The Revival of Essay-Type Questions in Medical Education: Harnessing Artificial Intelligence and Machine Learning.

OBJECTIVE: To analyse and compare the assessment and grading of human-written and machine-written formative essays. STUDY DESIGN: Quasi-experimental, qualitative cross-sectional study. Place and Duration of the Study: Department of Science of Dental Materials, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, from February to April 2023. METHODOLOGY: Ten short formative essays of final-year dental students were manually assessed and graded. These essays were then graded using ChatGPT version 3.5. The chatbot responses and prompts were recorded and matched with manually graded essays. Qualitative analysis of the chatbot responses was then performed. RESULTS: Four different prompts were given to the artificial intelligence (AI) driven platform of ChatGPT to grade the summative essays. These were the chatbot's initial responses without grading, the chatbot's response to grading against criteria, the chatbot's response to criteria-wise grading, and the chatbot's response to questions for the difference in grading. Based on the results, four innovative ways of using AI and machine learning (ML) have been proposed for medical educators: Automated grading, content analysis, plagiarism detection, and formative assessment. ChatGPT provided a comprehensive report with feedback on writing skills, as opposed to manual grading of essays. CONCLUSION: The chatbot's responses were fascinating and thought-provoking. AI and ML technologies can potentially supplement human grading in the assessment of essays. Medical educators need to embrace AI and ML technology to enhance the standards and quality of medical education, particularly when assessing long and short essay-type questions. Further empirical research and evaluation are needed to confirm their effectiveness. KEY WORDS: Machine learning, Artificial intelligence, Essays, ChatGPT, Formative assessment.

Self-assessment of active learning and critical thinking during problem-based learning: An exploratory study.

OBJECTIVE: To assess whether problem-based learning enhances students' perception of their active learning and critical thinking skills with time, and to validate the self-assessment scale regarding active learning and critical thinking in the local context. METHODS: The exploratory study was conducted at the Bahria University Dental College, Karachi, from February to September 2020, and comprised dental undergraduates in their first and second years of the academic programme. Data was collected using the self-assessment scale on active learning and critical thinking questionnaire which was administered twice after problem-based learning tutorials. Data was analysed using SPSS 23. RESULTS: There was a significant difference in the mean questionnaire scores of modules 1 and 3 of the first-year batch and modules 4 and 6 of the second-year batch (p=0.001). Cronbach's alpha value was 0.735 in the first-year cohort and 0.802 in the second-year cohort. CONCLUSIONS: Dental students' perception of active learning and critical thinking increased with time using problem-based learning as the tool. The self-assessment scale on active learning and critical thinking was also found validated in the local context.

Frequency of mental distress among medical students from selected medical colleges of Pakistan: A systematic review.

OBJECTIVE: To find out the frequency of mental distress among medical students in Pakistani medical colleges. METHODS: The systematic review comprised a search on PubMed and Google Scholar databases for articles published in English language between 2004 and 2019 having the key words 'mental distress', 'medical undergraduate', 'depression' and 'anxiety'. After a four-phase scrutiny process, articles were shortlisted for detailed review. Conventional content analysis was utilised for data analysis. RESULTS: Of the 30 articles, 18(60%) were reviewed in detail. Distress among Pakistani medical students was reported up to 90% which is alarmingly high. Study year, financial issues and academic burden were the noteworthy causal factors. Academics and examinations were substantial stress factors and religion was the commonly adopted coping strategy. CONCLUSIONS: Multiple studies showed evidence of an increasing rate of mental distress among medical undergraduates having various causative factors, mainly the academic burden.

Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study.

BACKGROUND: Delivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia. METHODS: The study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy. RESULTS: The analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context. CONCLUSION: The study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.

Review of ethics teaching in undergraduate medical education.

OBJECTIVE: To provide an overview of existing literature regarding ethics in undergraduate medical education around the world, and to identify gaps in literature for recommending areas for future research. METHODS: The scoping review was conducted in March 2016. PubMed and Web of Science search engines were used to identify English language literature on ethics in undergraduate medical education published over the preceding 20 years. Google search was used for grey literature. Two reviewers independently screened eligible studies for final study selection and review. Descriptive analysis of data was performed with mutual consensus. RESULTS: Of the 199 items located, 56(28%) were included; 37(33%) of 112 studies, and 19(22%) of 87 pieces of grey literature. Papers covered almost all regions of the world, including North and South America, Europe, Africa, and different Asian regions like Middle East, central, south-east and far east. The analysis identified several curriculum designs and teaching methods used for ethics education. CONCLUSIONS: The review identified gaps in evidence that required further research. These areas include theoretical underpinning of ethics curriculum, role of educators, standardisation and validation of teaching and learning strategies, and relevance to cultural context in the development and delivery of ethics curriculum, especially in Asian regions.

