COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions of Medical Students after 2 Years.

Undergraduate healthcare students were mobilized to support healthcare systems during the COVID-19 pandemic, but we have scarce information regarding their experience and its impact on their wellbeing. An anonymous online survey was conducted among undergraduate students and recently graduated physicians of a medical university in Spain, regarding their symptoms and volunteering experience during the initial months of the Spanish COVID-19 pandemic. Respondents showed a high prevalence of perceived stress, anxiety, and depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported healthcare-related volunteering tasks. Volunteering was a satisfactory experience for most of the respondents and the majority felt ready to do volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate specific-task education before starting, 20.8% reported not having appropriate supervision, and 33.3% feel they did not have proper protective equipment. More than half of volunteers feared getting infected, more than 70% feared infecting their relatives or friends, and 54.2% reported stigmatization. Volunteers showed significantly higher stress, anxiety, and depression scores than the rest of the respondents, and 32% reported a highly traumatic event during volunteering, with high scores on the IES-R in the 16% of volunteers. Our results should help guide future potential volunteering processes in emergencies, enhance academic programs at medical schools and provide valuable data for psychological support services.

Improvement of medical students' performance in simulated patient interviews by pre-clinical communication training.

Objectives: To compare the communication skills shown by medical students during simulated patient interviews between those who received training in communication during the preclinical years and those who did not. Methods: A retrospective study was conducted to analyze the communication skills of several cohorts of fourth-year medical students from Universitat Internacional de Catalunya during simulated patient interviews. Out of a total of 477 students included in the study, 229 (48%) had received training in communication skills through a 60-hour elective course during the preclinical second year, while the remaining 248 (52%) had received none. Communication skills were assessed by an evaluation team using a numerical scale (0 to 10) that included eight categories: "verbal", "non-verbal", "empathy", "concreteness", "warmth", "message content", "assertiveness", and "respect". Scores obtained by trained and non-trained students were compared using the t-test. Results: A trend towards obtaining better results was observed among students who had received communication training (mean score: 6.98/10) versus none (6.83/10, t(1,869)=-1.95, p=0.05). Non-trained male students obtained significantly lower mean scores than non-trained females in the categories of "respect" (7.48/10 vs. 7.83/10, t(968)=-2.89, p<0.01), "verbal communication" (6.87/10 vs. 7.15/10, t(968)=-2.61, p=0.01), "warmth" (6.53/10 vs. 6.95/10, t(968)=-3.40, p<0.01), and "non-verbal communication" (6.49/10 vs. 6.79/10, t(968)=-2.48, p=0.01). Trained female and male students had similar scores. Conclusions: Training in communication skills during the preclinical years may improve fourth-year students' performance in simulated interviews with patients, particularly among males. These results demonstrate the importance of introducing specific training in communication skills early in the undergraduate medical curriculum.

COVID-19: Making the Best out of a Forced Transition to Online Medical Teaching-a Mixed Methods Study.

Introduction: The first wave of the COVID-19 pandemic resulted in a decreed confinement in Spain from March until the end of term in June 2020, forcing an abrupt transition to exclusive distance learning in universities. We aimed to describe and analyze the perceptions and experiences of undergraduate medical students and faculty members as a consequence of this educational shift so as to identify the key elements for successful online medical learning. Methods: A convergent mixed methods design was employed, using both quantitative and qualitative data collected successively through Phase 1: Online teaching follow-up program; Phase 2: Discussion groups (two focus groups and a nominal group with students and faculty, respectively) and a survey of students from first to fifth year; and Phase 3: Triangulation of qualitative and quantitative data. Results: Thirteen strongly interconnected categories were identified. Four of them played an organizational role: course planning, coordination, communication, and pedagogical coherence. The remaining nine categories were learning outcomes, teaching methodology, online resources, evaluation, time management, workload, student motivation, participation, and teacher-student relationship. Among the key aspects of learning were those that promoted rapport between faculty and students, such as synchronous sessions, especially those based on clinical cases. Conclusions: Promoting student motivation and participation at all levels were the main lessons learned for enhancing online learning and teaching experiences in undergraduate medical education. Key elements to reach this goal are, among others, planning, coordination, communication, and pedagogical coherence. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01518-9.

