Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative.

PROBLEM: The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic. APPROACH: The authors developed a needs assessment to gauge students' educational requirements, which informed GMEC's 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26-May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors' home institutions. OUTCOMES: Within the first 2 months (April 26-June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial's topic after participating. NEXT STEPS: GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC's mission to promote equity in global medical education, the collaborative will need to be agile and responsive.

Current status and future perspectives of collaboration in surgical research: A scoping review of the evidence.

BACKGROUND: Surgery is rapidly changing in terms of techniques, education, and methods of conducting research. To keep up with this pace, surgeons have recently focused on collaborative research projects. The aim of this review was to investigate practices for collaborations in surgical research. METHODS: A scoping review was conducted according to the guidelines proposed by Peters et al. Publications on patterns of collaboration in surgical research between January 2000 and December 2020, irrespective of the study design or language of publication, which were indexed in PubMed, the Cochrane Library, and Google Scholar, were included. A research librarian assisted in choosing the search terms and conducting the search. The very broad nature of the subject necessitated a pragmatic search strategy, with primary focus on reviews about collaboration. A new form of crowd science was used that explored collaborations using social media and online shared documents. RESULTS: The search identified 38 studies that covered different aspects of collaboration in surgical research. Global, specialist, trainee-/student-led, and patient-led collaboratives are growing in number and size. Implementation of information technologies in surgical collaboration is still limited. The review identified attempts to include researchers from low- and middle-income countries in these collaborations, but these were at the early stages. CONCLUSION: There are many patterns of collaboration in surgical research. Involvement of low- and middle-income countries will lead to capacity building in these countries, fast recruitment for surgical trials, and more generalizability of trial results. Due to the complex nature of surgical research, implementation of information technologies might improve the quality of research.

Interdisciplinarity and interprofessionality in teamwork: perceptions of multiprofessional residents in Hospital Care

Multiprofessional Health Residency Programs were created to further align health training with the needs of the population and, through an emphasis on teamwork, have been contributing to the consolidation of the Brazilian Unified Health System. The present study sought to understand the perceptions of a group of multiprofessional residents in Hospital Care about interdisciplinarity and interprofessionality within the scope of teamwork. This is a qualitative study that had the participation of 29 multiprofessional residents in the 'Hospital Care' area of concentration, all female (six psychologists, six social workers, six nurses, six physiotherapists and five nutritionists). Data were collected by means of a semi-structured interview script. The corpuswas subjected to thematic content analysis. Most of the participants: (1) reported that their first contact with the notion of interdisciplinarity occurred when they were in college, which led to them assimilating it as a synonym for joint action, and (2) claimed to have no knowledge of the notion of interprofessionality, but valued the horizontalization of relations between health professionals. Additionally, important conditions concerning both interdisciplinarity and interprofessionality were not emphasized by the participants. Further studies on the subject are needed, due to its importance for public health.

"Fighting an uphill battle": A mixed methods exploration of surgeon involvement in medical schools' preclinical curricula.

BACKGROUND: Limited exposure to surgeons early on in medical school may adversely impact students' clerkship experiences and professional development. This explanatory sequential mixed methods study investigates a perceived discrepancy between surgical and nonsurgical instructors in our institution's preclinical curriculum. METHODS: The demographics of preclinical faculty were assessed before and after a curricular reform. Semi-structured interviews with 13 surgical faculty explored barriers and facilitators to surgeon involvement. Responses were inductively coded and thematically analyzed. RESULTS: Surgeons' contributions to preclinical instruction fell from 10% to 5% across the curriculum reform. Barriers both leading to and reinforced by surgeons' limited involvement relate to surgeon, medical school, and student factors. Participants proposed three solutions to barriers in each domain. CONCLUSIONS: Surgeons provide a minority of our preclinical instruction and may be disproportionately impacted by reform efforts. Deliberate efforts are necessary to increase opportunities for surgeons to engage with preclinical medical students.

A desafíos comunes, soluciones colaborativas: presentamos el Capítulo de Residentes Ibero Latinoamericanos de ICOPLAST / Common challenges, collaborative solutions: introducing the ICOPLAST Ibero-Latin-American Trainee Chapter

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Synthesis and Assembly of Virtual Collaborations.

The interplay between academics and society within the environment of the COVID-19 pandemic has impacted on scientists across the world, prompting reevaluation of how virtual toolboxes can be used to support responsible collaborative research practices. We provide awareness of virtual resources and activities that enable scientific discovery using safe and efficient practices.

Development of an Operative Trauma Course in Uganda-A Report of a Three-Year Experience.

