Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory.

Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.

A common curriculum in obstetrics and gynecology for medical students globally.

OBJECTIVE: Global variations in women's health outcomes, increased international migration, and an increase in the number of medical schools underpin the need for global standardization in obstetrics and gynecology curricula for medical students. However, there are currently no recommendations regarding the content of a common curriculum. The aim of this project was to agree the objectives for a common curriculum in obstetrics and gynecology for medical students globally. METHODS: The curriculum was developed and agreed by an international taskforce of obstetricians and gynecologists. Published curricula for medical students in a variety of regions globally were reviewed and discussed, and the objectives for a common curriculum in obstetrics and gynecology for medical students were agreed by consensus. RESULTS: The content of the proposed curriculum is classified into three domains: clinical skills, professional behaviors, and knowledge. The recommended curriculum covers health conditions that affect women globally in different social and cultural contexts, and addresses important global health issues of relevance to obstetrics and gynecology. CONCLUSION: The methods and outcomes of a project by an international taskforce of obstetricians and gynecologists to develop a common curriculum in obstetrics and gynecology for medical students globally are presented. More work is required to identify ways in which the curriculum may be adapted to a minimum essential required curriculum in times of man-made or natural disasters. Achieving these will facilitate the intended long-term aims of this curriculum, to improve women's health outcomes globally.

Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays.

BACKGROUND: Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS: The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS: The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION: Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.

A literature review and proposed framework for a core curriculum in obstetrics and gynecology for medical students globally.

BACKGROUND: There have been challenges in deciding the curricular content in obstetrics and gynecology (Ob/Gyn) for medical students because the core knowledge, competencies, and duration of Ob/Gyn clerkships, varies widely by country. OBJECTIVES: To investigate current recommendations for Ob/Gyn curricula for medical students globally, in a rapid review of the literature and websites of a selection of medical schools. SEARCH STRATEGY: A targeted search of selected databases (PubMed and Google Scholar) using relevant key words and a search of university websites. SELECTION CRITERIA: Studies that applied to medical or undergraduate students in Ob/Gyn. DATA COLLECTION AND ANALYSIS: A standardized extraction form on Microsoft excel to extract and chart data. MAIN RESULTS: We identified recommendations from national professional bodies (Royal College of Obstetricians and Gynaecologists, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Association of Professors of Gynecology and Obstetrics, and the Turkish-National Core Curriculum), and descriptions from five university websites. We also identified additional objectives, including teaching on intimate partner violence, health priorities in low- and middle-income countries, and a variation in practical skills recommended. CONCLUSIONS: Fitting all the recommended curricula content into medical student Ob/Gyn clerkships is a challenge. A framework to address this, for consideration by the International Federation of Gynaecology and Obstetrics and other stakeholders, is proposed in which priority is given to topics related to emergency Ob/Gyn, history taking, and examination of the pregnant and non-pregnant patient.

Creating a Framework for Medical Professionalism: An Initial Consensus Statement From an Arab Nation.

Background Medical professionalism has received increased worldwide attention, yet there is limited information on the applicability and utility of established Western professionalism frameworks in non-Western nations. Objective We developed a locally derived consensus definition of medical professionalism for the United Arab Emirates (UAE), which reflects the cultural and social constructs of the UAE and the Middle East. Methods We used a purposive sample of 14 physicians working in the UAE as clinical and education leaders. This expert panel used qualitative methods, including the world café, nominal group technique, the Delphi method, and an interpretive thematic analysis to develop the consensus statement. Results The expert panel defined 9 attributes of medical professionalism. There was considerable overlap with accepted Western definitions, along with important differences in 3 aspects: (1) the primacy of social justice and societal rights; (2) the role of the physician's personal faith and spirituality in guiding professional practices; and (3) societal expectations for professional attributes of physicians that extend beyond the practice of medicine. Conclusions Professionalism is a social construct influenced by cultural and religious contexts. It is imperative that definitions of professionalism used in the education of physicians in training and in the assessment of practicing physicians be formulated locally and encompass specific competencies relevant to the local, social, and cultural context for medical practice. Our goal was to develop a secular consensus statement that encompasses culture and values relevant to professionalism for the UAE and the Arab region.

Superficial and deep learning approaches among medical students in an interdisciplinary integrated curriculum.

INTRODUCTION: Students' learning approaches have a significant impact on the success of the educational experience, and a mismatch between instructional methods and the learning approach is very likely to create an obstacle to learning. Educational institutes' understanding of students' learning approaches allows those institutes to introduce changes in their curriculum content, instructional format, and assessment methods that will allow students to adopt deep learning techniques and critical thinking. The objective of this study was to determine and compare learning approaches among medical students following an interdisciplinary integrated curriculum. METHODS: This was a cross-sectional study in which an electronic questionnaire using the Biggs two-factor Study Process Questionnaire (SPQ) with 20 questions was administered. RESULTS: Of a total of 402 students at the medical school, 214 (53.2%) completed the questionnaire. There was a significant difference in the mean score of superficial approach, motive and strategy between students in the six medical school years. However, no significant difference was observed in the mean score of deep approach, motive and strategy. The mean score for years 1 and 2 showed a significantly higher surface approach, surface motive and surface strategy when compared with students in years 4-6 in medical school. DISCUSSION: The superficial approach to learning was mostly preferred among first and second year medical students, and the least preferred among students in the final clinical years. These results may be useful in creating future teaching, learning and assessment strategies aiming to enhance a deep learning approach among medical students. Future studies are needed to investigate the reason for the preferred superficial approach among medical students in their early years of study.

