Can Medical Students Evaluate Medical Websites?: A mixed-methods study from Oman.

Objectives: This study aimed to discover the extent to which medical students can evaluate medical websites, evaluation criteria used, factors affecting their abilities and whether a teaching intervention could rectify problems. Medical students and practitioners are required to evaluate medical information available on the Internet. Most current medical students are familiar with the Internet, but their ability to evaluate material may require improvement. Methods: A class of undergraduate medical students evaluated an unreliable medical website, received a teaching intervention on website evaluation criteria and re-evaluated the same site. This mixed-methods study was conducted at Sultan Qaboos University, Muscat, Oman, from September to December 2018. Results: A total of 149 (response rate: 82.3%) students participated. Students spent, on average, 4.69 hours per day on the Internet. No significant correlations were found between demographic indicators and Internet time. On a 10-point Likert scale, students' scores ranged from 5-6, with no significant differences between the pre- and post-intervention evaluations, except for increased polarisation away from the mean. Qualitative comments indicated an awareness of relevant criteria but an overall inability to critically apply them. Conclusion: The results indicate that one cannot make a blanket statement about medical students' ability to evaluate medical websites despite their familiarity with technology. Moreover, website evaluation should be viewed primarily from the information perspective and that critical thinking ability may play a major role. Due to these overriding factors, short interventions are unlikely to have an impact, and other educational strategies should be developed. These are necessary to ensure that medical students can function independently as life-long learners and medical professionals.

'Student tutors go online' - Investigation of cognitive and social congruence in online student tutorials - a longitudinal study.

The concept of peer-assisted learning (PAL) has been implemented at many medical faculties. Due to the Covid-19 pandemic, parts of the medical education experience transitioned to digital formats. However, little is known about PAL and online student tutorials. PAL is effective due to cognitive and social congruence. This study aims to investigate these concepts in an online student tutorial on taking a patient's medical history. This longitudinal study took place in a preclinical communication course on how to take a patient's medical history. In an online student tutorial, the students learned how to take a patient's psychosocial medical history. Using standardised questionnaires, cognitive and social congruence were assessed. T-tests of independent samples were performed for data comparison. The participants included 128 second-year medical students and 5 student tutors. Cognitive congruence (Mstudent = 4.19 ± 0.56; Mstudenttutor = 4.04 ± 0.57) and social congruence (MStudent = 4.25 ± 0.56; MStudenttutor = 4.06 ± 0.57) were high for both students and student tutors in the online setting. In comparison to the face-to-face group, students in the online setting considered the student tutors to be significantly (p < .05) more socially congruent. Learning success increased during the course; however, it was not influenced by cognitive congruence. Cognitive and social congruence are high in an online setting. The students' learning success increased during the online tutorial. Based on the higher level of social congruence, student tutors might be very motivated to be open and approachable in an online setting. Simultaneously, students might pay more attention and participate actively in the online setting. Social and cognitive congruence contribute to the effectiveness of online student tutorials and, thus, online student tutorials should be integrated into medical training.

"We Want Good Education for All of Us" - A Participatory Quality Improvement Approach.

Introduction: In ever changing conditions, medical faculties must face the challenge of preparing their medical students as best as possible for the demands of their future work. This requires involving all stakeholders, especially medical students in the constant redefinition of medical curricula. Using the idea of "Communities of Practice" as conceptual framework, this study looks at semester spokespeople as an example for participatory quality management. Methods: We conducted focus-group interviews with semester spokespeople at a German Medical Faculty. Data was recorded, transcribed, and analysed using MAXQDA. The interviews were analysed using meaning condensation method. Results: Eleven out of 48 semester spokespeople took part. We found seven topics that fell within three main categories: (1) role of the semester spokesperson, (2) role of the fixed meeting, and (3) contact and commitment. Communities of Practice principles could be aligned to topics and categories. Discussion: The idea of semester spokespeople based on the concept of Communities of Practice are useful in the quality management processes of a medical school and lead to greater involvement of medical students, identifying their needs. The reciprocal commitment among all stakeholders fosters mutual understanding and collaboration. Future studies could investigate the underlying motivational factors of dedicated students and how to transfer these characteristics to a larger cohort.