BACKGROUND: Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice. METHOD: Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater. RESULTS: Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P < 0.05) and road traffic crashes were reported more frequently (39 to 60%, P < 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%). CONCLUSIONS: The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.

Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica / Knowledge and use of clinical coordination mechanisms in healthcare networks in Latin America

OBJETIVO: Analizar el nivel de conocimiento y uso, y las características del uso, de los mecanismos de coordinación clínica entre niveles de atención en redes de servicios de salud de seis países de Latinoamérica. MÉTODO: Estudio transversal mediante encuesta, usando el cuestionario COORDENA®, a médicos de atención primaria y especializada (tamaño estimado: 348 médicos/país) de redes sanitarias públicas de Argentina, Brasil, Chile, Colombia, México y Uruguay (mayo-octubre 2015). Variables analizadas: conocimiento y uso de mecanismos de coordinación de la información (hoja de referencia/contrarreferencia-interconsulta [HRCR], informe de alta hospitalaria, teléfono, correo electrónico) y de la gestión clínica (guías de práctica clínica y reuniones conjuntas). Se realizó un análisis descriptivo. RESULTADOS: El conocimiento de los mecanismos de coordinación de la información es alto en ambos niveles de atención en las redes analizadas, así como también el uso de la HRCR. Existe mayor variabilidad en el envío del informe de alta hospitalaria (del 40,0% en Brasil al 79,4% en México) y, excepto en Argentina, destaca su baja recepción por los médicos de atención primaria (12,3% en Colombia y 55,1% en Uruguay). En cambio, el conocimiento de los mecanismos de coordinación de la gestión clínica es limitado, en especial entre los médicos de atención especializada. Llama la atención la alta adherencia a las guías de práctica clínica (del 83,1% en México al 96,8% en Brasil), mientras que la participación en reuniones conjuntas varía ampliamente (del 23,7% en Chile al 76,2% en Brasil). Las dificultades para la utilización de los mecanismos se refieren a factores estructurales y organizativos. CONCLUSIONES: El conocimiento y el uso limitados de los mecanismos de coordinación parecen reflejar su escasa difusión e implementación. Son necesarias estrategias que promuevan su uso, interviniendo sobre los factores determinantes

OBJECTIVE: To analyze the level of knowledge and use, and the characteristics of use, of care coordination mechanisms in public healthcare networks of six Latin America countries. METHOD: Cross-sectional study based on a survey using the COORDENA® questionnaire with primary and secondary care doctors (348 doctors/country) of public healthcare networks in Argentina, Brazil, Chile, Colombia, Mexico and Uruguay (May-October 2015). Analyzed variables: degree of knowledge and use of information coordination (referral/reply letter, discharge report, phone, e-mail) and of clinical management coordination (shared clinical guidelines, joint meetings) mechanisms. Descriptive analyses were conducted. RESULTS: Knowledge of clinical information coordination mechanisms was high in both care levels and analyzed networks as was the use of referral/reply letter. There was greater variability in the use of discharge reports (from 40.0% in Brazil to 79.4% in Mexico) and, except for Argentina, a low reception reported by primary care doctors stands out (12.3% in Colombia and 55.1% in Uruguay). In contrast, knowledge of clinical management coordination mechanisms was limited, especially among secondary care doctors. It is noteworthy, however, that adherence to clinical guidelines was high (from 83.1% in Mexico to 96.8% in Brazil), while participation in joint meetings varied widely (from 23.7% in Chile to 76.2% in Brazil). The difficulties reported in the use of the mechanisms are related to structural and organizational factors. CONCLUSIONS: The limited knowledge and use of coordination mechanisms shows insufficient diffusion and implementation. Strategies to increase its use are needed, including the related factors

Coronavirus y radiología. Consideraciones sobre la crisis / Coronavirus and Radiology. Considerations on the crisis

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Clinical Teaching Collaborative Program with California School of Podiatric Medicine and the Samuel Merritt University Motion Analysis Research Center.

At Samuel Merritt University (SMU), the California School of Podiatric Medicine (CSPM) collaborates with Motion Analysis Research Center to integrate hands-on quantitative clinical biomechanics research experience into the podiatric medical training program. This partnership provides an active learning environment to demonstrate the importance of critical thinking and evidence-based medicine and to demonstrate the role of research in providing patients with the best treatment options available. This article provides examples of CSPM podiatry students learning through engagement in clinical quantitative biomechanics laboratory sessions and research projects at the SMU Motion Analysis Research Center.

[Assessment of a newly-implemented blended teaching of intensive care and emergency medicine at Paris-Diderot University]. / Évaluation d'un enseignement multimodal intégrant du e-learning dans l'apprentissage de la réanimation et de la médecine d'urgence au cours du second cycle des études médicales.

