriculum for preclinical medical students at Massachusetts General Hospital , selected the curriculum components to provide a high-level overview of surgery, monitored the student experience, and evaluated outcomes using the student surveys. Based on the survey results, inductive thematic analysis was utilized to identify prominent positive and negative themes. The feedback was then used to tailor subsequent iterations of the immersion experience. RESULTS: Eighty-eight medical students completed the survey (RR = 93.6%), and 85% rated the immersion experience as "excellent", 11% "very good", 4% "good", and 0% "fair" or "poor". There was no significant difference in ratings between sessions. Several key themes were identified, including changed perceptions, diversity of surgical fields, teamwork, surgery clerkship preparedness, and the need for more preclinical exposure. CONCLUSIONS: Preclinical medical students gave overwhelmingly positive reviews of the surgical immersion experience. A half-day intervention is sufficient to begin changing students' views toward surgery, disproving stereotypes, and even inspiring some to consider a surgical field themselves. In addition, the KTA implementation framework is a useful model for the development and refinement of medical education curricula.

Real-Time Student Feedback on the Surgical Learning Environment: Use of a Mobile Application.

OBJECTIVE: Improvements to the medical student surgical learning environment are limited by lack of granular data and recall bias on end-of-clerkship evaluations. The purpose of this study was to identify specific areas for intervention using a novel real-time mobile application. DESIGN: An application was designed to obtain real-time feedback from medical students regarding the learning environment on their surgical clerkship. Thematic analysis of student experiences was performed at the conclusion of 4 consecutive 12-week rotation blocks. SETTING: Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts. RESULTS: Fifty-four medical students at a single institution were asked to participate during their primary clerkship experience. Students submitted 365 responses over 48 weeks. Multiple themes emerged which were dichotomized into positive and negative emotions centered on specific student priorities. Approximately half of responses were associated with positive emotions (52.9%) and half with negative emotions (47.1%). Student priorities included the desire to feel included in the surgical team (resulting in feeling engaged/ignored), to have a positive relationship with members of the team (perceiving kind/rude interactions), to witness compassionate patient care (observing empathy/disrespect for patients), to have a well-planned surgical rotation (experiencing organization/disorganization within teams), and to feel that student well-being is prioritized (reporting opportunities/disregard for student wellness). CONCLUSION: A novel, user-friendly mobile application identified several areas to improve the experience and engagement of students on their surgery clerkship. Allowing clerkship directors and other educational leaders to collect longitudinal data in real time may allow for more targeted, timely improvements to the medical student surgical learning environment.

Oral 'Board Style' Examination for Surgery Clerkship.

Evaluating medical students during surgical clerkships relies on multifactorial methods of evaluation. Clinical evaluations, combined with standardized multiple-choice exams, are often the foundation of evaluation highlighting the challenge of combining subjective and objective measurements. Oral board exams are standard amongst medical certification and employ an additional element to evaluate students more holistically. Course evaluations from years that incorporated an oral board exam were compared to a year that omitted the exam. We found course satisfaction was higher in the years that included the oral exam (3.25 /5) than years without the oral board exam (3/ 5). The oral exam adds a novel element to the evaluation of a medical student that allows for a comprehensive understanding of a student's fund of knowledge and helps prepare them for future board certifications. Because students have an opportunity to demonstrate knowledge in a standard, more comprehensive format, they have higher satisfaction with the course.

A Mixed-Methods Needs Assessment for a Longitudinal Surgical Preparation Course in Undergraduate Medical Education.

