Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school.

BACKGROUND: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school. METHOD: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. RESULTS: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. CONCLUSIONS: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Design of a Learning Development Program to Support First-Year Undergraduate Medical Students in the Transition to a PBL Curriculum.

While the evaluation of learning development interventions needs to be considered carefully and included at the curriculum design stage, there is limited literature on the actual design of interventions, especially on how these designs evolve and improve over time. This paper describes the evolution of a learning development program intended to support first-year medical students adjusting to a problem-based learning curriculum. We used a design-based research approach, articulating our theoretical grounding and incorporating students' voices to develop an "optimal" intervention for the specific challenges in our context. We describe lessons learned around four aspects: students' growth and development, teachers' professional growth and development, program design principles, and the emergent components of a learning development program. Overall, our students describe the Learning Success Program as adding value by enabling the adoption of a repertoire of skills and strategies for learning management. Additionally, the incremental nature of design-based research allowed for the development of a context-specific program that considers students' voices through needs assessment and feedback on the program offerings. It has also provided an opportunity for the professional development of teachers through feedback from classroom practice, reflection, and the literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01790-3.

Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training.

BACKGROUND: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers' abilities to provide quality care to patients of color.In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. OBJECTIVES: We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. METHODS: Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. RESULTS: PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. CONCLUSIONS: Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.

Enhancing learning in longitudinal clinical placements in community primary care clinics: undergraduate medical students' voices.

Longitudinal clinical placements are increasingly adopted by medical training institutions. However, there seems to be little evidence regarding their implementation in primary care settings in the developing world. This paper explored medical students' perceptions of their learning experiences in longitudinal placements in primary care clinics. The Manchester clinical placement index (MCPI) survey was offered to second-year medical students at the University of Botswana to determine perceptions of their 16 weeks clinical placement in primary care clinics. The MCPI provided data on eight aspects of clinical placements which were analysed to gain insight into students learning experiences while on placement. The eight items in the tool were grouped into four themes, namely, teaching and learning, learning environment, relationships and organisation of placements. Students cited the feedback they received whilst on placement and the learning environment in primary care clinics as aspects of clinical placements which could be improved to enhance their learning experience. For an enriched learning experience in primary care settings in a developing world context, there are critical aspects to be considered. Based on the students' perspective we suggest an approach of how learning in such placements could be enhanced.

Using a virtue ethics lens to develop a socially accountable community placement programme for medical students.

BACKGROUND: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, and what are the virtues that are likely to promote and sustain them? METHODS: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre's virtue ethics theory as the conceptual framework. RESULTS: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals' virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. CONCLUSION: This study found that MacIntyre's virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice.

Bring-your-own-device in medical schools and healthcare facilities: A review of the literature.

BACKGROUND: Enabling personal mobile device use through a bring-your-own device (BYOD) policy can potentially save significant costs for medical schools and healthcare facilities, as they would not always have to acquire facility-owned devices. The BYOD policy is also perceived as a driver for balancing user needs for convenience with institutional needs for security. However, there seems to be a paucity in the literature on BYOD policy development, policy evaluation, and evaluation of mobile device implementation projects. OBJECTIVE: This review explored the literature to identify BYOD policy components (issues, interventions, and guidelines) that could potentially inform BYOD policy development and implementation in medical schools and healthcare facilities. METHODS: A literature search on PubMed, Web of Science, and Ebscohost (Academic Search Premier, ERIC, CINAHL, and MEDLINE) was conducted using the following search terms and their synonyms: healthcare facilities, mobile devices, BYOD, privacy and confidentiality, and health records. We developed a review matrix to capture the main aspects of each article and coded the matrix for emerging themes. The database and hand search yielded 1 594 articles, 14 of which were deemed as meeting the inclusion criteria. RESULTS: Several themes emerging from the analysis include: device management, data security, medical applications, information technology, education and/or curriculum, policy, and guidelines. The guidelines theme seems to provide a direction for BYOD policy development and implementation while the policy theme seems to be the comprehensive solution that synergizes BYOD implementation. CONCLUSION: Rather than an approach of 'chasing' issues with interventions, a more feasible approach towards achieving a safe mobile device use environment is through the development of comprehensive BYOD policies that would balance users' need for convenience with organizational security and patient privacy. The paucity in peer-reviewed literature calls for robust research that uses socio-technical approaches to development and evaluation of BYOD policies in medical schools and healthcare facilities.

Learning support interventions for Year 1 medical students: a review of the literature.

