Normalizing Service Learning in Medical Education to Sustain Medical Student-Led Initiatives.

Medical students demonstrate their passion for participating in and improving health care both within and outside the classroom. As the COVID-19 pandemic swept across the world, medical students in the United States engaged in student-led service-learning initiatives to contribute to medicine and their local communities, including collecting and distributing personal protective equipment, creating and translating pandemic-related educational materials, and providing childcare for frontline workers. Their impact was recognized and appreciated. Service learning is an education method that incorporates community outreach with didactic coursework and student reflection. In this commentary, the authors argue for including service learning as a required component in the medical school curriculum to provide students with the tools and support to be advocates and leaders within society, as no such curriculum currently exists. The authors also discuss the history of medical student-led service-learning efforts through to the present day, barriers to implementing and sustaining student-led service-learning initiatives, and solutions to prepare students for service-learning initiatives.

The Moderating Role of Mathematical Skill Level when Using Curricular Methods to Learn Multiplication Tables / El papel moderador del nivel de habilidad matemática al emplear métodos curriculares para la enseñanza de las tablas de multiplicación

The present study explores the effect of two instructional methods for children with different levels of mathematical skills. One of these methods uses a conventional approach to learning multiplication and emphasizes the memorization of all arithmetic facts, whereas the other method is based on psychological principles and combines: a) the memorization of a small subset of problems aided by color cues and a portable time-table, with b) the use of single-step rules. One hundred and sixty second-grade children (aged 7-8) received instruction in one of these approaches – either the conventional method or the memory and rules method (M&R) – over the course of 6 months as part of their normal school education. Moderation analysis revealed that children with poor mathematical skills in the conventional group scored significantly better than their counterparts in the M&R group, whereas a significant advantage was observed in the M&R group for those children with strong mathematical skills. (AU)

El presente estudio explora el efecto de dos métodos de enseñanza de la multiplicación simple en alumnos de primaria con diferentes niveles de habilidades matemáticas. Un método se basa en el enfoque convencional para el aprendizaje de las multiplicaciones que enfatiza la memorización de todas ellas, mientras que el otro se basa en principios psicológicos y combina: a) la memorización de un pequeño subconjunto de multiplicaciones auxiliadas con claves de color y una tabla portátil con las multiplicaciones con b) el uso de reglas de un solo paso. Ciento sesenta niños y niñas de segundo de primaria (de 7 a 8 años) recibieron instrucción en uno de estos métodos, ya fuera el convencional o el método de memorización y reglas (M&R), durante 6 meses como parte de su educación escolar normal. El análisis de moderación reveló que los niños con habilidades matemáticas bajas en el grupo convencional obtuvieron puntuaciones significativamente mejores que sus pares en el grupo M&R, mientras que se observó una ventaja significativa en el grupo M&R para aquellos niños con altas habilidades matemáticas. (AU)

Uso de presentación de casos clínicos como herramienta virtual con estudiantes avanzados de medicina. Experiencia inicial / No disponible

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Competencias docentes para la enseñanza y el aprendizaje en un entorno virtual / No disponible

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Learning in the Time of COVID-19: Key Lessons From the Pandemic for Medical Trainees.

The COVID-19 pandemic has changed the face of education for undergraduate and graduate medical trainees. Lectures, clinical clerkships, and testing have all been impacted significantly because of patient care needs and concern for the health and safety of trainees. While traditional teaching strategies have been upended, the challenges posed by the pandemic have also created unique opportunities for trainees. In this article, the authors summarize lessons trainees can learn from the ongoing pandemic in the following areas: public health, disaster preparedness, and resource allocation; reinventing professional and personal roles to meet the needs of the health care system; flexibility in navigating testing, licensure, and certification; appraising scientific evidence quickly and accurately; balancing a physician's call to duty with fear for personal safety; combating moral injury; interprofessional collaboration; and advocating for oneself and one's colleagues. Focusing on these lessons can help educators steer their efforts to better prepare future physicians for unforeseen challenges that may come up in their personal and professional lives as well as in society as a whole.