OBJECTIVE: To assess the unmet needs associated with surgical education and skill development during the pre-clerkship years of medical school. DESIGN: A mixed-methods design was employed that leveraged semi-structured interviews and quantitative surveys followed by qualitative analysis. SETTING: A large midwestern academic medical center. PARTICIPANTS: Eighteen participants were enrolled representing second year medical students with an interest in surgery, surgical residents, and attending surgeons from a diverse array of surgical specialties. RESULTS: Unanimous support for the creation of a pre-clerkship surgical skills course emerged due to 2 main themes: (1) gaps in current surgical education offerings and (2) the value of early exposure to surgery and surgical skills followed by longitudinal practice. The components that participants deemed essential to a well-designed course were also revealed. Each stakeholder group (medical students, residents, surgeons) would benefit across all factors uncovered. CONCLUSIONS: There is a significant unmet need across all stakeholder groups for the creation of a longitudinal surgical skills course for pre-clerkship medical students. Future studies should seek to design a curriculum based on these study results and assess a pilot version of the curriculum to understand its feasibility under application.

Effects of Recorded versus Live Teleconference Didactic Lectures on Medical Student Performance in the Surgery Clerkship.

OBJECTIVE: Due to the COVID-19 pandemic, numerous institutions converted medical education didactics to electronic formats including both live teleconference didactics and recorded faculty lectures. This study aims to compare the effect of recorded versus live teleconference didactic lectures on medical student examination scores during the surgery clerkship. DESIGN: Medical students completing the Surgery Clerkship received a weekly series of didactic lectures taught by faculty via a teleconference (2020-2021 academic year) or recorded format (2021-2022 academic year). Performance outcomes included weekly quizzes, National Board of Medical Examiners (NBME) Surgery Shelf Exam, and clerkship Objective Structured Clinical Examination (OSCE) scores. SETTING: University of Miami Miller School of Medicine. PARTICIPANTS: All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over two academic years (n = 312). RESULTS: Students who received live teleconference lectures (n = 156) demonstrated higher average scores on weekly quizzes (89%) and the NBME shelf exam (76%) compared to those receiving recorded lectures (n = 156; 71% quiz, 70% shelf exam), both p < 0.001. There was a significant association with performance in the highest quartile (Q1) of weekly quiz scores and receiving live lectures (40% vs. recorded lectures 1%, p < 0.001). Comparing only MS3 students, mean weekly quiz scores and Q1 achievement were significantly higher (both p < 0.001) in the teleconference cohort with no significant difference in NBME shelf exam performance (p = 0.971). No difference in OSCE performance was observed between groups. CONCLUSION: These results suggest that synchronous teleconferences may be more effective than recorded lectures for achieving institutional learning objectives on the surgery clerkship without any negative impact on NBME shelf exam or clinical evaluation parameters. This information should be used to inform future institutional clerkship design and educational initiatives.

Bioseguridad y autocuidado: prioridad en la formación universitaria en momentos de pandemia / Biosafety and self-care: a priority in university training during pandemic times

Introducción: La bioseguridad y el autocuidado son dos prácticas importantes en el proceso de formación. Estas deben reforzarse permanentemente, ya que se relacionan de manera directa no solo con el riesgo de infecciones, sino con la calidad de la atención. Objetivo: Identificar la evidencia científica sobre los procesos de formación en bioseguridad y autocuidado en el marco de la pandemia. Métodos: Se hizo una revisión de la literatura científica publicada entre 2016 y 2020 sobre medidas de bioseguridad y autocuidado. La búsqueda se realizó en español, inglés y portugués, en la Biblioteca Virtual en Salud, Pubmed, Science Direct y el motor de búsqueda de Google Académico. Se aplicó la metodología PRISMA y se evaluaron en total 25 artículos científicos. Resultados: El año 2020 tuvo mayor frecuencia. La generalidad de los estudios se realizó en el contexto universitario en programas de salud. La higiene de las manos y el uso de guantes fueron las medidas de bioseguridad más informadas; mientras que las medidas de precaución se conocen e implementan. Las publicaciones denotan moderado conocimiento en cuanto a prevención de factores de riesgos biológicos, especialmente en prácticas clínicas. Conclusiones: En los procesos de formación debe tenerse en cuenta la relevancia de reforzar las medidas de bioseguridad y autocuidado para favorecer el ejercicio profesional. Es importante diseñar y repensar estos procesos, tanto en docentes como estudiantes, a través de nuevos métodos y cambios curriculares. La salud mental puede verse afectada no solo por la situación, sino por desconocimiento, miedo a infectarse y sobrecarga laboral(AU)

