Factors Affecting the Level of Reflective Thinking and Clinical Decision-Making Skills in Medical Faculty Students.

Objectives: The aim of this study is to evaluate the reflection skills of students at the Faculty of Medicine and the factors influencing these skills, as well as to measure the impact of students' reflection skills on their clinical decision-making. Methods: This study is an educational research project conducted on fifth-year Ear Nose Throat (ENT) interns at Vakif University's Faculty of Medicine. The "Reflective Thinking Level Determination Scale" and the "Clinical Decision-Making Scale," which are valid and reliable, were used to assess the reflection skills and clinical decision-making abilities of the 125 students participating in the study. Results: In our study, the mean score of the sub-dimensions of the Groningen Reflection Skills Scale was 77.04±5.14 for the fifth-year student population surveyed. Scores from the "Self-Reflection" and "Reflective Communication" sub-dimensions of the Groningen Reflection Skills Scale were compared based on gender, participation in summer internships, receipt of scholarships, membership in social sciences clubs, place of residence, school attended, diary-keeping habits, study styles, and cities of residence. Although there were some differences between the groups, these differences were not statistically significant. The total scores of the students on the Clinical Decision-Making Scale sub-dimensions ranged from 98 to 169, with a mean score of 146.18±10.97. A statistically positive and moderate correlation was found between the total scores of the participants on the Groningen Reflection Skills Scale and the total scores they obtained on the Clinical Decision-Making Scale (r=0.403; p=0.001). Conclusion: Consequently, an increase in the reflection skills of participants is associated with higher clinical decision-making scores. Reflection is the primary means of transitioning students from novices to experts, enhancing both comprehensive learning and learning experiences. Therefore, every medical school should develop a training program for student reflection, along with a feedback and assessment system integrated into the curriculum.

The short- and long-term effects of a course on rational drug use: A comparative study between prefinal- and final-year undergraduate medical students who attended the course in different clinical years.

BACKGROUND: Rational pharmacology use and appropriate prescribing are among the key learning outcomes in medical education. Some medical faculties include rational pharmacotherapy course in their education programs at different years of education in Turkey. The aims of this study were to investigate the differences in effect of rational pharmacotherapy course on short- and long-terms by comparing two cohorts who attended the course in different clinical years of medical education by identifying which parameters of prescription items are different among groups. MATERIALS AND METHODS: This quasi-experimental study was conducted in School of Medicine. Participants consisted of 157 students who attended the course in Grade 4 (n = 110, Group A) and Grade 5 (n = 47, Group B). Students were asked to complete a prescribing task both upon completion of the course and 1 year after. The performance in prescribing was determined by prescription scoring form. Repeated measures ANOVA was employed to test the intervention effect between two periods. McNemar test was employed to measure the change in each item on the prescription. Point-biserial correlations between each item on the prescription and their scores on the test as a whole were calculated. RESULTS: The mean score of Group A dropped to 59.41 (standard deviation [SD] = 14.06) from 90.43 (SD = 8.90), and the mean score of Group B dropped to 73.37 (SD = 12.56) from 83.91 (SD = 10.03). All the prescription components in the scripts of the Group A students worsened significantly, except the "name of drug," whereas Group B students maintained most of them after 1 year. CONCLUSIONS: This study shows that the long-term retention effect of rational pharmacotherapy course conducted in later years of education is better than the course conducted in earlier years of education, which may be related to the fact that students in later years are more likely to take on responsibility for patient therapy process in clinical education.

RE-AIMing COVID-19 online learning for medical students: a massive open online course evaluation.

BACKGROUND: Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated. METHODS: The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students' course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically. RESULTS: Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective. CONCLUSIONS: Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.

Potential drug-drug interactions in a medical intensive care unit of a university hospital.