Discharge Communication: A Multi-Institutional Survey of Internal Medicine Residents' Education and Practices.

PURPOSE: To characterize residents' practices around hospital discharge communication and their exposure to transitions-of-care instruction in graduate medical education (GME). METHOD: In 2019, internal medicine residents at 7 academic medical centers completed a cross-sectional survey reporting the types of transitions-of-care instruction they experienced during GME training and the frequency with which they performed 6 key discharge communication practices. The authors calculated a mean discharge communication score for each resident, and, using multiple logistic regression, they analyzed the relationship between exposure to types of educational experiences and discharge communication practices residents reported they performed frequently (> 60% of time). The authors used content analysis to explore factors that motivated residents to change their discharge practices. RESULTS: The response rate was 63.5% (613/966). Resident discharge communication practices varied. Notably, only 17.0% (n = 104) reported routinely asking patients to "teach-back" or explain their understanding of the discharge plans. The odds of frequently performing key discharge communication practices were greater if residents received instruction based on observation of and feedback regarding their communication (adjusted odds ratio 1.73; 95% confidence interval [CI], 1.07-2.81) or if they received explicit on-rounds teaching (adjusted OR 1.46; 95% CI, 1.04-2.23). In open-ended comments, residents reported that experiencing adverse patient events at some point in the postdischarge continuum was a major impetus for practice change. CONCLUSIONS: This study exposes gaps in hospital discharge communication with patients, highlights the benefits of workplace-based instruction on discharge communication skills, and reveals the influence of adverse events as a source of hidden curricula. The results suggest that developing faculty to incorporate transitions-of-care instruction in their rounds teaching and integrating experiences across the postdischarge continuum into residents' education may foster physicians-in-training who are champions of effective transitions of care within the fragmented health care system.

Advancing Our Pharmacy Reformation - Accelerating Education and Practice Transformation: Report of the 2019-2020 Argus Commission.

The Argus Commission examined changes that should be considered by colleges and schools of pharmacy to meet the bold aim of better integrating pharmacists' and physicians' practices articulated by President Sorensen. The Commission assessed the readiness of pharmacy educators to contribute to the acceleration of practice transformation. The primary focus of the report is on how the doctor of pharmacy curriculum and post-graduate training might be modified and better aligned to ensure that graduates complete their education ready to engage in roles partnered with primary care clinicians. The aim is to achieve comprehensive medication management and other pharmacist patient care services as standards of care. The Argus Commission provides preliminary recommendations for new or more intensified priorities by the 2020-21 AACP Strategic Planning Committee as they update the AACP plan. This includes the recommendation that AACP should create the Center for Academic Innovation and Practice Transformation, a hub to coordinate many current and emerging activities relevant to accelerating change in pharmacy education and practice.

Planificación de actividades de enseñanza en un currículo integrado: el riesgo de la "desintegración" / Planning activities within an integrated curriculum: the risk of "disintegration"

