Digital technology in informed consent for surgery: systematic review.

BACKGROUND: Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery. METHODS: A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice. RESULTS: A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice. CONCLUSION: Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.

Developing a framework of simulation-based medical education curriculum for effective learning

Simulation-based medical education (SBME) is considered to improve cognitive, affective and psychomotor domains of the medical trainees. However, very few institutions use a structured high-fidelity SBME curriculum. This systematic review provides an insight into a framework for planning, implementing and evaluating a simulation-based curriculum along with its required infrastructure. Electronic databases of ScienceDirect, Wiley online library, Ovid, Medline, Cochrane library, CI-NAHL, and ISI Web of knowledge were searched for full-text English language articles using key-words; simulation OR medical education OR simulators AND clinical training AND simulation-based medical education. An initial search selected 1146 titles. Using a systematic algorithm of data selection, extraction and synthesis, a total of eight studies were selected for further review. Research has shown that a triad of academia (faculty and instructors), program (planning, implementing and evaluating), and resources (simulators and tools) is required for designing a simulation-based curriculum. Planning a SBME curriculum involves gaps of identification and needs analysis, defining specific learning objectives and teaching pedagogies. Implementing SBME leads to enhanced psycho-motor skills to a greater extent than cognitive and affective learning. Practice, repetition and learning from errors with immediate and post-event feed-back makes the simulation exercises a perfect learning tool. This study provides a framework of key elements of SBME that can be embedded into medical curricula. Pillars of SBME curriculum include academia, program development and resources. Though psychomotor domain is largely augmented, in general, all clinical skills are improved

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Medical students' perception of test anxiety triggered by different assessment modalities.

OBJECTIVES: Test anxiety is well known among medical students. However, little is known about test anxiety produced by different components of exam individually. This study aimed to stratify varying levels of test anxiety provoked by each exam modality and to explore the students perceptions about confounding factors. METHODS: A self-administered questionnaire was administered to medical students. The instrument contained four main themes; lifestyle, psychological and specific factors of information needs, learning styles, and perceived difficulty level of each assessment tool. RESULTS: A highest test anxiety score of 5 was ranked for "not scheduling available time" and "insufficient exercise" by 28.8 and 28.3% students, respectively. For "irrational thoughts about exam" and "fear to fail", a highest test anxiety score of 5 was scored by 28.8 and 25.7% students, respectively. The highest total anxiety score of 1255 was recorded for long case exam, followed by 975 for examiner-based objective structured clinical examination. Excessive course load and course not well covered by faculty were thought to be the main confounding factors. CONCLUSIONS: The examiner-based assessment modalities induced high test anxiety. Faculty is urged to cover core contents within stipulated time and to rigorously reform and update existing curricula to prepare relevant course material.

Acceptability and potential impacts of innovative E-Portfolios implemented in E-Learning systems for clinical training.

OBJECTIVE: There is growing evidence that use of E-portfolios has a positive effect on learning experience. However, literature has not shown sufficient data about the effectiveness of E-portfolios in medical education. This study was conducted to assess the acceptability and potential impacts of E-portfolio use for undergraduate radiography students. METHODS: This cross-sectional quantitative study was conducted during the academic year 2016-2017 on students studying clinical courses. A self-administered questionnaire was distributed to the selected cohort of students. All participants completed the consent form before answering the questionnaire. RESULTS: Of 75 students, 66 completed the survey (response rate; 88%). Students' experience, students' learning support, and the challenges of E-portfolio use were identified. Forty-one (62%) students perceived that E-portfolios facilitated the effective organization of their work, and 40 (61%) agreed that E-portfolios enhanced their professional skills. In contrast, the students perceived a negative correlation between students' learning support and future utilization of E-portfolios (correlation coefficient -0.394, p = 0.05). Future utilization of E-portfolios was found to be positively correlated with challenges and commitment to deadlines, with correlation coefficients of 0.371 and 0.152, respectively. CONCLUSION: The study found that continuous technical support for E-portfolios throughout the course had a potential role in enhancing learning experience. Appropriate training for integrating E-portfolios into teaching and learning can potentially enrich the educational environment. Student and faculty feedback is the main cornerstone for E-portfolio success.