Introduction: Biosafety and self-care are two important practices in the training process. These should be permanently reinforced, since they are directly related not only to the risk of infections, but also to the quality of care. Objective: To identify the scientific evidence on the biosafety and self-care training processes in the context of the pandemic. Methods: A review of the scientific literature published between 2016 and 2020 on biosafety and self-care measures was carried out. The search was performed in Spanish, English and Portuguese, in the Virtual Health Library, PubMed, Science Direct, and the Google Scholar search engine. The PRISMA methodology was applied and a total of 25 scientific articles were assessed. Results: The year 2020 had the highest frequency. Most of the studies were carried out in the university context in health programs. Hand hygiene and glove-wearing were the most reported biosafety measures, while warning measures are known and implemented. The publications are indicative of moderate knowledge regarding prevention of biological risk factors, especially in clinical practices. Conclusions: The relevance of reinforcing biosafety and self-care measures to favor professional practice should be taken into account in training processes. It is important to design and rethink these processes, both in professors and students, through new methods and curricular changes. Mental health may be affected not only by the situation, but also by ignorance, fear of infection and work overload(AU)

The influence of surgical and procedural rotations and interest in a surgical discipline on medical students' suturing ability during clerkship.

BACKGROUND: Although suturing is an essential competency for medical students, there has been limited research into the skills acquisition process over the course of medical school curriculum. This study aimed to determine whether suturing ability improved over the course of clerkship and whether an interest in a surgical discipline was associated with improved skill acquisition. METHODS: The suturing ability of third-year medical students at a large Canadian medical school was assessed at the beginning of clerkship (August 2018) as well as before and after their surgery rotation by 2 expert reviewers using a validated, objective scoring system as well as a qualitative assessment, both in person and via blinded video recordings. Students were randomly allocated to 4 groups for their clerkship year by the medical school. RESULTS: Of 133 eligible students, 115 (86.5%) completed the study. Median suturing assessment scores improved significantly after the surgery rotation (214.5 [interquartile range (IQR) 191.1-235.0] v. 238.0 [IQR 223.5-255.0], p = 0.001). Groups that had completed a procedural rotation (emergency medicine, obstetrics and gynecology) between clerkship and starting their surgery rotation had improved scores between these time points (p < 0.05), whereas scores decreased for groups that did not have a procedural rotation between assessments. Regardless of previous rotations, suturing scores were similar between groups after the surgery rotation. The 21 students (18.3%) who were interested in a surgical discipline had higher suturing scores than students who were not interested in surgery at the beginning of clerkship (229.1 [IQR 220.2-253.0] v. 208.0 [IQR 185.0-228.0], p < 0.001) and after the surgery rotation (252.0 [IQR 227.0-268.0] v. 235.8 [IQR 220.5-251.2], p = 0.02). CONCLUSION: Medical students' suturing ability improved during the surgery rotation but was also influenced by other procedural rotations and students' interest in procedure specialties. Skill acquisition by medical students is complex and requires additional investigation.

Use of a Structured Observation Tool to Promote Medical Student Engagement in Trauma Resuscitations.