Introducción: en 2014, tras más de 10 años de comenzada la Carrera de Medicina en el Instituto Universitario Hospital Italiano de Buenos Aires (IUHIBA), en la comunidad educativa se comenzó a plantear la necesidad de realizar un cambio curricular con el objetivo de lograr la enseñanza de habilidades complejas en forma integrada para generar un aprendizaje significativo y un mayor desarrollo de competencias. El cambio curricular comenzó a implementarse en 2018. Propósitos: describir la experiencia de diseño de las actividades de enseñanza en un currículo integrado. Desarrollo: para el diseño de las actividades de cada módulo (de un cuatrimestre de duración) se conformaron grupos planificadores multidisciplinarios. El objetivo principal de la planificación fue que los estudiantes comenzaran a desarrollar las habilidades necesarias para poder llevar adelante las actividades profesionales (EPAs: Entrustable Professional Activities) al final de la carrera. Los escenarios donde transcurren las actividades del Ciclo Inicial son las sesiones de aprendizaje basado en problemas, los laboratorios para el desarrollo de habilidades, las charlas plenarias y la atención primaria orientada a la comunidad. Fueron definidas EPAs para desarrollarse en el Ciclo Inicial, que guiaron la planificación en diálogo con los contenidos seleccionados para el cuatrimestre. Para poder realizar un diseño integrado se estableció la relación de cada actividad con las de los módulos precedentes, retomando y complejizando los contenidos para que el diseño fuera espiralado. Conclusiones: el mayor desafío de esta experiencia radicó en que debimos sumergirnos en un nuevo paradigma. El principal logro como grupo planificador fue hacer propia esta nueva forma de enseñanza: basada en el alumno, en problemas, integrada, espiralada. Evaluaremos los resultados tras su implementación y rediseñaremos las actividades, de ser necesario. (AU)

Introduction: in 2014, after 10 years of the establishment of the School of Medicine at the Instituto Universitario Hospital Italiano de Buenos Aires (IUHIBA), the educational community identified the need to make a curricular change to teach complex skills in an integrated way to generate meaningful learning and further development of skills. The new curriculum was implemented in 2018. Purposes: to describe our experience in designing teaching activities for an integrated curriculum. Development: multidisciplinary planning groups were formed to design the activities of each four-month module. The main objective was for students to develop the skills necessary to carry out professional activities (EPAs: Entrustable Professional Activities) by the time of graduation. The "Initial Cycle" activities took place in four scenarios: (i) problem-based learning; (ii) skills lab (iii) forum discussions; and (iv) communityoriented education. The EPAs that would be acquired in the Initial Cycle were selected. Those EPAs, together with the contents selected for the semester guided the planning groups. To ensure an integrated design, the relationships of each module with the preceding one were established. We adopted a spiral design where we returned to the same topics at a deeper level and with more complexity. Conclusions: the greatest challenge was that this experience involved a paradigm change. Our main achievement was to adopt a new form of teaching that was student and problem based, within an integrated and spiral curriculum. We plan to evaluate the results after implementation and redesign the activities, if necessary. (AU)

Algunas lecciones aprendidas (o no tanto) de la COVID-19 / Some learned lessons (or not so much) from COVID-19

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Meeting the Needs of A Changing Landscape: Advances and Challenges in Undergraduate Biology Education.

Over the last 25 years, reforms in undergraduate biology education have transformed the way biology is taught at many institutions of higher education. This has been fueled in part by a burgeoning discipline-based education research community, which has advocated for evidence-based instructional practices based on findings from research. This perspective will review some of the changes to undergraduate biology education that have gained or are currently gaining momentum, becoming increasingly common in undergraduate biology classrooms. However, there are still areas in need of improvement. Although more underrepresented minority students are enrolling in and graduating from biology programs than in the past, there is a need to understand the experiences and broaden participation of other underserved groups in biology and ensure biology classroom learning environments are inclusive. Additionally, although understanding biology relies on understanding concepts from the physical sciences and mathematics, students still rarely connect the concepts they learn from other STEM disciplines to biology. Integrating concepts and practices across the STEM disciplines will be critical for biology graduates as they tackle the biological problems of the twenty-first century.

Application of Absorb-Do-Connect learning framework to foster experiential, practice, and career-ready learners.