INTRODUCTION: Blended-learning methods could be a response to student nonattendance. Non-compulsory teaching combining e-learning/interactive face-to-face sessions has been implemented at Paris-Diderot Medical School for the teaching of intensive care and emergency medicine during the 2018/2019 university period. The aim of the study was to assess this newly-implemented blended teaching. METHODS: Questionnaire submitted to the 388 DFASM3 medical students present at the faculty exam of intensive care/emergency medicine. Attendance at a teaching modality was defined by the follow-up of more than half of this teaching modality. Correlations between attendance at e-learning and/or interactive face-to-face sessions, and grade were performed. RESULTS: A total of 358/388 (92%) students participated in this survey. A quarter of the students (88/321 - 25%) reported they usually attended at traditional lectures. Regarding blended-learning, 210/317 (67%) students reported having attended at e-learning courses and 84/321 (27%) attended at interactive face-to-face sessions. The distribution of students according to their attendance at e-learning and/or interactive face-to-face sessions was significantly different (P<0.01). There was a significant correlation (P<0.001) between attendance at e-learning and grade obtained at the faculty exam. Nevertheless, this correlation was also found for these students in another course taught traditionally. Overall, 309/315 (98%) students were satisfied with the blended teaching, 297/318 (93%) wanted its extent to the whole medical school's curriculum. CONCLUSION: The use of combined learning methods reached more students than traditional teachings and allowed the University to focus on its role of knowledge transfer.

Aplicação de técnicas de mesa prática na disciplina de Anestesiologia Odontológica: análise de efeitos sobre a aprendizagem / Application of practical table techniques in the discipline of dental anesthesiology: analysis of effects on learning

Atualmente, em que os alunos estão cada vez mais familiarizados com novas tecnologias e, consequentemente, maior facilidade de obtenção de novas informações, o docente do ensino superior não pode mais se satisfazer com o ensino centralizado na pessoa do professor. Há a necessidade de estimular o aluno para obtenção de novos conhecimentos e de habilidades para suas aplicações práticas, cabendo ao docente direcionar esta busca, sedimentando o saber, para que o aluno consiga entender as contribuições da disciplina para sua formação. Por se tratar de uma ciência fundamental para prática diária do cirurgião dentista, a disciplina de Anestesiologia Odontológica foi escolhida para a realização deste estudo com o objetivo de sedimentar no aluno os conhecimentos fundamentais necessários para aplicação de técnicas anestésicas em seus atendimentos. Para tanto, foi proposto aos alunos realizarem levantamento bibliográfico sobre os temas relacionados a técnicas anestésicas e desenvolver apresentações práticas demonstrativas para os outros alunos da mesma turma. Dessa forma, o desenvolvimento dessa pesquisa leva a crer que o indivíduo retém muito mais informações quando ensina a outro, quando comparado ao indivíduo que apenas assistiu passivamente a matéria, observando projeções feitas pelo professor. Com esta aplicação de técnica ativa de ensino queremos avaliar se, após esta metodologia, teremos um aluno mais preparado para realizar as técnicas anestésicas fundamentais para o atendimento odontológico, que tenha desenvolvido capacidade e qualidades necessárias para ser um profissional mais capacitado(AU)

Nowadays, when students are increasingly familiar with new Technologies and, consequently, easier to obtain new information, higher education teacher can no longer be satisfied with teaching centered in the person of the teacher. There is a need to simulate the student to obtain new knowledge and skills for their practical apllications, and it is up to the teacher to direct this search, consolidating knowledge necssary for the aplication of anesthetic techniques in their care. To this ende, students will be asked to carry out a bibliographic survey on topic related to anesthetic techiniques and to develop practical demonstrative presentations for other students in the same classs. Thus, the hypothesis of this research is that the individual retains much more informatio when teaching another, when compared to the individual who only passively watche the material, observing projections made by the teacher. With this application of active teaching technique we want to assess whether, after this methodology, we will have a student better prepared to perfom the fundamental anesthetic techniques for dental care, who has developed the capacity and qualities necessary to be a successful professional(AU)

Collaborative Learning Teams to Longitudinally Teach and Assess Teamwork Behaviors and Attitudes.