BACKGROUND/AIM: Drug-drug interactions (DDIs) can impact patient safety. Occurrence of clinically important DDIs is higher for intensive care unit (ICU) patients. This observational study aimed to evaluate the potential DDIs in medical ICU patients of a university hospital. MATERIALS AND METHODS: The Medical Pharmacology Department organized consultation reports for ICU patients in order to detect the DDIs. To focus on clinically important DDIs, interactions in the C, D, or X risk rating categories of the Lexi-Interact online database were analyzed. Frequency and clinical risk rating categories of DDIs were detected. Relationship between number of prescriptions and DDIs were assessed. The most frequent drug/drug groups were identified. RESULTS: Of 101 ICU patients, 45.5% were found to have DDIs. We detected 125 C (72.2%), 37 D (21.4%), and 11 X (6.4%) risk category interactions. A statistically significant increase in the number of DDIs was shown with the number of prescriptions (P = 0.002). The most frequent DDIs were between agents acting on the cardiovascular system and corticosteroids (12.8%). CONCLUSION: Results of this study show that pharmacological consultation plays a critical role in the recognition of DDIs for improvement of medication management and effective therapeutic endpoints without any adverse or toxic reactions.

Students meeting with caregivers of cancer patient: results of an experience-based learning project.

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

The impact of a faculty development program: evaluation based on the self-assessment of medical educators from preclinical and clinical disciplines.

Self-assessment tools have previously been used to assess the impact of a faculty development program on the teaching skills of medical educators. In this study, we aimed to assess the impact of a faculty development program on the teaching performances of faculty members in relation to their medical disciplines and academic positions. A faculty-training program consisted of "training skills" and "student assessment instruments" courses. The impact of the program was evaluated by self-reporting of faculty members (a total of 225 reports) 1-2 yr after the program. Both courses were found to be beneficial by nearly all of the attendants. Clinicians benefited more from some topics in the student assessment course and could apply the structured learning and assessment guides, structured oral examination, and objective structured clinical examination more efficiently than their peers from preclinical departments. In conclusion, the results demonstrated that the participants of the faculty development program modified their teaching activities according to the demands of their clinical practice. The correlations between the benefits and behavioral changes were statistically significant.

[Medical ethics in residency training]. / Uzmanlik egitiminde tip etigi.

Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential.

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

Exposing nursing students to the marketing methods of pharmaceutical companies.

There is a strong association between reliance on the promotional activities of pharmaceutical companies and a generally less appropriate use of prescription drugs. Pharmaceutical companies direct some of their promotion towards health workers who do not have the authority to prescribe medicines, such as nurses in certain countries. The aim of this study was to determine the impact that exposure to the marketing methods of pharmaceutical companies has on judgments made by nursing students about health worker-pharmaceutical company relationships. A cross-sectional survey was carried out with 442 nursing students in Istanbul, Turkey. The exposure of students to the marketing methods of pharmaceutical companies, whether it be indirectly through observation or directly by first-hand experience, increases the probability that students will adopt rationales that underlie affirmative judgments of health worker-pharmaceutical company relationships. Based on the pervasiveness and ability of drug promotion to influence the perceptions of students, it is imperative that attempts be made to reduce its negative impact.

Avian influenza outbreak in Turkey through health personnel's views: a qualitative study.

BACKGROUND: Avian influenza threatens public health worldwide because it is usually associated with severe illness and, consequently, a higher risk of death. During the first months of 2006, Turkey experienced its first human avian influenza epidemic. A total of 21 human cases were identified, 12 of which were confirmed by the National Institute for Medical Research. Nine of the cases, including the four fatal ones, were from the Dogubeyazit-Van region. This study aims to evaluate the efforts at the avian influenza outbreak control in the Van-Dogubeyazit region in 2006 through the experiences of health personnel. METHODS: We conducted in-depth interviews with seventeen key informants who took active roles during the avian influenza outbreak in East Turkey during the first months of 2006. We gathered information about the initial responses, the progress and management of the outbreak control, and the reactions of the health professionals and the public. The findings of the study are reported according to the topics that appeared through thematic analysis of the interview transcripts. RESULTS: Following the first suspected avian influenza cases, a Van Crisis Coordination Committee was formed as the coordinating and decision-making body and played an important role in the appropriate timing of decisions. The health and agriculture services could not be well coordinated owing to the lack of integrated planning in preparation for outbreak and of integrated surveillance programs. Traditional poultry practice together with the low socio-economic status of the people and the lack of health care access in the region seemed to be a major risk for animal to animal and animal to human transmission. The strengths and weaknesses of the present health system - primary health care services, national surveillance and notification systems, human resource and management - affected the inter organizational coordination during the outbreak. Open communication between the government and the public played an important part in overcoming difficulties. CONCLUSION: Although there were problems during the avian influenza outbreak in Turkey, the rapid responses of the central and regional health authorities and the performance of the health workers were the key points in controlling the epidemic. The lessons from this outbreak should provide an opportunity for integrating the preparation plans of the health and agricultural organizations, and for revising the surveillance system and enhancing the role of the primary health care services in controlling epidemic disease. Developing successful strategies based on knowledge and experience may play a valuable role in delaying an avian influenza pandemic.