INTRODUCTION: As educators, we have the opportunity to produce experiential-ready, practice-ready, and career-ready practitioners. Student attitudes and values influence how learned knowledge and skills will be enacted, and therefore are key determinants of career-readiness. However, attitudes and values can be challenging to see and measure in learners. In this commentary, the authors propose purposeful selection and application of an educational framework to foster those less tangible, but powerful, factors. PERSPECTIVE: To illustrate this perspective, authors describe key components of the Absorb-Do-Connect learning framework and provide rationale for the framework's alignment with self-efficacy theory. The authors propose that Absorb-Do-Connect can be applied within pharmacy education to design learning activities that establish relevance in learning and subsequently foster self-efficacy through growth in attitudes and values. IMPLICATIONS: The Accreditation Council for Pharmacy Education Standards emphasize connecting current education to past experiences and future practice to establish relevance in learning. In this manner, authors suggest Absorb-Do-Connect can be used by schools and colleges of pharmacy to inform new innovations and revise existing coursework to meet the standards. Opportunity exists to formally assess the relationship between absorbing, engaging with and purposely connecting knowledge and skills, and the development of self-efficacy in student pharmacists.

The refinement of flipped teaching implementation to include retrieval practice.

There has been growing evidence that flipped teaching (FT) can increase student engagement. Traditional lecture-based teaching (TT) method was compared with FT and FT combined with retrieval practice (FTR) in a 400-level Exercise Physiology course over eight semesters. In the FT format, lecture content was assigned for students to prepare before class along with an online quiz. During class, the assigned content and quiz questions were reviewed, and a team-based learning (TBL) activity was conducted. Students found FT implementation three times a week (FT3) to be overwhelming, which led to reconfiguration of the FT design to minimize the quiz and TBL sessions to one per week. Subsequently, FT was combined with retrieval exercises (FTR), which involved recalling information, thus promoting retention. The students in the FTR format were given weekly quizzes in class, where no notes were allowed, which affected their quiz grade negatively compared with FT (P < 0.0001). Again, no resources were permitted during FTR's TBL sessions. When exam scores were compared with TT, student performance was significantly greater (P < 0.001) with the FT and FTR methods, suggesting these methods are superior to TT. While both male and female students benefited from FT and FTR methods compared with TT (P = 0.0008), male students benefited the most ((P = 0.0001). Similarly, when the exam scores were organized into upper and lower halves, both groups benefited from FT and FTR (P < 0.0001) approaches. In conclusion, both FT and FTR methods benefit students more compared with TT, and male students are impacted the most.

WHO guide to good prescribing is 25 years old: quo vadis?

INTRODUCTION: Twenty-five years ago, the World Health Organization (WHO) published the Guide to Good Prescribing (GGP), followed by the accompanying Teacher's Guide to Good Prescribing (TGGP). The GGP is based on a normative 6-step model for therapeutic reasoning and prescribing, and provides a six-step guide for students to the process of rational prescribing. METHOD: We reviewed the need to update both WHO publications by evaluating their use and impact, including new (theoretical) insights and demands. Based on information from literature, Internet, and other (personal) sources, we draw the following conclusions. RESULTS: 1. An update of the GGP and TGGP, both in terms of content and form, is necessary because of the current need for these tools (irrational medicine use and unavailability of medicines), the lack of similar documents, and the lack of connection with recent developments, such as Internet and modern education; 2. The basic (6-step) model of the GGP is effective in terms of rational prescribing in the undergraduate situation and is still consistent with current theories about (context) learning, clinical decision-making, and clinical practice; 3. The dissemination and introduction of the GGP and TGGP in education has been successful so far, but is still not optimal because of lack of support and cooperation. CONCLUSIONS: On the basis of the evaluation results, a plan for the revision of the GGP and TGGP is presented.

Implementing physically active learning: Future directions for research, policy, and practice.

