Assessment in Undergraduate Competency-Based Medical Education: A Systematic Review.

BACKGROUND: Studies that have methodically compiled the body of research on the competency-based medical education (CBME) assessment procedure and pinpointed knowledge gaps about the structure of the assessment process are few. Thus, the goals of the study were to create a model assessment framework for competency-based medical education that would be applicable in the Indian setting as well as to thoroughly examine the competency-based medical education assessment framework. METHODS: PubMed, MEDLINE (Ovid), EMBASE (Ovid), Scopus, Web of Science, and Google Scholar were the databases that were searched. The search parameters were restricted to English language publications about competency-based education and assessment methods, which were published between January 2006 and December 2020. A descriptive overview of the included research (in tabular form) served as the foundation for the data synthesis. RESULTS: Databases provided 732 records; out of which 36 fulfilled the inclusion and exclusion criteria. Thirty-six studies comprised a mix of randomized controlled trials, focus group interviews, and questionnaire studies, including cross-sectional studies, qualitative studies (03), mixed-method studies, etc. The papers were published in 10 different journals. The greatest number was published in BMC Medical Education (18). The average quality score for included studies was 62.53% (range: 35.71-83.33%). Most authors are from the UK (07), followed by the USA (05). The included studies were grouped into seven categories based on their dominant focus: moving away from a behavioristic approach to a constructive approach of assessment (01 studies), formative assessment (FA) and feedback (10 studies), the hurdles in the implementation of feedback (04 studies), utilization of computer or online based formative test with automated feedback (05 studies), video feedback (02 studies), e-learning platforms for formative assessment (04 studies), studies related to workplace-based assessment (WBA)/mini-clinical evaluation exercise (mini-CEX)/direct observation of procedural skills (DOPS) (10 studies). CONCLUSIONS: Various constructivist techniques, such as concept maps, portfolios, and rubrics, can be used for assessments. Self-regulated learning, peer feedback, online formative assessment, an online computer-based formative test with automated feedback, the use of a computerized web-based objective structured clinical examination (OSCE) evaluation system, and the use of narrative feedback instead of numerical scores in mini-CEX are all ways to increase student involvement in the design and implementation of the formative assessment.

Systematic review of assessment in undergraduate competency-based medical education and extrapolation of an assessment framework for Indian context - A study protocol.

There is a lack of studies that have systematically synthesized the existing literature related to the competency-based medical education (CBME) assessment process and identified gaps in existing knowledge about the assessment process structure. The aims of this study are as follows: 1. A systematic review of the assessment framework of CBME 2. Designing a model framework of assessment for CBME that will be relevant in the Indian context. The databases searched will be PubMed, MEDLINE (Ovid), EMBASE (Ovid), Scopus, Web of Science, and Google Scholar. General limits to the search will be set in the English language, published between January 2006 and December 2020, specific to competency-based education and assessment methods. After initial screening for duplicates and search limits, the title and abstract of the remaining studies will be screened. Subsequently, the full text of the articles will be screened against the inclusion and exclusion criteria for final selection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the systematic review will be used to describe the selection of the studies. The article quality will be assessed using the quality assessment tool for diverse study designs (QATSDD). The data synthesis will start with a descriptive summary (in tabular form) of the included studies. This study will try to provide comprehensive data to address challenges related to the CBME assessment process, which can help in evolving the robust assessment framework of CBME.

A Study to Design a Learning Tool "Virtual Patient" for Functional Diagnosis and Clinical Reasoning of Respiratory Dysfunction in the Undergraduate Physiotherapy Curriculum.

The aim of the present study was to develop and design software-based "virtual patient" for learning functional diagnosis with clinical reasoning of respiratory dysfunction based on need analysis and perception of faculty and student on utility in the undergraduate physiotherapy curriculum. The objective of the study was to design a framework of a respiratory case scenario that includes personal details, history taking, physical examination, differential diagnosis, investigations, functional impairment, and diagnosis, design a prototype of the virtual patient case scenario using software in a virtual environment created in oculus quest, obtain faculty and student feedback, and analyze the feedback. The result of the study obtained on feedback analysis suggests that the virtual patient case scenario (prototype) contains the relevant information in an organized and sequenced manner. The virtual patient case scenario on the virtual reality platform will be helpful as a teaching and learning modality. The study concluded that the present virtual simulated case scenario (prototype) with more cases helps to develop functional diagnosis and clinical reasoning skills as a part of the undergraduate physiotherapy curriculum.