AMEE Guide to ethical teaching in online medical education: AMEE Guide No. 146.

The Covid-19 pandemic necessitated Emergency Remote Teaching (ERT): the sudden move of educational materials online. While ERT served its purpose, medical teachers are now faced with the long-term and complex demands of formal online teaching. One of these demands is ethical online teaching. Although ethical teaching is practiced in face-to-face situations, online teaching has new ethical issues that must be accommodated, and medical teachers who wish to teach online must be aware of these and need to teach ethically. This Guide leads the medical teacher through this maze of complex ethical issues to transform ERT into ethical online teaching. It begins by setting the context and needs and identifies the relevant fundamental ethical principles and issues. It then guides the medical teacher through the practical application of these ethical principles, covering course design and layout (including the curriculum document, implementation, on-screen layouts, material accessibility), methods of interaction (synchronous and asynchronous), feedback, supervision and counselling, deeper accessibility issues, issues specific to clinical teaching, and assessment. It then discusses course reviews (peer-review and student evaluations), student monitoring and analytics, and archiving. The Guide aims to be a useful tool for medical teachers to solidly ground their online teaching practices in ethical principles.

Perspectives, benefits and challenges of a live OSCE during the COVID-19 pandemic in a cross-sectional study.

OBJECTIVES: Restrictions due to the COVID-19 pandemic mandated fundamental changes to student evaluations, including the administration of the observed structured clinical examination (OSCE). This study aims to conduct an in-person OSCE to verify students' practical skills under necessary infection control practices and the impact of face masks on student-patient interactions. DESIGN: Cross-sectional design. SETTING: The OSCE at Medical School of Tuebingen takes place in October 2020. PARTICIPANTS: A total of 149 students (third year of study) completed the survey (RR=80.1%). It was their first OSCE. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was how this type of OSCE was evaluated by participating students in regard to preparation, content and difficulty as well as in real life. Secondary outcome measures were how the implemented hygiene actions influenced the OSCE, including the interaction and communication between students and standardised patients (SPs). Items were rated on a 6-point Likert scale (1=completely to 6=not at all). Means, SDs, frequencies and percentages were calculated. RESULTS: 149 students, 32 SPs and 59 examiners participated. The students rated the OSCE with 2.37 (±0.52) for preparation and 2.07 (±0.32) for content. They perceived the interaction to be significantly disrupted by the use of face masks (3.03±1.54) (p<0.001) compared with the SPs (3.84±1.44) and the examiners (4.14±1.55). In general, the three groups considered the use of face masking the OSCE to be helpful (1.60±1.15). CONCLUSIONS: An in-person OSCE, even in the midst of a global pandemic, is feasible and acceptable to both students and faculty. When compared the students' results to previous students' results who completed the OSCE before the pandemic, the results indicated that students felt less prepared than under non-pandemic circumstances; however, their performances on this OSCE were not lower.

Evaluation of a Language Translation App in an Undergraduate Medical Communication Course: Proof-of-Concept and Usability Study.