Purpose: To identify co-produced multi-stakeholder perspectives important for successful widespread physically active learning (PAL) adoption and implementation. Methods: A total of 35 stakeholders (policymakers n = 9; commercial education sector, n = 8; teachers, n = 3; researchers, n = 15) attended a design thinking PAL workshop. Participants formed 5 multi-disciplinary groups with at least 1 representative from each stakeholder group. Each group, facilitated by a researcher, undertook 2 tasks: (1) using Post-it Notes, the following question was answered: within the school day, what are the opportunities for learning combined with movement? and (2) structured as a washing-line task, the following question was answered: how can we establish PAL as the norm? All discussions were audio-recorded and transcribed. Inductive analyses were conducted by 4 authors. After the analyses were complete, the main themes and subthemes were assigned to 4 predetermined categories: (1) PAL design and implementation, (2) priorities for practice, (3) priorities for policy, and (4) priorities for research. Results: The following were the main themes for PAL implementation: opportunities for PAL within the school day, delivery environments, learning approaches, and the intensity of PAL. The main themes for the priorities for practice included teacher confidence and competence, resources to support delivery, and community of practice. The main themes for the policy for priorities included self-governance, the Office for Standards in Education, Children's Services, and Skill, policy investment in initial teacher training, and curriculum reform. The main themes for the research priorities included establishing a strong evidence base, school-based PAL implementation, and a whole-systems approach. Conclusion: The present study is the first to identify PAL implementation factors using a combined multi-stakeholder perspective. To achieve wider PAL adoption and implementation, future interventions should be evidence based and address implementation factors at the classroom level (e.g., approaches and delivery environments), school level (e.g., communities of practice), and policy level (e.g., initial teacher training).

Illuminating Shadows: The Power of Learning by Observing.

"Shadowing" refers to the practice of a student following an instructor. Although the term implies less light, rather than more, shadowing as an instructional modality in medical education can illuminate, stimulate, and move students to emulate what they might otherwise never observe. In this Invited Commentary, the author reports on a teaching encounter in the office in which shadowing was the principal modality used. This modality is situated within the spectrum of approaches to learning-from experiential learning to passive learning. Based upon personal experience as both a teacher and learner, the author identifies the unique value of shadowing, including its value in influencing career choice.

"Getting Out of That Siloed Mentality Early": Interprofessional Learning in a Longitudinal Placement for Early Medical Students.

PURPOSE: Although descriptions of interprofessional education often focus on interactions among students from multiple professions, embedding students from 1 profession in clinical settings may also provide rich opportunities for interprofessional learning (IPL). This study examines affordances and barriers to medical students' interactions with and opportunities to learn from health care professionals while learning health systems science in clinical workplaces. METHOD: In May 2017, 14 first-year medical students at the University of California, San Francisco participated in a semistructured interview about IPL experiences during a 17-month, weekly half-day clinical microsystem placement focused on systems improvement (SI) projects and clinical skills. Communities of practice and workplace learning frameworks informed the interview guide. The authors analyzed interview transcripts using conventional qualitative content analysis. RESULTS: The authors found much variation among the 14 students' interprofessional interactions and experiences in 12 placement sites (7 outpatient, 4 inpatient, 1 emergency department). Factors influencing the depth of interprofessional interactions included the nature of the SI project, clinical workflow, student and staff schedules, workplace culture, and faculty coach facilitation of interprofessional interactions. Although all students endorsed the value of learning about and from diverse health care professionals, they were reluctant to engage with, or "burden," them. CONCLUSIONS: There are significant IPL opportunities for early medical students in longitudinal placements focused on SI and clinical skills. Formal curricular activities, SI projects conducive to interprofessional interactions, and faculty development can enhance the quality of workplace-based IPL.

Evaluation of multiple active learning strategies in a pharmacology course.

BACKGROUND AND PURPOSE: The objectives of this study were to implement multiple active learning strategies in pharmacology and evaluate the most effective method to promote understanding. EDUCATIONAL ACTIVITY AND SETTING: A structured, student-centered learning approach was launched. The implemented active learning strategies were Kahoot web-based interactive games, crossword puzzles, an instructional video, a music video, and fill-in-the-blank tables. For three consecutive years, several topics in pharmacology were taught by the same instructor. While traditional teaching was used for the class of 2016, the above-mentioned active learning strategies were utilized for the classes of 2017 and 2018. Student perceptions on traditional teaching vs. active learning and on the different active learning methods were determined by anonymous survey. The effectiveness of active learning on understanding pharmacology concepts was detected by extracting student performance data from ExamSoft item analysis. FINDINGS: Based on exam performance assessment, students in the classes of 2017 and 2018 performed significantly better when fill-in-the-blank activities and videos were utilized. However, students believed that web-based games helped them better understand concepts. Variables between the classes of 2016, 2017, and 2018 were minimized through comparison of the same lecture topics and having the same instructor write exam questions. SUMMARY: Although students perceived Kahoot web-based interactive gaming as the most valuable active learning strategy, fill-in-the-blank activities and videos were more effective in understanding the pharmacology concepts as measured by their exam performance.