Decoding Human Personality Through Dermatoglyphics.

Background Dermatoglyphics refers to the study of epidermal ridges or patterns on fingers (fingerprints) and palms (palmprints). These epidermal ridges grow concurrently with a fetus's neural development during the intrauterine stage of life. Determining genetic anomalies using dermatoglyphics can help identify congenital deformities, various other medical conditions, and how the brain functions well ahead of time. A self-report questionnaire called the Myers-Briggs Type Indicator (MBTI) is used to identify several psychological traits influencing how people perceive their surroundings and make decisions.  Further investigation of this connection between Dermatoglyphics and Myers-Briggs Personality types can provide helpful insight into understanding a child's potential and perception of the world at a very tender age, student's potential towards a particular profession, and guiding their career choices. Understanding a child's personality type can give the parents an edge over understanding and catering to their emotional and social needs, hiring qualified employees, etc.  Objective The study aims to clarify the connection between Myers-Briggs personality types by utilizing fingerprint patterns. Methodology An analytical cross-sectional study was conducted on 200 consenting students aged 25-30 years in a rural Medical School in the backdrop of central India. The study duration was two months, and the data collection was based on NERIS Type Explorer (based on the Myers-Briggs 16 personality type). The study involved the collection of fingerprints by using ink (type) and paper. At the same time, the data analysis was done statistically using the chi-square test. Result Statistically, a significant association was found between a few of the personality types and fingerprint patterns using the chi-square test (P=0.05, Significant) for INTJ with whorl, INTP with whorl (two cores), INFJ with ulnar loop, ENFJ with ulnar loop, ENFP with ulnar loop, ESTJ with ulnar loop, ISTP with ulnar loop, ISFP with ulnar loop and ESTP with composite. Additionally, more than 90% of the subjects were satisfied with the accuracy of the results of the Questionnaire (Survey questionnaire by NERIS Type Explorer). Conclusion The study found that participants with the left loop/right loop fingerprint type made up the majority and had more moderate personality qualities. Left loop's overall average was the highest of the 16 personality types, showing that people with this fingerprint type typically exhibited apparent personality features. The 16 personality components' total average for arch/whorl was second highest, specifically in the constructs of "socially harmonious method of operation," "strong sense of responsibility," "enthusiastic attitude," and "concern for others' well-being." The total average of the arch/whorl fingerprint type was higher than the S-type/right loop fingerprint type in these four constructs, demonstrating that participants with this fingerprint type showed good leadership abilities. INFJ personality type seems to be the most occurrent among the studied population, as the study was conducted with medical school students.

Evaluation of a Product-Centered Learning Behaviors for Adolescent and Adult Learners Using a Validated Learning Behavior Questionnaire: A Mixed-Method Analytical Cross-Sectional Study.

BACKGROUND:  A learner transitions from being a primary learner to an adolescent learner and further to an adult learner in his/her academic life. The learners exhibit specific learning behaviors at all stages of learning, the mapping of which is required for optimization of learning. PRIMARY OBJECTIVE:  To assess the product-centered learning behaviors in adolescent and adult learners using a validated learning behavior questionnaire. SECONDARY OBJECTIVES:  To develop a self-monitoring checklist and a Set, Train Your Mind, Apply, and Reinforce (STAR) matrix from the learning behavior questionnaire. MATERIAL AND METHODS: It was a mixed-method analytical cross-sectional study. A total of 944 learners participated in the study, out of which 456 were adolescent learners (11-16 years) from an English-medium school (Central Board of Secondary Education (CBSE)) and 488 were adult learners (18-23 years) from a health professional institute. The quantitative component of the study was the validated learning behavior questionnaire, in which the study participants had to rate listed items on a scale of 0, 1, and 2. The qualitative component of the study was the focus group discussions (FGDs), which were conducted each for group of adolescent and adult learners. All the responses were tabulated and statistically analyzed using STATA-14 software. RESULTS: The mean scores of product-centered learning behaviors was significantly higher in adult learners as compared to adolescent learners. The findings of the qualitative component evaluated were in tune with the findings of the analysis of the learning behavior questionnaire. The self-monitoring checklist and STAR matrix were generated from the validated learning behavior questionnaire. CONCLUSION:  The evolved self-monitoring checklist and STAR matrix may aid in the assessment of learning behaviors and facilitate the inculcation of learning behaviors amongst adolescent and adult learners.