¿Aprender Medicina a distancia?: percepción de estudiantes confinados por la pandemia COVID-19

Background: The suspension of face-to-face teaching activity due to the COVID-19 pandemic forced an abrupt transition to distance learning in Spanish universities. Aim: To know how medical students value distance learning in the context of COVID-19 pandemic. Material and Methods: Undergraduate medical students from first to fifth year in Barcelona (Spain) were invited to answer an anonymous online survey about their perceptions and level of satisfaction with virtual learning. Results: Of 483 students invited to the survey, 244 (50.5%) answered it. Respondents from the first and second year rated distance learning as acceptable (mean 3.1) on a Likert scale from 1 to 5. Those from third to fifth years rated distance learning as unsatisfactory (mean 2.7). The best evaluated aspects were synchronous lectures (3.9) and lectures based on cases (3.4). The worst evaluated issues were motivation (2.3), interaction with faculty (2.1), and additional workload (0.7). Conclusions: The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.

[Perceptions of students confined by the COVID-19 pandemic on distance learning in medicine]. / ¿Aprender Medicina a distancia?: percepción de estudiantes confinados por la pandemia COVID-19.

BACKGROUND: The suspension of face-to-face teaching activity due to the COVID-19 pandemic forced an abrupt transition to distance learning in Spanish universities. AIM: To know how medical students value distance learning in the context of COVID-19 pandemic. MATERIAL AND METHODS: Undergraduate medical students from first to fifth year in Barcelona (Spain) were invited to answer an anonymous online survey about their perceptions and level of satisfaction with virtual learning. RESULTS: Of 483 students invited to the survey, 244 (50.5%) answered it. Respondents from the first and second year rated distance learning as acceptable (mean 3.1) on a Likert scale from 1 to 5. Those from third to fifth years rated distance learning as unsatisfactory (mean 2.7). The best evaluated aspects were synchronous lectures (3.9) and lectures based on cases (3.4). The worst evaluated issues were motivation (2.3), interaction with faculty (2.1), and additional workload (0.7). CONCLUSIONS: The perceptions expressed by these students reinforce the importance of facilitating communication, motivation and participation of students in distance learning in Medicine.

Evaluación de competencias en comunicación clínica en estudiantes de medicina con paciente simulado / Evaluation of clinical communication skills in medical students with simulated patients

Background: Communication skills are not learnt innately. It is therefore necessary to both train and evaluate medical students in this area. Aim: To evaluate communication skills of fourth-year medical students with the use of a simulated patient (SP). Material and Methods: Four clinical scenarios (CS) for clinical interviews with simulated patients were designed: chronic and acute diseases, difficult and functional patients. Each student performed the four CS, and his communication skills were evaluated using our own questionnaire as agreed with the SP. The questionnaire included items on verbal and nonverbal communication, warmth, respect, specificity, assertiveness and empathy (rated from 0 to 10). The response variable was the arithmetic mean of the scores on each item. All students received a detailed evaluation report. Results: Sixty one students (32 men) performing 244 interviews, were evaluated. The overall mean score was 7.87 (4.62 to 9.03). The highest scores were for respect and specificity (7.57 and 7.15 respectively). The lowest were for empathy and nonverbal communication (6.44 and 6.84 respectively). The CS evaluations were 7.87 (chronic disease), 7.02 (difficult patient), 6.46 (acute disease) and 6.14 (functional pathology). Women had higher overall scores compared to men (7.26 and 6.51 respectively; p < 0.01) and a significantly higher score in all communication variables (p < 0.01). Conclusions: The overall assessment in clinical communication with SP is satisfactory although there is room for improvement, especially in empathy and nonverbal communication. Women had significantly higher scores than men.