OBJECTIVE: We describe a novel approach to promoting medical student learning and engagement during trauma resuscitation with implementation of a structured observation and debriefing tool. DESIGN: In the context of a multifaceted quality improvement effort in our emergency room, we implemented a structured trauma observation tool (SOT) for medical students based on ATLS trauma guidelines. The SOT reflects the American College of Surgeons and Association for Surgical Education (ACS/ASE) trauma evaluation module for medical students. Two medical students from our quality improvement working group undertook a proof-of-concept study to determine whether the SOT facilitated accurate observations of trauma resuscitations and promoted educational debriefs with precepting providers. Results were encouraging, so the tool was implemented for elective use on surgical clerkships. Clerkship students who used the SOT were given the opportunity to share its impact on their experience. Institutional Review Board approval was obtained under Pro00109569. SETTING: A large level 1 trauma center at an academic hospital in the southeastern United States. PARTICIPANTS: An interdisciplinary working group including surgeons, emergency medicine physicians, nurses, and students developed the observation tool. Two medical students from this team showed that the tool was effective at guiding observations and facilitating debriefs prior to its broader implementation on the general surgery clerkship. RESULTS: A total of 630 resuscitation tasks were observed during 15 trauma activations prior to implementation on the surgery clerkship. There was over 97% agreement between students observations and evaluating physicians self-reporting on which tasks were completed. Tasks on which there was disagreement were discussed to aid student learning. The tool was implemented for elective use on the surgery clerkship where students reported positive experiences. CONCLUSIONS: Early data suggest that this structured observation tool facilitates accurate trauma assessment observations and provides an opportunity for high-yield debriefs with the evaluating physician. This promotes student comprehension of ATLS principles. The SOT is being implemented as a pedagogic tool for students on the surgery clerkship to guide their observations, improve comprehension of decisions made in a hyperacute setting, and offer real time feedback as part of their learning in the trauma bay. The tool appears to be a valuable supplement which supports the ACS/ASE curriculum.

Comparison of quality metrics in an education-centered medical home with local and national benchmarks.

The Education-Centered Medical Home (ECMH) is a longitudinal clerkship where students provide care to patients at one clinic site for the entirety of medical school. Studies have demonstrated that ECMHs have higher completion rates of preventative measures than traditional student-run free clinics (SRFCs). However, data comparing ECMHs with licensed primary care provider clinics are limited. We performed a prospective chart review that examined vaccination and cancer screening rates of patients in an ECMH and those seen by primary care physicians (PCPs) at the same free clinic site. We then compared these groups with participants in the 2018 National Health Information Study (NHIS). A total of 62 ECMH patients, 3,515 PCP patients, and 25,045 NHIS participants were included in the study. Within the ECMH, 72.7% and 80.0% of patients were screened for breast and cervical cancer, respectively. These rates did not differ significantly from those of PCP patients or NHIS participants. While the percentage of ECMH patients screened for colon cancer was similar to that of PCP patients (78.9% vs. 65.8%, p = 0.09), it was proportionally greater than NHIS screening rates (78.9% vs. 63.3%, p = 0.043). In addition, the rate of influenza and pneumococcal pneumonia vaccination among ECMH patients (41.4% and 58.3%, respectively) did not differ significantly from the PCP and NHIS groups. Our study found that the ECMH model allows students to deliver preventative care comparable to licensed practitioners and national benchmarks. It reaffirms the ECMH as an effective method for students to provide high quality care to underserved patients.

Estrategia pedagógica para la práctica clínica en la asignatura Cuidado del Adulto II / A pedagogical strategy for clinical practice in the subject Adult Care II