Stages of Concern of Medical Faculty toward Adoption of Competency-based Medical Education in India: A Multicentric Survey.

Context: Currently, a major curricular reform in the form of competency-based medical education (CBME) curriculum is being rolled out across all medical colleges in India. However, it is important to find out and address the concerns of faculty regarding various aspects of this new curriculum. Aim: To analyze the concerns of the faculty members of medical colleges in India in response to the changes emerging from the adoption and implementation of the new curriculum through the concerns-based adoption model by applying the stages of concern (SoC) questionnaire. Methodology: A multicentric, cross-sectional quantitative study involving faculty members currently working in medical colleges and with more than 2 years of teaching experience was conducted using SoC questionnaire (SoCQ). The questionnaire was delivered as Google Form. Results: Of the 744 faculty participants, 41.1% (306) of faculty belonged to the 31-40 years age group followed by the 41-50 years age group (267, 35.9%). Respondents rated their level of concern differently among the seven SoC - percentile scores were highest in Stage 0- awareness (94) and least in Stage 4- consequences (59). An appreciably higher percentile scores were seen at the consequences stage (63 vs. 54), collaboration stage (80 vs. 68), and refocusing stage (77 vs. 69) in those faculty members who were trained in curriculum implementation support program (CISP) compared to the untrained group. However; the SoCQ profiles of CISP trained and untrained faculty were very much similar. SoCQ profiles of holders of advanced training in medical education and non-holders were also the same. Conclusion: Almost after 2 years of well-planned introduction of the CBME curriculum in India, the generalized faculty profile is still suggestive of interested but non-user type for the adoption of CBME. However; compared to untrained faculty, CISP trained faculty is more concerned about the impact of CBME on students, collaborating with colleagues for its proper implementation and exploring more benefits from the implementation of CBME, indicating that more hand-holding is required for faculty development beyond CISP.

Enhancing Dental Students' Understanding of Behavior Management in Pediatric Dentistry: A Comparison of Two Teaching Methods.

Aim Communication, behavioral, and attitudinal skills are an integral part of teaching behavior management to dental undergraduate students. Due to the complexity of these skills, clinical teaching through the didactic method imparts minimal capacity for adopting a deep approach to learning. The implications of role play and group discussion could be an opportunity to facilitate such learning outcomes. The objectives of this study were to evaluate and compare the efficacy of role play and group discussion as teaching-learning methods for behavior management in pediatric dentistry. Material and methods The study was carried out with 92 final-year Bachelor of Dental Surgery (BDS) undergraduate students at Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, India. The Tell-Show-Do and non-pharmacological behavior management techniques were taught to the intervention and control groups by the role-play and group discussion methods, respectively. To assess knowledge gain, a pre-test and post-test were conducted. To evaluate the acquisition of communication, behavioral, and attitudinal skills, students were made to perform a clinical procedure, i.e. placement of pit and fissure sealant in primary molars. Each student was evaluated by direct observation using a checklist. Results The results revealed a statistically significant difference between the post-test scores of the role-play and group discussion methods, with average values of 8.57±0.98 and 6.97±0.12, respectively (p= 0.020). The average scores of communication and attitudinal skills among the intervention and control groups were 19.70±0.87 and 13.98±1.51, respectively (p=0.027). Hence, the role-play method was found to be a highly effective method. Conclusion Role-play as a teaching tool was highly effective in instilling behavior management skills among students to deal with young patients in clinical situations as compared to the group discussion method. The difference is depicted in higher scores in the intervention group.

Applying visual mapping techniques to promote learning in community-based medical education activities.