The effect of intermittent maternal fasting on computerized fetal heart tracing.

OBJECTIVE: To determine effects of maternal fasting on antepartum computerized fetal heart tracing analysis. STUDY DESIGN: This was a cross-sectional study of two groups of healthy pregnant women who were recruited, a fasting and a nonfasting control group. Each pregnant woman gave a blood sample, and had a computerized fetal heart tracing. RESULTS: A total of 124 pregnant women were studied. The mean hours since the last oral intake were significantly different between the two groups (p=0.003). Fetuses of fasted mothers had fewer episodes of large acceleration compared to the controls (p=0.001). This difference was significantly associated with maternal appreciation of fetal movement (p=0.003). CONCLUSION: The number of large accelerations in computerized fetal heart tracing is decreased in pregnant women abstaining from food and water.

Women's attitudes towards psychosocial support in labour in United Arab Emirates.

OBJECTIVE: The objective of this study was to determine women's attitudes and preferences regarding psychosocial support during childbirth in United Arab Emirates (UAE). METHODS: A consecutive sample of 400 mothers with singleton normal pregnancies delivered vaginally during 2 months was interviewed postpartum about their experience and satisfaction with supportive care during labour using structured questionnaire. RESULTS: Birth attendant continuously accompanied 237 (59.3%) participants including mother (59.5%), sister (31.2%), friend (7.2%), other family member (1.3%) or husband (0.8%). Preference in the no-companion group ( n=163, 40.7%) was health professional (56.4%), mother (25.8%), sister (16.6%) or husband (1.2%). Labour was significantly shorter ( P<0.0001) with less need for analgesia ( P<0.0001), oxytocin augmentation ( P<0.0001) and neonatal intensive care ( P=0.03) in the companion group. Rates of instrumental delivery, episiotomy and perineal tear were similar in both groups. Three hundred and fifty (87.5%) subjects felt that psychosocial support during childbirth is essential and best provided by non-professional attendant (companion group) or midwife/obstetrician (no-companion group). 59.3% and 19.7% of mothers, respectively, reported less satisfaction and negative feelings about their perinatal experience that was more frequent in the no-companion group ( P=0.001, P<0.0001; respectively). CONCLUSION: Perceptions, experiences and outcomes of companion support during childbirth in UAE, although relatively less available, are therefore not different from those described elsewhere.

Obstetric outcome of excessively overgrown fetuses (> or = 5000 g): a case-control study.

AIMS: To compare the obstetric outcome of excessively- and appropriately-grown fetuses. METHODS: Medical records of mothers who delivered excessively overgrown fetuses, defined as birthweight > or = 5000 g, in our hospital between 1996 and 2000 (n = 47, study group), and a control group who delivered fetuses with normal birthweight (n = 47) were reviewed. RESULTS: Incidence of excessively overgrown fetuses was 0.24% and 68% were boys. Mothers in this group were significantly older, overweight and multiparous (p < 0.0001) and had gestational diabetes mellitus (p < 0.0001) and prolonged pregnancies (p = 0.04). A previous big baby was also significant (p < 0.0001) and the commonest risk factor. There were no obvious risk factors in nine (19.1%) cases. More than half (n = 28, 59.5%) of these babies were delivered vaginally without clinical suspicion of excessive fetal size. Duration of second stage of labor and incidence of maternal trauma were similar in both groups. Cesarean delivery (p = 0.0003), postpartum hemorrhage (p = 0.004), birth asphyxia (p = 0.007), shoulder dystocia (p < 0.0001) and fetal trauma (p = 0.03) were significantly more frequent in the study group. CONCLUSIONS: Excessively overgrown fetuses are associated with the same risk factors as fetal macrosomia and should be delivered by cesarean if diagnosed antenatally because of increased maternal and perinatal morbidity during vaginal delivery.

Women's perceptions of and experiences with medical student involvement in outpatient obstetric and gynecologic care in the United Arab Emirates.

OBJECTIVE: The purpose of this study was to determine the experiences, satisfaction, and comfort of women with medical student participation in outpatient care during obstetric and gynecology clerkships. STUDY DESIGN: A consecutive sample of 303 women who attended the clinic were interviewed before consultation; a structured questionnaire was used. RESULTS: Two hundred sixty-four women (87.1%) accepted student involvement; 158 women (59.8%) and 173 women (66.5%), respectively, preferred female students or preceptors. Comfort levels were significantly lower with male students or preceptors in all skills that were tested (P <.0001), particularly pelvic examination and the discussion of sexual problems. Acceptance was associated significantly with older age (P <.0001), higher parity (P <.0001), higher education (P =.002), husband's occupation (P =.006), obstetric consultation (P <.0001), previous teaching encounters (P =.0006), recognition of the students' roles (P =.004), and satisfaction with clinical service (P = 0.01). Reasons for nonacceptance (n = 39 women, 12.9%) were concern about privacy during examination (53.8%) or counseling (25.6%) and the extent of the students' involvement (20.5%). CONCLUSION: Most women agreed to participate in the teaching of obstetric and gynecologic skills to medical students.