Introducción: El proceso de enseñanza y aprendizaje en enfermería se caracteriza por articular teoría y práctica. La propuesta se estructuró en el aprendizaje experiencial, donde el sujeto deja de ser observador y se vuelve partícipe de su propia experiencia de aprendizaje. Objetivo: Diseñar una estrategia pedagógica para la mejora de la práctica clínica en la asignatura de Cuidado del Adulto II. Métodos: Estudio cuantitativo, no experimental. Participaron 37 estudiantes de Enfermería de la asignatura Cuidado del Adulto II. Se realizó sistematización de la literatura, revisión de los informes académicos anteriores, exámenes diagnósticos sobre procedimientos básicos y específicos, y diagnóstico rápido de curso, lo que sirvió de insumo para el diseño de la estrategia. Resultados: La alineación de la asignatura permitió definir la relación Resultado Aprendizaje Enfermería (RAE)-Resultado Aprendizaje Parcial (RAP)-Resultado de Aprendizaje de Curso (RAC) y elaborar la "Matriz Resultados de Aprendizaje-Actividades de Aprendizaje y Valoración Cuidado II", que facilitó estructurar la práctica clínica. Se incorporaron varias Técnicas de Aprendizaje Colaborativo. Se estructuraron las tarjetas de habilidades, las rotaciones de la práctica clínica, y se ajustaron las listas de chequeo para los procedimientos de Enfermería generales y específicos. Conclusiones: Resulta significativo que el docente genere estrategias pedagógicas que ayuden al estudiante a construir y conectar su conocimiento a partir de las herramientas que los servicios clínicos le puedan proporcionar, para que este participe, decida y sea personaje, al fomentar el ser y el hacer para un conocer y convivir(AU)

Introduction: The teaching and learning process in nursing is characterized by articulating theory and practice. The proposal was structured upon experiential learning, in which the subject is not an observer anymore and becomes a participant in his/her own learning experience instead. Objective: To design a pedagogical strategy for improving clinical practice in the subject Adult Care II. Methods: Quantitative and nonexperimental study carried out with 37 Nursing students during their Adult Care II course. Literature systematization, review of previous academic reports, diagnostic tests on basic and specific procedures, as well as rapid course test, were carried out, which served as an input for the strategy design. Results: The alignment of the subject allowed to define the relationship between nursing learning outcome, partial learning outcome and course learning outcome (NLO-PLO-CLO) and create a matrix relating learning outcomes, learning activities and Adult Care II assessment, which facilitated structuring the clinical practice. Several collaborative learning techniques were incorporated. Skill cards and clinical practice rotations were structured, and checklists for general and specific nursing procedures were adjusted. Conclusions: It is significant that the professor creates pedagogical strategies that help the student build and connect his/her knowledge based on the tools that clinical services can provide them with, in order for the student to participate, decide and be a direct player, by encouraging being and doing in view of knowing and interacting with others(AU)

Qualities of excellent resident and attending teachers recognized by medical students: A qualitative analysis of nominations for surgical clerkship teaching awards.

BACKGROUND: Effective teaching positively impacts student experience during the surgical clerkship. We sought to better understand how medical students characterize excellent surgical educators and how these characteristics may differ between residents and attendings. METHODS: 289 nominations by third-year medical students for a surgical resident and attending teaching award were examined for thematic content using conventional content analysis. RESULTS: Six major themes emerged: inclusion of students, prioritizing student education, facilitating procedural involvement, utilizing effective educational methods, providing mentorship, and role modeling. Residents were more frequently commended for the first three themes, while residents and attendings were recognized equally for the latter three. CONCLUSIONS: In identifying excellent surgical educators, students emphasized the educators' roles in fostering a positive learning environment where student education is prioritized. Residents were recognized more often than attendings for a broader set of qualities valued by students. Residents as teachers training should be structured to develop these qualities.

Evaluating Teaching Effectiveness of Medical Humanities in an Integrated Clerkship Program by a Novel Prospective Propensity Score Matching Framework.

BACKGROUND: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. METHODS: Between 2013-2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). RESULTS: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient-Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. CONCLUSIONS: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

Problemas que limitan la interdisciplinariedad entre la Farmacología y las asignaturas clínicas en Estomatología / Problems that limit interdisciplinary between Pharmacology and Stomatology clinical subjects