BACKGROUND: Teaching and learning Community-Based Medical Education (CBME) requires the active engagement of students in various activities to cover planned curricular content. CBME being multifaceted involves careful application and formation of links when attending to community health problems and public health issues. Students often depend on factual recall rather than 'engaging in', to counteract the broad and comprehensive nature of CBME. This study was conducted to assess the effectiveness of Visual mapping techniques as a learning tool in a CBME program for the subject Community Medicine and thereby assist medical undergraduate students in overcoming identified learning challenges. METHODOLOGY: An interventional study was conducted where medical undergraduates were randomly assigned to two different groups (each group = 30). After sensitization, a broad theme was taught to both the groups as a part of community-based teaching (CBT), each week for a month. The students in the intervention group were given the assignment to draw visual maps using the mind mapping & concept mapping techniques, after each CBT session, while the control group had Question-Answer session with built-in discussion (Conventional method) by an equally qualified, experienced faculty with no mapping assignments. A surprise written examination was conducted on the topics taught, and scores of both the groups were compared. Feedback was obtained from the intervention group. RESULTS: Mean score of the examination by the intervention group (29.85 ± 3.22) was significantly higher than and that of the control group (23.06 ± 4.09) (t = 7.14 and p < 0.05). The students shared that the assignment of drawing mind and concept maps for topics taught helped in attempting questions of the written examination by facilitating easy recall of the information learned. It aided to frame the answers to descriptive questions in a structured way with the use of keywords. However, identifying the concepts and establishing relationship between them was slightly challenging. CONCLUSION: 'Visual mapping' in the form of Mind and Concept mapping was found to be an effective learning tool for multifaceted CBME especially in promoting meaningful learning and facilitating rational thinking by the medical undergraduates.

Introduction of Class-room quality circles among 1st year MBBS students and its effect on students learning.

AIM: The aim of this interventional study was to introduce classroom quality circles (QCs) among first-year MBBS students, to assess the effectiveness of QCs on learning experience of the students, and to evaluate the students' satisfaction level during the process of learning. MATERIALS AND METHODS: A problem pool was created through a questionnaire. The study was carried out in the department of biochemistry, for a period of 6 months. Student's quality circle (SQC) group of five students was created. Then, feedbacks were collected from students by SQC after every class/topic delivered, and fortnightly meeting was held between the SQC group and faculty members of the department, and issues were brought to focus depending on these feedbacks collected by them. Possible initiatives and improvements were done on teaching-learning strategies depending on the outcome of these discussions. RESULTS: The effectiveness of SQC group was assessed by a pre-post questionnaire (Questionnaire-3) feedback from the students and scoring was done based on 5-point Likert scale. There was a statistically significant difference (P = 0.009) between the mean of pre-post questionnaire. To analyze the students' satisfaction level, a set of questionnaires were given to them and scoring was done. Thirty-four students agreed, 11 students were neutral, and 6 students were disagreed, that introduction of SQC was effective in solving their problems related to teaching and learning of biochemistry. CONCLUSION: SQC creates an environment of student centric, fairness, student empowerment, improving solving skills. Implementation of student-generated feedback through introduction of SQC has improved the quality of the course as well as its delivery. It complements and supplements in achieving students intended learning outcome and hence may contribute to overall learning quality in the long run.

Curriculum Evaluation of Physiology subject of medical undergraduate using 'FIPO model'.

BACKGROUND: After the formal process of developing/revising and implementing the curriculum, the need arises for its 'Evaluation'. A plan of evaluation is an integral part of the process of curriculum development, which ultimately yields an evaluation report, giving us the directives for the curriculum reforms in the future. 'Curriculum Evaluation' is one of the six steps of curriculum development as given by David E Kern. OBJECTIVE: The present study was undertaken with an objective to evaluate the whole process of curriculum revision and effectiveness of the Physiology curriculum in achieving the goals, objectives, and outcomes. METHODOLOGY: A framework or model is developed named 'FIPO model' of curriculum evaluation. According to this, all four components (Formative phase, Input, Process, Output and Outcome) are evaluated for the 'Curriculum'. In addition, the model also states the key/concerned person/persons responsible and the assessment/monitoring modality for each component. RESULT: All parameters included in the 'Formative phase' of the model, helped to evaluate the initial preparation for carrying out the curriculum revision. For 'Input' evaluation, various resources of Physiology department for curriculum revision, implementation, and evaluation, were assessed. It includes Manpower, Infrastructure, Material, Time, Money, etc. The third component of the FIPO model, i.e. process evaluation dealt with two processes, i.e. curriculum revision and curriculum implementation. Evaluation of 'Output and Outcome' of the entire exercise of undertaking curriculum revision was undertaken. CONCLUSION: The curriculum evaluation report stated that the curriculum of Physiology subject of MBBS (Phase I) is revised, implemented and evaluated systematically as per the prescribed guidelines using the available resources in an effective and efficient manner. The demonstrable output for the same was the document of 'Revised Curriculum' and significant outcomes were in the form of satisfactory result and distinctions for the subject Physiology.