BACKGROUND: Language barriers in medical encounters pose risks for interactions with patients, their care, and their outcomes. Because human translators, the gold standard for mitigating language barriers, can be cost- and time-intensive, mechanical alternatives such as language translation apps (LTA) have gained in popularity. However, adequate training for physicians in using LTAs remains elusive. OBJECTIVE: A proof-of-concept pilot study was designed to evaluate the use of a speech-to-speech LTA in a specific simulated physician-patient situation, particularly its perceived usability, helpfulness, and meaningfulness, and to assess the teaching unit overall. METHODS: Students engaged in a 90-min simulation with a standardized patient (SP) and the LTA iTranslate Converse. Thereafter, they rated the LTA with six items-helpful, intuitive, informative, accurate, recommendable, and applicable-on a 7-point Likert scale ranging from 1 (don't agree at all) to 7 (completely agree) and could provide free-text responses for four items: general impression of the LTA, the LTA's benefits, the LTA's risks, and suggestions for improvement. Students also assessed the teaching unit on a 6-point scale from 1 (excellent) to 6 (insufficient). Data were evaluated quantitatively with mean (SD) values and qualitatively in thematic content analysis. RESULTS: Of 111 students in the course, 76 (68.5%) participated (59.2% women, age 20.7 years, SD 3.3 years). Values for the LTA's being helpful (mean 3.45, SD 1.79), recommendable (mean 3.33, SD 1.65) and applicable (mean 3.57, SD 1.85) were centered around the average of 3.5. The items intuitive (mean 4.57, SD 1.74) and informative (mean 4.53, SD 1.95) were above average. The only below-average item concerned its accuracy (mean 2.38, SD 1.36). Students rated the teaching unit as being excellent (mean 1.2, SD 0.54) but wanted practical training with an SP plus a simulated human translator first. Free-text responses revealed several concerns about translation errors that could jeopardize diagnostic decisions. Students feared that patient-physician communication mediated by the LTA could decrease empathy and raised concerns regarding data protection and technical reliability. Nevertheless, they appreciated the LTA's cost-effectiveness and usefulness as the best option when the gold standard is unavailable. They also reported wanting more medical-specific vocabulary and images to convey all information necessary for medical communication. CONCLUSIONS: This study revealed the feasibility of using a speech-to-speech LTA in an undergraduate medical course. Although human translators remain the gold standard, LTAs could be valuable alternatives. Students appreciated the simulated teaching and recognized the LTA's potential benefits and risks for use in real-world clinical settings. To optimize patients' and health care professionals' experiences with LTAs, future investigations should examine specific design options for training interventions and consider the legal aspects of human-machine interaction in health care settings.

Coping Styles Among High School Graduates Aiming to Study Medicine in Dealing With Depressive and Anxious Symptoms.

Background: Psychological distress, its associated stressors and resilience factors, and the implications derived for the education and training of medical students and physicians have long been the subject of international studies. The study presented here investigated affective symptoms in association with coping styles in the earliest phase of University medical education: high school graduates aiming to study medicine. Materials and Methods: We conducted a self-report survey at a medical school in Germany among high school graduates who indicated being interested in studying medicine at the university's on-campus recruitment day. The questionnaire included validated instruments for the self-assessment of symptoms of depression (i.e., Patient Health Questionnaire; PHQ-9) and anxiety (i.e., Generalized Anxiety Disorder 7 (GAD-7), and participants were also asked to rate functional and dysfunctional behavior-based coping styles for symptoms of depression and anxiety. Additional variables addressed were gender, motivation, interest in studying medicine, and parental employment in medicine. Results: Of 400 high school graduates, 346 (87%) completed the survey. More than 40 (12.5%) and nearly 30 (8.4%) reported relevant symptoms of depression (PHQ-9 sum score ≥10) and anxiety (GAD-7 sum score ≥10), respectively. Among the graduates, young women had higher values for symptoms of depression than young men, and one's interested exclusively in studying human medicine tended to have marginally higher levels of symptoms of depression than ones who were also interested in other subjects. Relevant functional coping styles included seeking social support, relaxing, engaging in sports, listening to or making music, and reading books, whereas relevant dysfunctional coping styles included consuming alcohol, abusing drugs, restrictive eating, watching TV, surfing the Internet, and withdrawing and ruminating. Conclusion: The results clarify the burden and associated resilience factors of premedical high school graduates at the earliest phase of their University education. As such, they reveal ways to address educational and supportive services and support the need for further investigation into factors of success in studying human medicine.

Association of professional pre-qualifications, study success in medical school and the eligibility for becoming a physician: A scoping review.