[Immigrations to Anatolia, related public health problems and healthcare services in the beginning of the Twentieth Century]. / Yirminci yüzyilin baslarinda Anadolu'ya göçler, olusan halk sagligi sorunlari ve sunulan saglik hizmetleri.

Anatolia, one of the most important crossroads between two continents, has witnessed so many immigrations throughout the history. It is a place where different civilizations and cultures met and transformed each other by interaction. History of important immigrations to Anatolia during the reign of the Ottoman Empire goes back to 1683. Also, the period between the end of 19th century and the beginning of 20th century was the time of wars, immigrations, and death and birth of nations. The Ottoman Empire had joined the several wars as well, and the new Republic of Turkey was established after it collapsed. In this study, we investigated the two large scale immigrations to Anatolia between Balkan Wars and the first years of Republic, and tried to compile our knowledge about the public health problems and the healthcare services provided.

Attitudes of Turkish anatomists toward cadaver donation.

There is an insufficient number of cadavers in anatomy education in Turkey. This is because of decreased number of unclaimed bodies and very few cadaver donations. Increasing the number of cadaver donation is one of the probable solutions. Although anatomists encourage people to donate bodies, the attitudes of anatomists toward donating their own bodies for dissection is not well known. In this study, the attitudes of Turkish anatomists toward cadaver donation were evaluated. The questionnaires were sent to the anatomists in Turkey by mail and E-mail. Eighty-three anatomists replied to the questionnaire. The main solutions proposed for cadaver insufficiency included increasing the supply of unclaimed bodies (77.1%) and increasing body donation (78.3%). Further, 51.8% of the respondents thought that increasing body donation was a long-term solution. The general belief (83.1%) was that a campaign would help to increase body donation and 47% of respondents were willing to participate in such a campaign. Of the 83 anatomists, 20.5% of the respondents donated their organs and 49.4% were planning to donate them. Further, 15.7% were planning to donate their bodies; however, 63.9% did not consider donating. The main reasons of the respondents to object the donation were: to be dissected by a colleague (15.7%), the unacceptability of donation by family (26.5%), psychological reasons (43.4%), the anxiety of disrespectful behavior to cadavers (26.5%), and religious beliefs (3.6%). Although the majority of the respondents objected to donating their bodies due to psychological reasons, body donation was proposed as the main solution of cadaver insufficiency.

Integration of a problem-based multidisciplinary clinical cancer management course into undergraduate education.

BACKGROUND: Undergraduate cancer education programs usually involve diagnosis and treatment of various organs and tissues of the body that are invaded by this disease. Teaching organ system-based oncology by different disciplines causes a fragmented structure of knowledge with difficulty on reuniting the knowledge for the real patient. METHODS: Along with the reorganization process of the curriculum, an integrated, problem-based multidisciplinary clinical cancer management course has been introduced to fifth-year students. The course has consisted of group studies, panel discussions, site visits to departments involved in diagnosis and treatment of cancer, and lecture tutorials enriched with interactive learning methods. RESULTS AND CONCLUSION: Overall assessment of the course has been encouraging in terms of a clinical approach for students to the cancer patient, and innovations for better learning have been implemented for the following year.