Objective. To create and assess the effectiveness of a model of continuous development of teamwork skills (CDTS), which used a longitudinal peer feedback process across multiple courses that incorporated collaborative team learning. Methods. Pharmacy students participated in collaborative learning teams across the first three years of the doctor of pharmacy (PharmD) curriculum, with team membership changing annually. Self, peer, and team evaluations were completed using the Comprehensive Assessment of Team Member Effectiveness (CATME) Smarter Teamwork system at four time points each year (three formative assessments and one summative assessment). Faculty members used peer and team evaluations to identify when additional coaching on teamwork behaviors, attitudes, and norms was needed. Results. Self, peer, and team evaluations of 261 unique learning teams were conducted between fall 2015 and spring 2018. The majority of students and teams performed highly on teamwork behaviors and attitudes. Individual students and teams were identified for additional development on teamwork behaviors and attitudes as follows: for the 2015-2016 academic year, 5 (2%) individual students and 8 (20%) teams; for the 2016-2017 academic year, 15 (3%) individual students and 19 (22%) teams; and for the 2017-2018 academic year: 15 (2%) individual students and 24 (18%) teams. Conclusion. The CDTS model, which incorporates formative and summative assessments, identified individual students and teams that met the teamwork standards established by the college as well as those students and teams that needed additional coaching to achieve the teamwork learning outcome.

Effects of interprofessional education on teamwork and on knowledge chronic conditions management.

OBJECTIVE: Evaluate the effect of interprofessional education on the climate of Primary Health Care teams and on the acquisition of knowledge about management of chronic non-communicable diseases. METHOD: Quasi-experimental study of interprofessional education intervention. Seventeen Primary Health Care teams (95 professionals) participated in the study, of which nine teams (50 professionals) composed the intervention group and eight teams (45 participants) composed the control group. The team climate inventory scale and a questionnaire on knowledge about management of chronic conditions in Primary Health Care were applied before and after intervention. Type I error was fixed as statistically significant (p<0.05). RESULTS: In the analysis of knowledge about management of chronic conditions, the teams that participated in the interprofessional education intervention presented higher mean post-intervention increase than the teams of the control group (p < 0.001). However, in the analysis of both groups, there was no significant variation in the teamwork climate scores (0.061). CONCLUSION: The short interprofessional education intervention carried out during team meetings resulted in improved apprehension of specific knowledge on chronic conditions. However, the short intervention presented no significant impacts on teamwork climate.

Big data and machine learning in critical care: Opportunities for collaborative research / Big data y machine learning en medicina intensiva: oportunidades del trabajo colaborativo

The introduction of clinical information systems (CIS) in Intensive Care Units (ICUs) offers the possibility of storing a huge amount of machine-ready clinical data that can be used to improve patient outcomes and the allocation of resources, as well as suggest topics for randomized clinical trials. Clinicians, however, usually lack the necessary training for the analysis of large databases. In addition, there are issues referred to patient privacy and consent, and data quality. Multidisciplinary collaboration among clinicians, data engineers, machine-learning experts, statisticians, epidemiologists and other information scientists may overcome these problems. A multidisciplinary event (Critical Care Datathon) was held in Madrid (Spain) from 1 to 3 December 2017. Under the auspices of the Spanish Critical Care Society (SEMICYUC), the event was organized by the Massachusetts Institute of Technology (MIT) Critical Data Group (Cambridge, MA, USA), the Innovation Unit and Critical Care Department of San Carlos Clinic Hospital, and the Life Supporting Technologies group of Madrid Polytechnic University. After presentations referred to big data in the critical care environment, clinicians, data scientists and other health data science enthusiasts and lawyers worked in collaboration using an anonymized database (MIMIC III). Eight groups were formed to answer different clinical research questions elaborated prior to the meeting. The event produced analyses for the questions posed and outlined several future clinical research opportunities. Foundations were laid to enable future use of ICU databases in Spain, and a timeline was established for future meetings, as an example of how big data analysis tools have tremendous potential in our field