Educational theories that inform the educational strategies for teaching ethics in undergraduate medical education.

OBJECTIVE: To find out the most appropriate learning theory for the ethics education of medical undergraduates. METHODS: Two electronic databases were searched PubMed and Web of Science. We searched for published articles written in English without a time limit using the keywords: ethics education, medical undergraduates and learning theory. In the four-phased retrieval process, six full texts out of 133 citations were included in this review. Data were analyzed done by conventional content analysis. RESULTS: This systemic review revealed that reflection is the most effective pathway to develop ethical attributes and values of the physician. Social constructivist and experiential theory seem appropriate to form the basis for developing effective ethics curriculum. CONCLUSIONS: This review heightens the importance of learning theories for ethics education. It gives prompt evidence that reflection is the most suitable model for ethical education. Therefore, the educational theories and teaching activities that endorse reflective learning should be used for ethics education.

Students' perception of portfolio as a learning tool at King Abdulaziz University Medical School.

BACKGROUND: Medical education has a longstanding tradition of using logbooks to record activities. The portfolio is an alternative tool to document competence and promote reflective practice. This study assessed the acceptance of portfolio use among Saudi undergraduate medical students. METHODS: Portfolios were introduced in the 2nd through 5th years at King Abdulaziz University over a two-year period (2013-2015). At the end of each academic year, students completed a mixed questionnaire that included a self-assessment of skills learned through the use of portfolio. RESULTS: The results showed a difference in focus between basic and clinical years: in basic years students' focus was on acquiring practical skills, but in clinical years they focused more on acquiring complex skills, including identifying and managing problems. The questionnaire responses nonetheless revealed a positive trend in acceptance (belief in the educational value) of portfolios among students and their mentors, across the years of the program. CONCLUSIONS: Using portfolios as a developmental learning and formative assessment tool in the early undergraduate years was found to contribute to students' ability to create their own clinical skills guidelines in later years, as well as to engage in and appreciate reflective learning.

Culture and ethics in medical education: The Asian perspective.

The world is geographically divided into hemispheres, continents and countries, with varying cultures in different regions. Asia, the largest of continents, has a variety of philosophically distinctive cultures and lifestyles, informing the norms of societies that are much different from cultures in other continents. These complexities in the societal norms in Asian cultures have created unique issues in development of ethics education in the region. This paper looks in to the distinctions in what is generally referred to as the "non-western" Asian culture, the importance of cultural context and how it influences the ethics curriculum in the region.

Innovation in ethics and professionalism course: Early experience with portfolio-workbook.

OBJECTIVE: To analyse students' perception regarding the use of portfolio-workbook in ethics course. METHODS: This mixed method study was conducted at the King Abdulaziz University, Jeddah, Saudi Arabia, in 2014, and comprised fourth-year medical students. The "portfolio-workbook", developed on principles of cognitive load and guided learning theories, contained essential reading material. Learning sessions were also facilitated by teaching tools like role-plays, movie/video clips, vignettes, etc., followed by reflective writing exercises. Feedback questionnaire with open- and closed-ended questions was used to collect data. Quantitative data was analysed for frequencies and percentages. Content analysis was conducted for the open-ended responses. RESULTS: Of the 20 participants, 10(50%) considered using portfolio-workbook as difficult initially. However, on completion of module 16(80%) found it easy. Moreover, 17(85%) appreciated it as a learning tool. Besides, 19(95%) students found teaching videos and 13(65%) found open discussions as effective learning tools. Portfolio-workbook as an assessment tool was preferred by 19(95%) students. CONCLUSIONS: The use of portfolio-workbook in teaching ethics to undergraduates was found to be encouraging as it generated interest and interaction.

Tale of two cities: comparison of educational environment of two colleges (Jeddah and Rabigh) affiliated with one university.

OBJECTIVE: To evaluate students' perception about the educational environment at two medical colleges. METHODS: The cross-sectional study was conducted at King Abdulaziz University, Rabigh and Jeddah campuses, in Saudi Arabia, during the first semester of the year 2014 using Dundee Ready Education Environment Measure inventory. Data was collected from undergraduate medical students and analysed using SPSS 16. RESULTS: Of the 279 subjects in the study, 141(50.5%) belonged to the Rabigh campus, and 138(49.5%) to the Jeddah campus. Overall mean Dundee Ready Education Environment Measure inventory score was 124.90±20.66. The score for Jeddah was 131.38±21.37 and for Rabigh it was 118.56±17.85 (p=0.0001). The difference was also statistically significant in all domains of the inventory (p<0.05 each). CONCLUSIONS: Students' perception of their educational environment was positive in both campuses, it was more positive in Jeddah compared to Rabigh.

