Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71.

BACKGROUND: Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. METHODS: Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned. RESULTS: Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment. CONCLUSIONS: This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64.

BACKGROUND: COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research. METHODS: The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts. RESULTS: One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement). CONCLUSIONS: This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.

Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63.

BACKGROUND: The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned. METHODS: The authors systematically searched four online databases and hand searched MedEdPublish up to 24 May 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias for included articles. Discrepancies were resolved by a third author. A descriptive synthesis and outcomes were reported. RESULTS: Forty-nine articles were included. The majority were from North America, Asia and Europe. Sixteen studies described Kirkpatrick's outcomes, with one study describing levels 1-3. A few papers were of exceptional quality, though the risk of bias framework generally revealed capricious reporting of underpinning theory, resources, setting, educational methods, and content. Key developments were pivoting educational delivery from classroom-based learning to virtual spaces, replacing clinical placement based learning with alternate approaches, and supporting direct patient contact with mitigated risk. Training for treating patients with COVID-19, service reconfiguration, assessment, well-being, faculty development, and admissions were all addressed, with the latter categories receiving the least attention. CONCLUSIONS: This review highlights several areas of educational response in the immediate aftermath of the COVID-19 pandemic and identifies a few articles of exceptional quality that can serve as models for future developments and educational reporting. There was often a lack of practical detail to support the educational community in enactment of novel interventions, as well as limited evaluation data. However, the range of options deployed offers much guidance for the medical education community moving forward and there was an indication that outcome data and greater detail will be reported in the future.

Twelve tips for undertaking a focused systematic review in medical education.

The exponential growth of the systematic review methodology within health has been mirrored within medical education, allowing large numbers of publications on a topic to be synthesized to guide researchers and teachers. The robust, transparent and reproducible search methodologies employed offer scholarly rigor. The scope and scale of many reviews in education have only been matched by the size of the commitment needed to complete them and occasional lack of utility of reports. As such, we have noticed a growth in reviews across journals in the field that have questions that are more focused in scope. The authors propose 12 tips for performing a focused review in the right settings for the right reasons and discuss why such "focused reviews" may be more beneficial in those circumstances. Focused reviews allow researchers to formulate answers to specific local issues that have explicit utility of findings. Such reviews are equipped to identify what works for specific groups in specific circumstances and even question how and why this may occur. An additional impact of a focused approach can be a rapid turnaround. This article explains the purpose and benefits of focused review and provides guidance on how to produce them.

What do we mean by 'systematic' in health education systematic reviews and why it matters!

For anyone who reads the health education literature regularly, journal sections that focus on "reviews" are common, yet the use of the term "systematic" to describe these reviews is sporadic. Further, we believe this term is used in a manner in the field that does not accurately reflect the methodological implications of the term in this context. There are examples of "systematic" works that simply don't describe themselves in that way, despite a clear alignment with many of the principles of "systematic reviewing". Conversely, there are reviews that are clearly not systematic, yet describe themselves as such. In this piece, we discuss how this difficulty with methodological nomenclature has occurred and the distinct and important meaning of the term "systematic" in relation to health education reviews.

The ASPIRE initiative: Excellence in student engagement in the school / La iniciativa ASPIRE: excelencia en la participación de los estudiantes en la facultad

Student engagement in the school' is offered as one dimension of the ASPIRE-to-Excellence initiative launched in 2012 by AMEE (International Association for Medical Education) to recognize/reward excellence in teaching. For a school to be awarded in 'student engagement' there must be evidence that students contribute to the academic community, take an active role, are consulted, involved and participate in shaping the teaching-learning experience. Four spheres of 'student engagement' can be recognized as main criteria namely: school management, education program, academic community and local community. So far fourteen schools were awarded. Looking at what makes 'student engagement' work we learned that ASPIRE is a global phenomenon with features common worldwide, not depending on school resources and not imposing a fixed model of excellence. ASPIRE is there to prove that excellence in teaching can be assessed. It brought something new because although basic standards for medical education quality were already available the best practices relevant to the schools who wish to achieve excellence in teaching were only defined with ASPIRE in 2012. ASPIRE is much more than to recognize and reward schools. Its ultimate goal is to have the schools achieving excellence in teaching, independently of having them applying to the award