Psychometric properties of the Spanish version of the Jefferson Scale of Empathy: making sense of the total score through a second order confirmatory factor analysis.

BACKGROUND: Empathy is a key aspect of the physician-patient interactions. The Jefferson Scale of Empathy (JSE) is one of the most used empathy measures of medical students. The development of cross-cultural empathy studies depends on valid and reliable translations of the JSE. This study sought to: (1) adapt and assess the psychometric properties in Spanish students of the Spanish JSE validated in Mexican students; (2) test a second order latent factor model. METHODS: The Spanish JSE was adapted from the Spanish JSE-S, resulting in a final version of the measure. A non-probabilistic sample of 1104 medical students of two Spanish medical schools completed a socio-demographic and the Spanish JSE-S. Descriptive statistics, along with a confirmatory factor analysis, the average variance extracted (AVE), Cronbach's alphas and composite reliability (CR) coefficients were computed. An independent samples t-test was performed to access sex differences. RESULTS: The Spanish JSE-S demonstrated acceptable to good sensitivity (individual items - except for item 2 - and JSE-S total score: -2.72 < Sk < 0.35 and -0.77 < Ku < 7.85), convergent validity (AVE: between 0.28 and 0.45) and reliability (Cronbach's alphas: between 0.62 and 0.78; CR: between 0.62 and 0.87). The confirmatory factor analysis supported the three-factor solution and the second order latent factor model. CONCLUSIONS: The findings provide support for the sensitivity, construct validity and reliability of the adapted Spanish JSE-S with Spanish medical students. Data confirm the hypothesized second order latent factor model. This version may be useful in future research examining empathy in Spanish medical students, as well as in cross-cultural studies.

Aprendizaje de las competencias de investigación en el Grado de Medicina: análisis y evaluación de las calificaciones de los estudiantes en el Trabajo de Final de Grado / Learning to perform research in the degree of medicine: analysis and evaluation of the student ratings of the final degree dissertation

La adaptación al Plan Bolonia del Grado de Medicina en España ha introducido en los planes de estudio la realización del Trabajo de Final de Grado (TFG). A continuación se presenta un modelo de TFG y se estudia la validez de un sistema de evaluación de las calificaciones para medir los resultados del aprendizaje de las competencias de investigación y pensamiento crítico. Se evaluaron 62 trabajos. Para su realización los estudiantes contaron con un equipo de tutores expertos en investigación clínica y en metodología. El trabajo fue evaluado por tres profesores, cada uno completó una rúbrica de 10 ítems. La validez del sistema de evaluación se analizó mediante el modelo de múltiples facetas de Rasch, que permite estudiar las diferencias en la severidad de los evaluadores, los resultados de los estudiantes y la dificultad de los ítems. Se calificaron los trabajos de 62 estudiantes, totalizando 186 rúbricas. El 58% de los estudiantes mostraron una habilidad superior a la severidad de los evaluadores y a la dificultad de los ítems de la rúbrica. No se observaron diferencias significativas en la severidad de los evaluadores, ni en las calificaciones finales según el tipo de evaluador. El ítem más difícil para los estudiantes fue la selección del diseño epidemiológico del protocolo. El método de análisis propuesto para el TFG es eficaz para evaluar la adquisición de las competencias relacionadas con la investigación y el pensamiento crítico en los estudiantes del último curso del Grado de Medicina