RESUMEN Fundamento: El desarrollo de la interdisciplinariedad entre la unidad curricular Farmacología y las asignaturas clínicas de la Disciplina Principal Integradora en la carrera Estomatología, resulta indispensable para la formación integral del futuro egresado. Objetivo: Identificar los problemas que limitan el desarrollo de la interdisciplinariedad entre la Farmacología y las asignaturas clínicas de la Disciplina Principal Integradora en la carrera Estomatología. Metodología: Se realizó un estudio observacional descriptivo transversal entre noviembre y diciembre de 2020 en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Santiago de Cuba. Se consideraron como unidades de análisis: actividades docentes y directivos académicos, se seleccionó una muestra aleatoria en ambos casos (n=18 y n=8, respectivamente). Se estudiaron las variables: relaciones interdisciplinarias con la Farmacología (se observa, no se observa y se observa poco), categoría docente, categoría científica, grado académico/científico, grado de especialización y opinión de directivos académicos (siempre, a veces y nunca). Como instrumento de medición se empleó guía de observación y de entrevista, respectivamente. Se empleó el porcentaje como medida de resumen. Resultados: En más del 50 % de las actividades docentes de las asignaturas clínicas de la Disciplina Principal Integradora, no se observa las relaciones interdisciplinarias con la Farmacología. En las entrevistas realizadas a los directivos académicos, predominó la opinión: nunca. Conclusiones: Las insuficiencias didácticas, metodológicas, académicas e investigativas identificadas, limitan el desarrollo de la interdisciplinariedad entre la unidad curricular Farmacología y las asignaturas clínicas de la Disciplina Principal Integradora en la carrera Estomatología.

ABSTRACT Background: The development of interdisciplinarity between the curricular Pharmacology unit and the clinical subjects of the Main discipline in the Stomatology career is essential for the integral formation of the future graduate. Objective: To identify the problems that limit the development of interdisciplinarity between Pharmacology and the clinical subjects of the Main Comprehensive Discipline in the Stomatology career. Methodology: A cross-sectional descriptive observational study was conducted between November and December 2020 in the Stomatology Faculty at the Santiago de Cuba University of Medical Sciences. The following were considered as analysis units: teaching activities and academic directors, a random sample was selected in both cases (n=18 and n=8, respectively). The following variables were studied: interdisciplinary relations with Pharmacology (observed, not observed and little observed), teaching category, scientific category, academic/scientific degree, specialization degree and the academic directors´ opinion (always, sometimes and never). Observation and interview guides were used respectively as measurement instruments. Percentage was used as a summary measure. Results: In more than 50 % of the teaching activities of the clinical subjects of the Main Comprehensive Discipline, interdisciplinary relations with Pharmacology are not observed. In the interviews conducted with academic managers, the prevailed opinion was never. Conclusions: The didactic, methodological, academic and research inadequacies identified, limit the development of interdisciplinarity between the curricular unit Pharmacology and the clinical subjects of the Main Comprehensive Discipline in the Stomatology career.

"Rhythm of the Night": Medical student reflections on overnight trauma call.

INTRODUCTION: On their surgical clerkship, students reflected on their experience on a traditional overnight call. We explored whether perceived learning experiences differ between students who identify surgical specialties as their career compared to those who do not. METHODS: Medical students participated in traditional call at a Level 1 Trauma Center and submitted guided reflections. Reflections were coded using thematic analysis. We used Epistemic Network Analysis to compare codes based on matched specialty. RESULTS: 418 students submitted reflections between 2016 and 2019.95% learned something on call they could not have during daily services. Students who matched in surgical specialties connected more call learning experiences to formation of student agency through individualized teaching experiences and awareness of stamina. CONCLUSIONS: Most students found participation in overnight call valuable, and professed increased awareness of their skills and future residency duties. Results indicate students who matched in surgical specialties had more formative experiences on call.