Exam anxiety in the undergraduate medical students of Taibah University.

BACKGROUND AND OBJECTIVES: Assessment is perceived to create highly stressful environment among medical students. Several studies have reported exam-related anxiety symptoms but the contributing factors seem to differ across institutions. This study aimed to determine the prevalence of exam anxiety, gender differences and the variables that moderate exam anxiety among students of a Saudi medical school. METHODS: A cross-section study was done on 5th year medical students by administering a 12-statement self-administered questionnaire. The degree of exam anxiety was gauged by a visual analog scale. RESULTS: Of 125 students, 111 responded (response rate 89%). About 65% students experienced exam anxiety due to various reasons. Studying all night before exam (28 students; 25.2%) and extensive course load (26 students; 23.4%) were the major confounding factors. Female students experienced more stress due to extensive course load as compared with male students (p = .00). CONCLUSIONS: The data about the identified risk factors for exam anxiety can help medical educators to deeply understand the reasons for exam anxiety. There is a need to reassess the amount of study material in undergraduate medical curricula and students need to organize their time management skills to cope with exam anxiety.

Correlation of clinical, radiological and serum analysis of hypovitaminosis D with polycystic ovary syndrome: A systematic review and meta-analysis.

OBJECTIVES: Vitamin D deficiency leads to a myriad of healthcare problems from cardiovascular, metabolic, endocrine, and neurological disorders to cancer. However, the role of vitamin D deficiency in the etiopathogenesis of polycystic ovary syndrome (PCOS) is unclear. This study aimed to measure objectively the impact of vitamin D deficiency on PCOS through a quantitative assessment of the existing literature. METHODS: We conducted a systematic search of published literature on the following online databases using EndnoteX7: MEDLINE, EBSCO, ScienceDirect, and CINAHL. Searches were limited to full-text English-language journal articles published between 2006 and 2016. Eligible clinical studies employed control group data to investigate the association between vitamin D deficiency and PCOS. RESULTS: We identified 10 studies eligible for this meta-analysis. The summary intervention effect calculated for this meta-analysis yields a value of -0.45 with a confidence interval of -1.68 to 0.79, supporting the hypothesis that lower concentrations of serum vitamin D play a role in the hormonal and metabolic dysregulation seen in PCOS. CONCLUSIONS: Lower concentrations of serum vitamin D are associated with a greater risk of developing PCOS. However, the therapeutic effect of vitamin D in the setting of PCOS remains unclear and must be determined by future interventional studies.

Low bone mineral density among young healthy adult Saudi women. Prevalence and associated factors in the age group of 20 to 36 years.

OBJECTIVES: To screen for low bone mineral density among young adult Saudi women using quantitative ultrasound (QUS) and exploring the high risk groups. Methods: A cross-sectional study was performed on 279, 20-36 years old female students and employees of Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia between January and May 2014. The study included bone status assessed using QUS, a structured self-reported questionnaire, anthropometric measurements, and evaluation of bone markers of bone metabolism. Results: The prevalence of low bone mineral density was 9%. Serum osteocalcin was found significantly higher in candidates with low bone mineral density, 20.67 ng/ml versus 10.7 ng/ml, and it was negatively correlated with T-scores. At any given point in time the exposed subjects to low calcium intake and inadequate sun exposure in the population were 11 times and 3 times more likely to have low bone mineral density, (adjusted odds ratio [OR], 11.0; 95%confidence interval [CI]=3.16, 38.34; p=0.001) and (adjusted OR, 3.32, 95%CI=1.27, 8.66, p less than 0.01). Conclusion: Early detection screening programs for low bone mineral density are needed in Saudi Arabia as it affects young Saudi women specially the high-risk group that includes young women with insufficient calcium intake and insufficient sun exposure. Serum osteocalcin as a biomarker for screening for low bone mineral density could be introduced.

The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine.

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms "professionalism" AND "duty" AND "assessment" OR "professionalism behavioural" AND "professionalism-cognitive" were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.