La «participación y contribución de los estudiantes al currículo y a la facultad -Students Engagement-» es una dimensión de la iniciativa ASPIRE, lanzada en 2012 por la Asociación Internacional de Educación Médica (AMEE), para reconocer/premiar la excelencia educativa. Para que una facultad sea premiada por la «participación de sus estudiantes» deben existir evidencias de que ellos contribuyen a la comunidad académica, participan activamente en la toma de decisiones, son consultados y se implican en dar forma a la experiencia enseñanza-aprendizaje. Cuatro esferas de «participación y contribución de los estudiantes» son reconocidas como criterios principales: gestión de la facultad, programa educativo, comunidad académica y comunidad local. Hasta el momento, 14 facultades has sido galardonadas por la «participación de sus estudiantes» y hemos aprendido que ASPIRE es un fenómeno global con características comunes a nivel mundial, no depende de los recursos de la facultad y no impone un modelo fijo de excelencia. ASPIRE existe para demostrar que la excelencia docente puede evaluarse. Esto es algo nuevo, ya que, aun estando disponibles estándares básicos para la calidad de la educación médica, únicamente ASPIRE ha conseguido definir las mejores prácticas, trascendentales para facultades que desean alcanzar la excelencia docente. ASPIRE va mucho más allá de reconocer y premiar facultades. Su objetivo principal es hacer que las facultades alcancen la excelencia docente, independientemente de que estén solicitando el reconocimiento

Best Evidence Medical and Health Professional Education (BEME) collaboration: A moving spotlight.

Early this year, a Massachusetts Institute of Technology professor of philosophy presented a new theory of time that caught our interest. One of the key concepts that Professor Skow presented is the "moving spotlight" theory. As Skow asserts, the experiences had a year ago or 10 years ago are still just as real, they're just "inaccessible" because they are now in a different part of spacetime. This was felt to be an elegant notion to inform this 'spotlight' piece on BEME ( www.bemecollaboration.org ).

Magnetic Resonance Imaging Study on Blebs Morphology of Ahmed Valves.

PURPOSE: To determine the morphometric parameters of filtration blebs of a valved aqueous humor drainage device. MATERIALS AND METHODS: Orbital magnetic resonances imaging (MRI) was taken after implantation of an Ahmed valve (FP7 model). Outcomes of the analysis were intraocular pressure (IOP) and the bleb's morphometric analysis (volume, height, major and minor axis). Associations between IOP and the imaging-related study variables were explored by Spearman's correlation test. RESULTS: Eleven patients underwent orbital MRI examination. Recordings were taken after a mean of 2.7 months (1-6 months) after surgery. IOP was significantly lower than its preoperative values (17.6 ± 6.4 mm Hg vs 36.1 ± 6.4 mm Hg, p < 0.01). Mean bleb volume was 856.9 ± 261 mm(3) and its height, major and minor axis were 5.77 ± 1.9, 14.8 ± 2.9 and 8.14 ± 3.6 mm, respectively. A positive correlation was detected between IOP and mean height (r = 0.77, p = 0.048) and major axis (r = 0.83, p = 0.03). Interestingly, the overall bleb volume was related to IOP levels immediately prior to surgery (r = 0.75, p < 0.01). Additionally, the posterior part of the plate was found to be displaced from the scleral surface in five cases (45%). CONCLUSION: Ahmed valve's bleb morphology seems to correlate with both the pre- and postoperative IOP, which might suggest a clinical benefit of administering aqueous suppressants pre- as well as postoperatively. The plate of the device may show a significant dislocation from its initial surgical implantation site. How to cite this article: Ferreira J, Fernandes F, Patricio M, Brás A, Rios C, Stalmans I, Pinto LA. Magnetic Resonance Imaging Study on Blebs Morphology of Ahmed Valves. J Curr Glaucoma Pract 2015;9(1):1-5.

Is the OSCE a feasible tool to assess competencies in undergraduate medical education?