Percepción docente de la evaluación en las prácticas clínicas de enfermería / Professors' perception about evaluation of clinical nursing practice

Introducción: La metaevaluación como instrumento en los procesos de calidad ha favorecido la toma de decisiones de las Instituciones de Educación Superior en cuanto a la mejora del proceso enseñanza-aprendizaje, al permitir un seguimiento de los discursos de la academia y su puesta en práctica por los docentes, por lo que se han encontrado nuevas interpretaciones del fenómeno evaluativo. Objetivo: Describir las percepciones de los profesores sobre la evaluación del programa de enfermería de la Universidad de Santander en el período académico B-2018 en la formación de la práctica clínica. Métodos: Investigación descriptiva, exploratoria y de tipo cualitativa. La población estuvo conformada por docentes de asignaturas teórico-prácticas del programa de enfermería de la Universidad de Santander. El muestreo fue intencionado-selección por criterios. Los datos recolectados se procesaron a través del software IRAMUTEQ. Resultados: El soporte del análisis lexical definió dos ejes temáticos, formados por cuatro clases semánticas. Estos fueron: Eje temático No. 1: Proceso cuantitativo a superar que contiene las clases 1 y 2 (Evaluación como calificación y Proceso de doble vía); y Eje temático No. 2: Pautas de valoración que contiene las clases 3 y 4 (Progreso centrado en el estudiante y Valoración final del hacer). Conclusiones: La percepción de los docentes frente a la evaluación de la práctica clínica de enfermería es considerada en términos de medición y calificación(AU)

Introduction: Meta-evaluation, as an instrument in quality processes, has permitted to support decision-making inhigher education institutions, with respect to improvement of the teaching-learning process, by allowing to followup academic discourses and their implementation by professors; in this scenario, new interpretations of the evaluation phenomenon have been found. Objective: To describe professors' perceptions about the evaluation of the Nursing program at University of Santander in the academic period B-2018 concerning clinical practice formation. Methods: Descriptive, exploratory and qualitative research. The population was made up of professors of theoretical-practical subjects of the Nursing program ofUniversity of Santander. The sampling was intentional (selection by criteria). The data collected was processed using the IRAMUTEQ software. Results: The lexical analysis support resulted in two thematic axes, made up of four semantic classes:thematic axis # 1 (quantitative process to be passed), which contains the classes 1 and 2 (evaluation as qualification and feedback process); and thematic axis # 2 (evaluation guidelines), which contain the classes 3 and 4 (student-centered progress and final evaluation of performance). Conclusions: Professors' perception about the evaluation of clinical nursing practice is considered in terms of measurement and qualification (AU)

Attracting the Best Students to a Surgical Career.

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.

Medical student attitudes and actions that encourage teaching on surgery clerkships.

INTRODUCTION: Surgical faculty and residents are responsible for the clinical education of medical students during their core surgical clerkship, sub-internships, and clinical electives. Much attention has been paid to faculty development in teaching, as well as residents-as-teachers programs, to enhance student learning in the surgical environment. This focus to "train the trainers" has not addressed what medical students can do to take ownership of and improve their own learning, as partners in educational interactions. The purpose of this exploratory study was to investigate how medical students' attitudes and actions can enhance clinical teaching interactions during surgical rotations. METHODS: Previously collected data from a multiple case study that explored the learning environment at a single academic medical center was analyzed to understand the roles that students play in their learning. The data includes transcriptions from semi-structured interviews with four 4th year mediacl students, three general surgery residents, and four surgery attendings, and focus groups with two sets of 3rd year medical students. Two authors employed thematic analysis to code the data. RESULTS: Findings were organized into five themes: eagerness, humility, confidence, team player, and adaptability. Each attitudinal theme was associated with specific actions that students adopted to encourage teaching behaviors from resident and faculty surgeons during their surgery rotations. Participants discussed the importance of students "seek[ing] out opportunities" for learning (eagerness) and being "willing to be wrong" (humility). Student expressions of confidence in their knowledge and skills were marked by following "steps that I know," which signaled to teachers that they could be entrusted to participate in patient care. Students categorized as team players "follow[ed] up on information without specifically being told." Finally, students categorized as adaptable responded to "immediate feedback" by making "adjustments." CONCLUSIONS: Medical students are important stakeholders and contributors to teaching interactions and are likely to impact their own learning experience through the adoption of key attitudes and associated actions.