Innovative, integrative, and interactive in-class activity on metabolic regulation: Evaluating educational impacts.

Medical students tend to have difficulties in developing a holistic view of metabolic pathway and hormone regulation. To address this issue, an interactive activity was implemented for first-year medical students at the School of Medicine, University of Minho, Portugal. Students' previous knowledge on metabolic pathways was evaluated by a pre-test followed by an interactive activity. In the supervised activity, students were challenged to elaborate a diagrammatic representation regarding enzymes, co-factors, and hormonal metabolic regulation in early fasting during the night, as well as in well-fed conditions. The activity was concluded with a post-test to determine the students' learning gains and a few days later students were evaluated by a final exam. Afterwards, students evaluated the activity by filling a questionnaire. Results from four different cohorts showed that the activity resulted in significant learning gains, particularly favoring students who have less prior knowledge. The comparison between the pre-test and the final exam also revealed significant learning gains for low achievers students. On the questionnaires, the majority of the students rated the activity as good or very good. Students agreed that this activity promotes: (a) reactivation of previous knowledge; (b) a better understanding of the interconnections between the metabolic pathways; (c) the application of learned concepts in real scenarios; and (d) sharing knowledge with peers. This study describes an active, unpretentious, and easily implemented activity available for early medical and biochemical curricula.

Designing a National Curriculum to Advance Surgical Oncology in Mozambique: A Delphi Consensus Study.

OBJECTIVE: Mozambique is currently experiencing an increase in chronic diseases including cancer. There is a large unmet need for cancer surgery in Mozambique. The aim of this study was to define the content and the design of a training program for practicing surgeons in surgical oncology that would be consensually regarded as adequate to care for oncological patients requiring surgical interventions. DESIGN & SETTING: A 3-round modified-Delphi approach was implemented to obtain consensus on surgical oncology training curriculum. The participants were purposefully selected experts in surgical oncology working in Mozambique. In round 1, participants answered a questionnaire with open-ended questions regarding the content of the curriculum and the timing and venue of training. In round 2, answers from the first round were presented to a purposeful selected sample of nationally recognized experts in oncology and surgical oncology, including members of the Mozambican College of Surgeons and leadership of the Ministry of Health. A final round was carried out to discuss the draft version of the training program aiming to achieve a predetermined consensus level of 80%. PARTICIPANTS: Fifteen of 23 experts (65.2%) responded to round one.The response rate for round 1 and 3 was 80% (12 of the 15 participants in round one). RESULTS: The responses collected in the first round were analyzed and revealed that basic principles of oncology and basic principles of surgical oncology should be included in the curriculum of surgical residency in Mozambique (80% of the experts agree; Cronbach α = 0.93); a 24-months fellowship in surgical oncology should take place after residency in the surgical field (86.6% of experts agree; Cronbach α = 0.97); and should occur at Maputo Central Hospital and at comprehensive cancer centers abroad (100% agree). In round 2 the proposal for the program of surgical oncology fellowship obtained a strong agreement amongst the experts (97.3%). The final proposal for the program was divided into the following structure: (1) theoretical components; (2) duration; (3) location; (4) methodology; (5) technical skills in oncology; and (6) competency and paid particular attention to the oncological diseases prevalent in Mozambique. The agreement amongst the experts was 97.3%. CONCLUSIONS: The experts reached a consensus regarding the general structure for a cancer surgery postgraduate training program in Mozambique, which should be a 24-months fellowship after residency in surgical disciplines. This fellowship should mostly take place in Mozambique, but it should also include dedicated internships in recognized cancer hospitals abroad. Such curricula embrace the Global Curriculum in Surgical Oncology including in particular the oncological nosology of Mozambique and should advance the quality of oncology surgical care provided in the country.