BACKGROUND: The Objective Structured Clinical Examination (OSCE) was introduced by Harden et al. (1975) trying to answer the problems regarding the assessment of clinical competencies. Despite increasingly widespread use of OSCEs, debate continues with arguments as 'why using such a demanding format if other methods are available?' AIM: To review and synthesize evidence on technical and economic feasibility of OSCE in undergraduate medical studies. METHODS: Best Evidence Medical Education methodology was applied by two independent coders to 1083 studies identified by literature search from 1975 until the end of 2008. KEY FINDINGS: The OSCE is a feasible approach to the assessment of clinical competence for use in different cultural and geographical contexts; to assess a wide range of learning outcomes; in different specialties and disciplines; for formative and summative purposes; to assess students a curriculum or an educational intervention; in the different phases of education including the early and later years of the undergraduate curriculum; and in different health care professions. CONCLUSION: Despite being an expensive test format, evidence suggests that the use of OSCE produces reliable results. The study also suggests that one reason for the wide-scale adoption of the OSCE and the feasibility of its use in different contexts and situations is its inherent flexibility in terms of the number of students that can be assessed, the number of examiners included, the type of patients represented and the format of the examination itself, including the length of the examination, the number and duration of stations.

[Thromboembolic complications during endovascular treatment of ruptured intracranial aneurysms--prevention and therapy]. / Complicações tromboembólicas durante a terapêutica endovascular de aneurismas rotos intra-cranianos--profilaxia e terapêutica.

Thromboembolic phenomena are the most commonly reported complications during endovascular treatment of intracranial aneurysms with coils. Frequency of this complication varies in the literature, but authors reported rates ranging from 2.5 to 28%. Several mechanisms may be involved in the formation and migration of thrombus: it may be already existing inside the aneurysm and be dislocated and then migrate distally; it can be formed on the surface of the coils or catheters used, or it can appear in the remnant aneurysm sac it. Studies have shown a higher incidence of thromboembolic complications in wide neck aneurysms. In this paper we discuss the importance of prevention of thromboembolic complications during and after endovascular treatment of ruptured intracranial aneurysms. We also refer options and strategies to adopt in the event of a vascular occlusion is detected during the procedure, as the administration of inhibitors of glycoprotein IIb/IIIa or the release of an intra-cranial stent. Illustrative cases are shown. The prevention of thromboembolic complications and rapid action after the vascular occlusion is essential in order to improve the prognosis of patients undergoing endovascular treatment of ruptured intracranial aneurysms. Extensive knowledge of available options is essential to the pursuit of that goal.

Bologna in Medicine Anno 2012: experiences of European medical schools that implemented a Bologna two-cycle curriculum--an AMEE-MEDINE2 survey.

BACKGROUND: The 1999 Bologna Agreement implies a European harmonization of higher education using three cycles: bachelor and master before doctorate. Undergraduate medical programmes were restructured in only seven of the 47 countries. AIM: Given the debate about a two-cycle system in undergraduate medical education, providing an overview of experiences in medical schools that applied this structure was the purpose of this investigation. METHODS: In 2009, an AMEE-MEDINE2 survey was carried out among all the 32 medical schools that applied the two-cycle system in medicine. At the end of 2011, a member-check validation using a draft manuscript was carried out to complete an accurate up-to-date impression. RESULTS: All the 32 schools responded initially; 26 schools responded to the second round. All schools had implemented the two-cycle system (all but one in a 3 + 3 year model) with hardly any problems. All reported smaller or larger curriculum improvements, often triggered, but not caused, by the two-cycle system. No school reported that introducing the system interfered with any desired curriculum development, particularly horizontal or vertical integration. CONCLUSION: In 32 of the 442 medical schools in Bologna signatory countries, introducing a two-cycle model for basic medical education was successfully completed. However, harmonization of medical training in Europe requires further international collaboration.

Systematic reviews of evidence in medical education and clinical medicine: is the nature of evidence similar?