The Bologna Plan applied to the Medicine Degree in Spain has included a final degree dissertation into the coursework. In this manuscript, we analyzed the validity of a rubric and the grading criteria used to assess the students skills in research and their critical thinking. A total of 62 final degree dissertations were evaluated. Each student was supervised by a clinical or epidemiologist researcher. Each dissertation was rated by three academic assistants using a 10-item rubric. The validity of the scores and the differences in the severity of the examiners were analyzed with a multi-faceted Rasch model, which allowed examining severity within evaluators, ability of the students and difficulty of items. 62 final dissertation were evaluated with a total of 186 rubrics. 58% of the students had higher ability than the severity of the evaluators and the difficulty of the items of the evaluation rubric. No significant differences were observed within the severity of the professors, neither within the final scores. The most difficult item for students was selection of epidemiological design. This study showed that the methodology proposed to evaluate the final degree dissertation is effective to assess the skills of conducting research and critical thinking in medicine students

Educational climate perception by preclinical and clinical medical students in five Spanish medical schools.

OBJECTIVE: The purpose of this study was to investigate student's perceptions of Educational Climate (EC) in Spanish medical schools, comparing various aspects of EC between the 2nd (preclinical) and the 4th (clinical) years to detect strengths and weaknesses in the on-going curricular reform. METHODS: This study utilized a cross-sectional design and employed the Spanish version of the "Dundee Ready Education Environment Measure" (DREEM). The survey involved 894 2nd year students and 619 4th year students from five Spanish medical schools. RESULTS: The global average score of 2nd year students from the five medical schools was found to be significantly higher (116.2±24.9, 58.2% of maximum score) than that observed in 4th year students (104.8±29.5, 52.4% of maximum score). When the results in each medical school were analysed separately, the scores obtained in the 2nd year were almost always significantly higher than in the 4th year for all medical schools, in both the global scales and the different subscales. CONCLUSIONS: The perception of the EC by 2nd and 4th year students from five Spanish medical schools is more positive than negative although it is significantly lower in the 4th year. In both years, although more evident in the 4th year, students point out the existence of several important "problematic educational areas" associated with the persistence of traditional curricula and teaching methodologies. Our findings of this study should lead medical schools to make a serious reflection and drive the implementation of the necessary changes required to improve teaching, especially during the clinical period.

Aplicación de un modelo híbrido de aprendizaje basado en problemas como estrategia de evaluación e interrelación ‘multiasignaturas’ / Application of a hybrid model of problem-based learning as a strategy for assessment and the integration of ‘multiple subjects’

Se ha diseñado e implementado un modelo 'híbrido' de aprendizaje basado en problemas (ABP) como estrategia de enseñanza, evaluación e interrelación de las asignaturas de 'Fisiopatogenia' y 'Semiología' del grado de medicina de la Universitat Internacional de Catalunya. El modelo hibrido ha sido diseñado sobre la plataforma de tecnología de la información Moodle que facilita su desarrollo con menos recursos. El ABP implementado funciona como una actividad integradora que trata de fomentar el desarrollo de competencias transversales y el pensamiento complejo, en un entorno de aprendizaje activo. Promueve en el estudiante la construcción de su propio conocimiento para el desarrollo de competencias como el razonamiento clínico y la toma de decisiones, al tiempo que posibilita la integración de los conocimientos procedentes de distintas asignaturas. Los resultados de este trabajo han reflejado un alto grado de satisfacción del alumnado con la metodología fundamentada en el ABP, habiéndose logrado una participación activa en el proceso enseñanza aprendizaje

A 'hybrid' model of problem-based learning (PBL) was designed and implemented as a teaching strategy, assessment and means to integrate knowledge related to the subjects 'Physiopathogenesis' and 'Semiotics' of Medicine in the Universitat Internacional de Catalunya. The hybrid model was designed within the e-learning platform, Moodle, which facilitates the development of PBL methodology but with fewer resources. PBL functions as an integrative activity which seeks to promote development of generic skills and complex thought in an active learning environment. PBL encourages students to construct their own knowledge for the development of skills such as clinical reasoning and decision-making, while enabling the integration of knowledge from different subjects. The outcomes of this project indicate a high degree of student satisfaction with this PBL-based methodology as has been manifested by the achievement of active participation in the teaching-learning process