Evaluation of diploma in bioethics programme, Karachi, Pakistan: An educational research.

OBJECTIVE: To perform an outcome-based evaluation of the diploma programme initiated in 2006 at the Centre of Biomedical Ethics and Culture. METHODS: The broad based evaluation was done at the Centre of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, Karachi, from July 2011 to June 2012 and comprised pass out batches from 2006 to 2010. Outcome logic model was applied through a questionnaire-based approach. Emails were sent to the graduates, containing a mix of closed and open-ended questions. Quantitative feedback was analysed for frequencies and percentages. Content analysis was conducted for open-ended responses. SPSS 19 was used for statistical analysis. RESULTS: Four batches had graduated in the five-year study period. A total of 50 students had been enrolled, while 41(82%) graduated. Of them, 31(76%) graduates responded. Overall, 10(24%) graduates completed their Masters in bioethics, and 16(39%) were involved in institutional ethics committee. All (100%) believed the diploma had increased their knowledge of ethics and they were involved in disseminating the acquired knowledge through presentations, seminars/conferences 29(93.5%), teaching and awareness activities 22(71%). Besides, 28(90%) respondents believed their behaviour had changed and 27(87%)were improving the quality of work and environment, while 18(58%) had published related articles after their diploma. CONCLUSIONS: The programme was found to have achieved its objective during the first five years of its inception.

Formative assessment in undergraduate medical education: concept, implementation and hurdles.

Formative assessment, described as "the process of appraising, judging or evaluating students' work or performance and using this to shape and improve students' competence", is generally missing from medical schools of Pakistan. Progressive institutions conduct "formative assessment" as a fleeting part of the curriculum by using various methods that may or may not include feedback to learners. The most important factor in the success of formative assessment is the quality of feedback, shown to have the maximum impact on student accomplishment. Inclusion of formative assessment into the curriculum and its implementation will require the following: Enabling Environment, Faculty and student Training, Role of Department of Medical Education (DME). Many issues can be predicted that may jeopardize the effectiveness of formative assessment including faculty resistance, lack of motivation from students and faculty and paucity of commitment from the top administration. For improvement in medical education in Pakistan, we need to develop a system considered worthy by national and international standards. This paper will give an overview of formative assessment, its implications and recommendations for implementation in medical institutes of Pakistan.

Involvement of medical students and fresh medical graduates of Karachi, Pakistan in research.

OBJECTIVE: To study the involvement in research, of final year medical students and fresh graduates of Karachi, Pakistan and to identify the factors influencing their interest in medical research. METHODS: A cross-sectional, questionnaire based study was conducted in 2007-2008. Five institutes representing the private and public hospitals in the city were selected by cluster sampling. Final year medical students and fresh graduates were included. Descriptive statistics were charted using SPSS v.16 after double data entry. RESULTS: Out of 378, 186 (49%) participants had journal reading habits due to the requirement of their institution. Mostly, 157 (41%) undergraduates had already participated in a research project, however mostly in the field as data collectors or computer work. Institutional influence and speciality of interest was found to be statistically significant factors related to a respondent's interest or involvement in research. (chi2 =9.970, p-value = 0.007). CONCLUSION: There is keen interest and involvement in research, among final year medical students and fresh graduates of Karachi, Pakistan. However, the factors driving them are based on their university research encouragements and future plans.

Promoting motivation towards community health care: a qualitative study from nurses in Pakistan.

Based on the extensive health care needs of Pakistani population, the idea of Community Health Nursing was introduced in 1985. The educational nursing institutes adopted nursing curriculum in order to produce competent nurses to meet the rising demands of society. However, very few numbers of nurses choose community health nursing as their career pathway in Pakistan. Based on the current observation, enhancing motivation among graduate nurses has always been viewed as a great challenge for the academic nursing institutions. This study was intended to explore motivating and de motivating factors in nurses towards community Health Nursing. By utilizing self concept based model of motivation, semi structured interviews were conducted with newly graduated nurses, nurse educators and nursing students. The findings revealed that certain traits, values and competencies are required to motivate nurses as well as to build their capacity towards working effectively in the community setting. Moreover, through this study several realistic recommendations by the participants are highlighted that could foster motivation among future nurses towards this field.