Effectiveness of formal training in bioethics of 3rd semester undergraduate medical students in recognizing bioethical issues and principles in patient care.

INTRODUCTION: Despite well-described code of conduct for physician the recent increase in litigation against doctors is an issue of concern which says that doctors and health professionals are confronted with many ethical problems regularly. The aim of the present study was to see the ability to recognize different bioethical issues in relation to patient care among 3rd semester undergraduate students and also the change in the pattern of recognition of bioethical issues after formal training. METHODS: This cross-sectional study was carried out using self-administered questionnaire among the fifty 3rd semester undergraduate MBBS students. Each question was designed in a "Likert scale" pattern carrying a minimum score of 1 (1 = strongly disagree) and maximum score of 5 (5 = strongly agree). After 6 months of training and bedside clinical exposure, students were assessed again with same set of questionnaire. The statistical analyses were performed using SPSS 17.0. RESULTS: All of the respondents in the study group were of the opinion that medical ethics is very important but only 24% aware about existence of ethics committee in the institute. Changes has been observed after clinical exposure in response like disclosure of patient's condition to close relatives (agreed 54% versus 84% pre and postexposure, respectively) and discussion of related ethical issues with clinical case discussion (agreed 74% versus 94% pre and postexposure, respectively). Some of the issues needs further clarification even after clinical exposure like doctors must not refuse to do abortion (56% disagreed and 38% agreed), consent regarding treatment in children (60% disagreed and 32% agreed), and uses of branded versus generic drugs (76% generic and 26% branded). CONCLUSION: There is a need to stress the importance of ethical practice in the undergraduate curriculum to make the doctors confident enough to deal the ethical dilemma for themselves and better professional efficiency.

Skill Learning Through Early Clinical Exposure: An Experience of Indian Medical School.

INTRODUCTION: Indian Medical curriculum being discipline based, there is a line of demarcation between preclinical and clinical subjects. The challenges in medical education include the methods that would enhance the clinical education quality; one such method been Early Clinical Exposure (ECE). ECE can help to instill the skill component of medical education in the first year students helping to minimize the line of demarcation. Hence this study was undertaken to assess the skill learning of students through early clinical exposure and to collate the perception of them. MATERIALS AND METHODS: In the present study, students of 1(st) MBBS were exposed to ECE as an adjunct teaching method with preset modules. They were evaluated by Objectively Structured Clinical Examination (OSCE). Feedback was obtained from 1(st) MBBS and also from the same students after passing the 1(st) MBBS in 4(th) semester. RESULTS: Significant differences in pre and post OSCE scores were noted (p<0.0001). Seventy six percent students rated ECE as an excellent tool. Second year students also perceived ECE held in 1(st) year was helpful to correlate topics and increasing confidence. CONCLUSION: ECE had an effective influence on learning as manifested in skills gained by the students and their perceptions of ECE being helpful prospectively in their routine clinical posting.

Fostering Educational Research among Medical Teachers: Evaluation of a Faculty Development Program in India.

INTRODUCTION: Medical education can be enormously benefitted from research. Since clinicians/medical teachers are directly involved in teaching learning processes, they should participate in Educational Research (ER) practices to generate evidence and insights about teaching learning. Faculty Development Program (FDP) has a positive influence amongst health professionals and therefore can prove to be of consequence in instilling a strong educational research culture. AIM: Present study was undertaken to evaluate the efficacy of a Faculty Development Fellowship Program in Medical Education to foster educational research culture amongst medical teachers. MATERIALS AND METHODS: Study utilized the Kirkpatrick model of program evaluation for evaluating the fellowship program. It aimed to evaluate the third level of the model i.e., "Change in Behaviour" of participants (n=40) after completion of the course. The tool used was a pre-validated survey questionnaire consisting of five items. RESULTS: Study population was sparsely aware about educational research and had never attempted the same (100%) before joining the fellowship program. A 32.5% faculty with average professional experience of seven years undertook new educational projects after the fellowship and knowledge gained during fellowship program helped them in guiding educational research (coded into four categories) at their workplaces. CONCLUSION: There is a need, to direct effort towards focused training for educational research through FDPs for medical teachers. This will encourage academicians and clinicians to become active in ER and guide policies in Teaching Learning Practices in Medical Education.