La aparición de los sistemas de información clínica (SIC) en el entorno de los cuidados intensivos brinda la posibilidad de almacenar una ingente cantidad de datos clínicos en formato electrónico durante el ingreso de los pacientes. Estos datos pueden ser empleados posteriormente para obtener respuestas a preguntas clínicas, para su uso en la gestión de recursos o para sugerir líneas de investigación que luego pueden ser explotadas mediante ensayos clínicos aleatorizados. Sin embargo, los médicos clínicos carecen de la formación necesaria para la explotación de grandes bases de datos, lo que supone un obstáculo para aprovechar esta oportunidad. Además, existen cuestiones de índole legal (seguridad, privacidad, consentimiento de los pacientes) que deben ser abordadas para poder utilizar esta potente herramienta. El trabajo multidisciplinar con otros profesionales (analistas de datos, estadísticos, epidemiólogos, especialistas en derecho aplicado a grandes bases de datos), puede resolver estas cuestiones y permitir utilizar esta herramienta para investigación clínica o análisis de resultados (benchmarking). Se describe la reunión multidisciplinar (Critical Care Datathon) realizada en Madrid los días 1, 2 y 3 de diciembre de 2017. Esta reunión, celebrada bajo los auspicios de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) entre otros, fue organizada por el Massachusetts Institute of Technology (MIT), la Unidad de Innovación y el Servicio de Medicina Intensiva del Hospital Clínico San Carlos, así como el grupo de investigación «Life Supporting Technologies» de la Universidad Politécnica de Madrid. Tras unas ponencias de formación sobre big data, seguridad y calidad de los datos, y su aplicación al entorno de la medicina intensiva, un grupo de clínicos, analistas de datos, estadísticos, expertos en seguridad informática de datos realizaron sesiones de trabajo colaborativo en grupos utilizando una base de datos reales anonimizada (MIMIC III), para analizar varias preguntas clínicas establecidas previamente a la reunión. El trabajo colaborativo permitió establecer resultados relevantes con respecto a las preguntas planteadas y esbozar varias líneas de investigación clínica a desarrollar en el futuro. Además, se sentaron las bases para poder utilizar las bases de datos de las UCI con las que contamos en España, y se estableció un calendario de trabajo para planificar futuras reuniones contando con los datos de nuestras unidades. El empleo de herramientas de big data y el trabajo colaborativo con otros profesionales puede permitir ampliar los horizontes en aspectos como el control de calidad de nuestra labor cotidiana, la comparación de resultados entre unidades o la elaboración de nuevas líneas de investigación clínica

Interprofessional training on resilience-building for children who experience trauma: Stakeholders' views from six low- and middle-income countries.

Children exposed to multiple adversities are at high risk of developing complex mental health and related problems, which are more likely to be met through integrated interprofessional working. Combining the expertise of different practitioners for interprofessional care is especially pertinent in low- and middle-income countries (LMIC) in the absence of specialist resources. The aim of this study was to work with practitioners who deliver care to vulnerable children in six LMIC (Turkey, Pakistan, Indonesia, Kenya, Rwanda, and Brazil) to understand their perspectives on the content of an interprofessional training programme in building resilience for these children. Seventeen participants from different professional backgrounds, who were in contact with vulnerable children were interviewed. A thematic analytic framework was used. Four themes were identified, which were the benefits of a tiered approach to training, challenges and limitations, perceived impact, and recommendations for future training. The findings indicate the importance of co-ordinated policy, service, and training development in an interprofessional context to maximize resources; the need for cultural adaptation of skilled-based training and interventions; and the usefulness of new technologies to enhance accessibility and reduce costs in LMIC.

Challenges and innovations in interprofessional education: Promoting a public health perspective.

Public Health has been a key contributor in the Interprofessional Education Collaborative expert panel for Interprofessional Education (IPE) programs; however, limited programs have directly addressed population health concepts such as social determinants of health and health disparities in healthcare, which directly impact the health and well-being of patients. Thus, this study presents the development and implementation of population health concepts within a traditional, clinically focused IPE program. Within the IPE program conducted in 2016, more than 575 students from 12 health-related disciplines participated in a 4-month academic course. A new curriculum was developed that included a new module on social determinants of health. Previously developed sessions on roles and responsibilities, standardized patient interviewing, patient care planning, and patient safety were re-examined to incorporate the concepts of social determinants of health and health disparities. Course evaluations reported higher mean scores for each new session when compared to scores from previous years evaluation, when social determinants of health had not been addressed. Findings from this evaluation highlight the importance of developing innovative experiential learning experiences that include public health concepts within IPE in order to create a more fulfilling and enriched curriculum to better prepare healthcare students to address the social determinants of health that they will be encountering in their future practice.

Utilizing a collaborative learning activity to sensitize interprofessional students to palliative care scopes of practice with adolescent and young adults.

Adolescent and young adults diagnosed with cancer represent a vulnerable population needing careful collaborative care from interprofessional teams. Healthcare providers must understand and appreciate the respective scopes of practice of palliative care team members to maximize the quality of care provided to these patients. A team of graduate students engaged in a collaborative learning activity to explore professional roles and responsibilities of palliative care team members when caring for adolescent and young adult oncology patients. Following a literature review and community expert interviews, students identified shared responsibilities of all team members and unique contributions of various professions. Engaging in this process highlighted and clarified the full scope of practice for each specialized team member. Educators should consider utilizing a similar collaborative learning activity to enhance students' understanding of the roles and responsibilities of each member of the interprofessional healthcare team.