CONTEXT: The journey through medical school can be challenging, especially for undergraduate medical students who must deal with a demanding curriculum, coupled with the demands of transitioning into adulthood. Despite experiencing learning challenges, most students succeed with appropriate learning support. Many medical schools offer learning support programmes, particularly in the latter years, but it has been suggested that such support could be more beneficial, especially during the initial years. OBJECTIVES: This review explores learning support intervention programmes used to address learning challenges and deficits in the first year of medical school. Additionally, we propose a potential framework for supporting learning during the first year of medical school. METHODS: We searched PubMed, Web of Science, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Academic Search Premier and Google Scholar using the search terms 'learning support', 'learning challenge', 'remediation', 'change', 'medical education' and 'first year'. We developed and used a review matrix to record the main elements of each article. We also coded the matrix to identify emerging themes. RESULTS: The main themes that emerged from the study were 'intervention approaches', 'area of intervention', 'intervention strategies', 'intervention dose' and 'intervention outcomes'. INTERVENTIONS: (i) used proactive-deficit, reactive-deficit and proactive-developmental approaches; (ii) addressed content knowledge, academic success skills, personal and professional skills and programme-related elements; (iii) utilised faculty staff-facilitated, peer-facilitated, support staff-facilitated, experiential placement, self-study and reduced-load strategies; (iv) varied in length from 5 weeks to 2 years, and (v) generally showed positive results. CONCLUSIONS: This review has identified the main components of learning support interventions used for Year 1 medical students. Interventions, however, are generally not grounded on empirical assessment that elucidates the nature of the challenges faced by students. Future research should provide empirical understanding of the learning challenges to be addressed.

The role of tablets in accessing information throughout undergraduate medical education in Botswana.

BACKGROUND: Mobile learning (mLearning) uses wireless networks and mobile devices to expand physician trainees' and healthcare providers' access to and exchange of medical information. Opportunities to increase implementation and expand use of mobile devices to support health care information access and delivery in Africa are vast, but the rapid growth of mLearning has caused project implementation to outpace objective measurement of impact. This study makes a contribution to the existing body of literature regarding mLearning implementation in Africa through its focus on the use of smart devices (tablets) in undergraduate medical education and medical students' perceptions of the effects on their learning environment. MATERIALS AND METHODS: The population of this prospective mixed-methods study consisted of 82 undergraduate medical students (45 third year and 37 fourth year) at the University of Botswana Faculty of Medicine. They received tablets in the earliest phase of the mLearning project implementation (between November 2012 and January 2013), when they were in the third and fourth year of their medical training. Usage of the tablets was assessed both quantitatively and qualitatively, through both application usage tracking and focus groups. RESULTS: Based on application usage data and coding and analysis of focus group discussions, undergraduate medical students indicated that tablets were useful in their medical education, allowing them continual access to information and opportunities for communication. Participants noted that the primary barrier to use of tablets was the lack of mobile cellular Internet beyond the Wi-Fi zones at the training sites. Moreover, participants offered suggestions for improvements to the implementation process. CONCLUSIONS: Even in resource-limited settings where Internet access can be unreliable and intermittent, the adoption of tablets can have benefits to medical education by providing consistent access to extensive and current medical information resources. This study highlights the value of clinical resources with offline functionality, with or without consistent access to the Internet. There is also the potential for optimizing the use of tablets through improved training and technical support.

A systems approach to implementation of eLearning in medical education: five MEPI schools' journeys.

How should eLearning be implemented in resource-constrained settings? The introduction of eLearning at four African medical schools and one school of pharmacy, all part of the Medical Education Partnership Initiative (MEPI) eLearning Technical Working Group, highlighted the need for five factors essential for successful and sustainable implementation: institutional support; faculty engagement; student engagement; technical expertise; and infrastructure and support systems. All five MEPI schools reported strengthening technical expertise, infrastructure, and support systems; four schools indicated that they were also successful in developing student engagement; and three reported making good progress in building institutional support. Faculty engagement was the one core component that all five schools needed to enhance.

Establishing a new medical school: Botswana's experience.

Having adequate numbers of qualified human resources for health is essential for any effective health care system. However, there is a global shortage of skilled health care workers, especially in Sub-Saharan African countries. This shortage is exacerbated by a disproportionately high rate of infectious diseases, the burden of emerging chronic, noncommunicable diseases, and the emigration of medical doctors. Botswana has also experienced this critical shortage of doctors for many years. To address the shortage, the country in the 1990 s embarked on an aggressive program to train its students at foreign medical schools. Despite intensified training, many graduates have not returned. As a result, the country decided to establish a medical school within Botswana. The newly established school was awarded a grant from the Medical Education Partnership Initiative, which has helped to accelerate the school's development. This paper describes the authors' experiences, highlighting curriculum, staffing, infrastructure approaches, key successes, and challenges encountered. The paper concludes by proposing solutions. The authors' experiences and the lessons learned can inform colleagues in other countries considering similar endeavors.