Peer Teaching to Foster Learning in Physiology.

INTRODUCTION: Peer teaching is an effective tool to promote learning and retention of knowledge. By preparing to teach, students are encouraged to construct their own learning program, so that they can explain effectively to fellow learners. Peer teaching is introduced in present study to foster learning and pedagogical skills amongst first year medical under-graduates in physiology with a Hypothesis that teaching is linked to learning on part of the teacher. MATERIALS AND METHODS: Non-randomized, Interventional study, with mixed methods design. Cases experienced peer teaching whereas controls underwent tutorials for four consecutive classes. Quantitative Evaluation was done through pre/post test score analysis for Class average normalized gain and tests of significance, difference in average score in surprise class test after one month and percentage of responses in closed ended items of feedback questionnaire. Qualitative Evaluation was done through categorization of open ended items and coding of reflective statements. RESULTS: The average pre and post test score was statistically significant within cases (p = 0.01) and controls (p = 0.023). The average post test scores was more for cases though not statistically significant. The class average normalized gain (g) for Tutorials was 49% and for peer teaching 53%. Surprise test had average scoring of 36 marks (out of 50) for controls and 41 marks for cases. Analysed section wise, the average score was better for Long answer question (LAQ) in cases. Section wise analysis suggested that through peer teaching, retention was better for descriptive answers as LAQ has better average score in cases. Feedback responses were predominantly positive for efficacy of peer teaching as a learning method. The reflective statements were sorted into reflection in action, reflection on action, claiming evidence, describing experience, and recognizing discrepancies. CONCLUSION: Teaching can stimulate further learning as it involves interplay of three processes: metacognitive awareness; deliberate practice, and self-explanation. Coupled with immediate feedback and reflective exercises, learning can be measurably enhanced along with improved teaching skills.

Role of information communication technology in higher education: learners perspective in rural medical schools.

BACKGROUND: Higher education has undergone profound transformation due to recent technological advancements. Resultantly health profession students have a strong base to utilize information technology for their professional development. Studies over recent past reflect a striking change in pattern of technology usage amongst medical students expanding prospects exponentially by e-books, science apps, readymade power-point presentations, evidence based medicine, Wikipedia, etc. Aim & Objectives: The study was undertaken with an aim to explore the general perceptions of medical students and faculties about the role of Information Communication Technology in higher education and to gauge student's dependence on the same for seeking knowledge and information. STUDY DESIGN: Cross-sectional, mixed research design. MATERIALS AND METHODS: The study was conducted in Department of Physiology, Datta Meghe Institute of Medical Sciences (Deemed University). Study population included students (n=150) and teaching faculty (n=10) of I(st) phase of medical curriculum. The survey questionnaire (10 closed ended and 5 open ended items) and Focus group discussion (FGD) captured the perceptions and attitudes of students and faculties respectively regarding the role and relevance of technology in higher education. OBSERVATIONS AND RESULTS: Quantitative analysis of closed ended responses was done by percentage distribution and Qualitative analysis of open ended responses and FGD excerpts was done by coding and observing the trends and patterns respectively. Overall the observations were in favour of increasing usability and dependability on technology as ready reference tool of subject information. Learners valued text books and technology almost equally and regarded computer training as a desirable incorporation in medical curriculum. CONCLUSION: Role of technology in education should be anticipated and appropriate measures should be undertaken for its adequate and optimum utilization by proper training of students as well as facilitators.

Accidental unilateral and incomplete strangulation injury in a patient while traveling on a bicycle.

Chunni (a piece of cloth worn around the neck by many Indian women) is a well recognized accidental ligature around the neck. We report a rare case of accidental strangulation with chunni where the patient was pillion rider on bicycle; in spite of very common of use of bicycle to best our knowledge this kind of injury has not been reported previously.