A review to identify key perspectives in PBL meta-analyses and reviews: trends, gaps and future research directions.

In the past 50 years, the original McMaster PBL model has been implemented, experimented, revised, and modified, and is still evolving. Yet, the development of PBL is not a series of success stories, but rather a journey of experiments, failures and lessons learned. In this paper, we analyzed the meta-analyses and systematic reviews on PBL from 1992 to present as they provide a focused lens on the PBL research in the past 5 decades. We identified three major waves in the PBL research development, analyzed their impact on PBL research and practice, and offered suggestions of research gaps and future directions for the field. The first wave of PBL research (polarization: 1990-mid 2000) focused on answering the question "Does PBL work?" and the outcomes. The results were conflicting. The researchers took polarizing positions and debated over the merits of PBL throughout this wave. However, the contradictory results and the debates in fact pushed the researchers to look harder for new directions to solve the puzzle. These efforts resulted in the second wave (from outcomes to process: mid 2000-mid 2010) that focused on the question "How does PBL work?" The second wave of PBL research targeted at investigating the effects of implementation constituents, such as assessment formats or single versus curriculum wide implementations. The third wave (specialization: mid 2010 and onward) of PBL research focused on "How does PBL work in different specific contexts?" These research widened our perspectives by expanding our understanding of how PBL manifests itself in different contexts. Given the diversification of PBL and more hybrid PBL models, we suggest "Why does PBL with particular implementation characteristics for specific outcomes work or not work in the condition where it is implemented?" to be the question to answer in the next wave of PBL research.

Investigating factors affecting on medical sciences students' intention to adopt mobile learning.

BACKGROUND: Mobile learning (m-learning) provides a good opportunity for students' lifelong learning. The design and implementation of effective and successful mobile learning requires identification of factors that affect m-learning. The aim of this study was to investigate the factors that affect the intention of students of medical sciences to adopt mobile learning based on theory of planned behavior (TPB). METHODS: In this cross-sectional study, 332 students of medical sciences were randomly selected. The study tool was a based a questionnaire that had been designed based on TPB model. Descriptive statistics (mean, standard deviation, frequency and percentage) were calculated. In order to determine the standardized factor loading and assess the study hypotheses, structural equation modeling was used. Composite reliability, average variance extracted, and standardized factor loading were used to determine the convergent validity. RESULTS: The mean of mobile learning readiness was 3.59 ± 0.83. Among the TPB structures, the structures of attitude (ß = 0.525) and behavioral control (ß = 0.318) had positive and significant effect on the intention to adopt m-learning (P ≤ 0.01). However, the structure of subject norm did not have a significant effect on the intention to adopt m-learning. In general, attitude, behavioral control and subject norm structures were 0.675 determinants of the intention to adopt m-learning (r2 = 0.675). CONCLUSIONS: In this study Mobile learning readiness of the students was at moderate level. Also the results indicated Positive and significant effect of attitude and behavioral control on the intention of students to accept m-learning. The TPB-based model was a suitable model for identifying psychological factors that affect the intention of students of medical sciences to adopt m-leaning. In order to increase the students' acceptance of mobile learning, we suggest that, other psychological, behavioral, social, and cultural factors that affect the acceptance of m-learning should be identified. Educational programs are also suggested to be introduced to students to familiarize them with the m-learning and its application in learning process.