BACKGROUND: Literature, individual experiences and common considerations suggest that prior professional qualification can be an advantage for later career development. For instance, in Germany, professional pre-qualification has been honored by medical faculties in selection procedures for several years. However, a systematic evaluation of this relationship lacks. This scoping review summarizes existing literature and addresses the role of prior professional pre-qualifications on objective or subjective study success and the choice of a specialization. METHODS: The scoping review was performed oriented on the PRISMA guidelines. PsycINFO and PubMed databases were searched for relevant studies that included data of medical students with and without professional pre-qualifications. To answer the underlying research questions, this scoping review also includes studies that examine professional pre-qualifications in association with non-cognitive "soft" criteria. RESULTS AND FURTHER DIRECTIONS: 1055 items were identified and reviewed by two independent reviewers with final 11 studies were included for this scoping review. The results of identified studies that report possible effects of prior pre-professional qualifications are inconclusive but suggest that prior professional qualifications tend not to have rather an advantage on study success. Medical school success for students with prior professional qualifications tended to be below average in the preclinical setting, and there were no differences in the clinical setting compared with students without prior professional qualifications. The influence of professional pre-qualifications has not yet been adequately studied without the moderator variable "waiting time" and "A-levels grade". The scoping review indicates insufficient number of articles stating a co-relation of prior pre-qualifications and subjective data. Again, the results found are not sufficient to state a clear relationship between professional pre-qualifications and the choice of a specific speciality preference. However, professional pre-qualifications, both in medicine and as "practical experience in rural areas", tend to be beneficial for the choice of becoming a rural physician. Large-scale cross-sectional and longitudinal studies are needed to investigate the influence of professional pre-qualifications on different study trajectory parameters.

Medical education in times of COVID-19: survey on teachers' perspectives from a German medical faculty.

Background: Clinicians in their role as teachers and medical faculties were struggling to address the medical students' needs regarding their medical education in times of COVID-19. They were especially confronted with several challenges regarding what medical training should look like and how to transfer medical training to integrate relevant skills like interpersonal or practical competencies. This study aimed to investigate the teachers' perspectives on medical education and COVID-19 in general, including their distress level. Methods: This quantitative questionnaire study was distributed online among responsible lecturers of medical training at the Medical Faculty of Tuebingen. Teachers answered questions about the medical training, COVID-19 in general (on a seven point- Likert scale from "not at all" to "completely") and their mental well-being (STAI). Descriptive data analysis and t-tests were performed. Results: The teachers reported being significantly (p<.01) more distressed regarding the medical training (M=4.63, SD=1.24) in comparison to their private lives (M=3.58, SD=1.38) or the clinical context (M=3.33, SD=1.95). They also felt significantly less informed about the medical training in times of COVID-19 (p<.001). They wished for more support and information from their medical faculty. When teachers were asked which teaching should be implemented in future, they reported the most the online lectures (87.5%), followed by collaborative working (75.5%), live broadcast (62.5%) and online chats (58.3%). Teachers also saw the current situation of COVID-19 as a chance for a digital transformation of the medical education (M=5.92, SD=0.95). Discussion: Teachers of the Medical Faculty of Tuebingen saw online-based teaching formats as a chance to meet the medical students' needs regarding the medical education. Video-based formats like online lecturers and online chats with teachers might play a relevant role in order to impart knowledge. Furthermore, medical students should also be taught in digital formats like telehealth, including patient-physician distance interactions.

How Have Researchers Acknowledged and Controlled for Academic Work Activity When Measuring Medical Students' Internet Addiction? A Systematic Literature Review.

Internationally, medical students' Internet Addiction (IA) is widely studied. As medical students use the Internet extensively for work, we asked how researchers control for work-related Internet activity, and the extent to which this influences interpretations of "addiction" rates. A search of PubMed, CINAHL, Web of Science, Scopus, and Google Scholar was conducted on the search phrase of "medical students" and "internet addiction" in March 2020. In total, 98 studies met our criteria, 88 (90%) used Young's Internet Addiction Test, and the studies' IA rates ranged widely. Little note was taken of work-related activity, and, when discussed, had little to no impact on the interpretation of Internet "addiction". Studies seldom accounted for work-related activities, researcher bias appears to influence their position, "usage" appears conflated with "addiction", and correlations between "addiction" and negative behaviours are frequently confused with one-way causation. In spite of IA's not being officially recognised, few researchers questioned its validity. While IA may exist among medical students, its measurement is flawed; given the use of the Internet as a crucial medical education tool, there is the risk that conscientious students will be labelled "addicted", and poor academic performance may be attributed to this "addiction".