BACKGROUND: It is accepted worldwide that clinical and educational decisions should be informed by the best available evidence, not individual opinion only. AIMS: This article discusses the epistemological basis of educational evidence, as compared with clinical evidence, looking at the different nature of the science behind each one. METHOD: Two models--BEME Reviews in medical education and Cochrane Reviews in clinical medicine--based on our own experience of a soon to be published BEME Review (BEMER) and several systematic reviews our group has published in clinical medicine--were used to identify similarities and differences between the two approaches. KEY FINDINGS: The evidence to support clinical as well as educational decision making is different in its nature, as well as in its quality. However, their approach is similar in its fundamental steps (design a question, select evidence, critically appraise it, synthesize and apply), so the differences between BEME and Cochrane are perhaps more a matter of degree, than the existence of fundamental differences. CONCLUSIONS: Two fundamental principles--decision making should be supported by a hierarchy of evidence and evidence alone is never sufficient for sound practice--apply to BEME and Cochrane reviews. The capacity to transfer their results into practice is the most important factor in terms of success of both approaches.

The Bologna Process - A global vision for the future of medical education.

What has become known as the Bologna Process has evolved over a series of ministerial conferences with the last meeting in Leuven and Louvain-la-Neuve in 2009. There has been a move towards recognition of the benefits to be gained from greater transparency, a general recognition of degrees across Europe, cooperation with regard to quality assurance, an emphasis on more flexible learning paths and lifelong learning, and the promotion of mobility. This paper highlights the ambitious objectives underpinning the Bologna Declaration and Process and the developments since the 1999 Declaration and the current position in particular with regard to medicine. The paper describes common myths and misunderstandings about the Process relating to the two cycle model, the progress of students after the first cycle and the concept of harmonisation rather than uniformity. It is argued that the Bologna Process can serve as a catalyst for the necessary change in medical education. With careful management and imaginative implementation and the necessary vision, creativity and enthusiasm, any problems can be circumnavigated and rich rewards achieved. The Bologna Process is constantly evolving and its dynamic nature is one of its strengths. Medicine has much to contribute and should be part of this Process.

A comprehensive checklist for reporting the use of OSCEs.

BACKGROUND: The Objective Structured Clinical Examination (OSCE) has experienced an explosion of use which has rarely been accompanied by systematic investigations on its validity, reliability and feasibility. A systematic review of OSCE was undertaken as part of Best Evidence Medical Education at the Centre for Evidence Based Medicine of the Faculty of Medicine of the University of Lisbon. Several problems were identified with published papers relating to completeness of information presented, methodological issues or the use of terminology. AIM: To identify a need for standardization within the reporting of OSCE studies in medical education based in the first 104 papers of the aforementioned review. METHOD: Two independent reviewers coded each paper. RESULTS: The most important problem identified was the lack of information, followed by the degree of inconsistency when reporting on OSCEs (papers with missing data and papers where data was given in a way that interpretation is difficult or impossible in terms of evidence; heterogeneity in reporting, lack of a standardized vocabulary, statistical errors and lack of structure within reporting). CONCLUSIONS: The authors present a 'Comprehensive Checklist for those describing the use of OSCEs in the report of educational literature' as an attempt to encourage better report standards.

Implementation of the Bologna two-cycle system in medical education: where do we stand in 2007? - results of an AMEE-MEDINE survey.

BACKGROUND: The Bologna Declaration aims to harmonize European higher education. At workshops held at AMEE Conferences (2001/2007), it was observed that medical educators seem unaware of Bologna Declaration policies in their own countries. Specifically the objective to structure higher education in two cycles evokes strong opinions, but an overview on the implementation progress is lacking. METHOD: To determine the present state of implementation of the Bologna two-cycle system in medical education, an AMEE-MEDINE survey was sent to all forty-six signatory countries, inquiring about legislative decisions. RESULTS: Not all answers were unequivocal, but it appears that only seven countries decided for adoption and nineteen decided not to adopt it. The remainder fifteen have not decided or leaves the decision to their medical schools. Non-European countries seem to reject the system more often than European countries. DISCUSSION: We found that very few persons are well informed about national policies and harmonization of medical education does not seem to be enhanced by the Bologna Declaration. Our findings point in the direction of a diversification regarding curricula structure. There is a need for clarity and dialogue on many aspects of Medical Education. The Bologna process could serve as a vehicle to reach this goal.