Twelve tips for developing a systematic acute care curriculum for medical students.

There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students' reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals.

How community and organizational culture interact and affect senior clinical educator identity.

PURPOSE: The development of Educator Identity has a significant impact on well-being, motivation, productivity, and the quality of teaching. Previous research has shown that conflicting responsibilities and a challenging work environment could negatively affect the development of Clinical Educator Identity within an organization. However, there is a lack of research that identifies the factors affecting Clinical Educator Identity Formation and provides guidance on how organizations can support its development, maintenance, and advancement. METHODS: To examine the phenomenology of Professional Identity Development in experienced Senior Clinical Educators in Singaporean hospitals, the study utilized an exploratory qualitative approach. The data was collected from September 2021 to May 2022 through one-to-one interviews. Four investigators analyzed the data using constant comparative analysis to identify relevant themes. RESULTS: Eleven senior educators revealed that personal, relational, and organizational factors influenced the development of Clinical Educator Identity. The relational aspect was a vital enabler, while organizational culture was a strong barrier. The study also identified several ways in which organizations can support Educator Identity development. CONCLUSION: The study findings provide insight into how organizations can support the development of Clinical Educator Identity. The results could aid organizations in understanding the areas where they can channel resources to support Clinical Educator Identity development.

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals-A Qualitative Analysis.

Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders' perspectives and experiences regarding end-of-life care in the ED. Materials and Methods: A descriptive qualitative study was conducted from November 2019 to January 2020. Study participants were recruited from the EDs of three tertiary hospitals and community care settings in Singapore through purposive sampling. Data collection included focus group discussions with 36 ED staff, 16 community healthcare professionals, and one-on-one semi-structured interviews with seven family members. Results: Three main themes and several subthemes emerged from the data analysis. (1) Reasons for ED visits were attributed to patients' preferences, families' decisions, limited services and capabilities in the community, and ease of access. (2) Barriers to providing end-of-life management in the ED included: conflicting priorities of staff, cramped environment, low confidence, ineffective communication, and lack of standardised workflows. (3) Discussion about continuity of end-of-life care beyond the ED uncovered issues related to delayed transfer to inpatient wards, challenging coordination of terminal discharge from the ED, and limited resources for end-of-life care in the community. Conclusions: Key stakeholders reported challenges and shared expectations in the provision of end-of-life care in the ED, which could be optimised by multidisciplinary collaborations addressing environmental factors and workflows in the ED. Equipping ED physicians and nurses with the necessary knowledge and skills is important to increase competency and confidence in managing patients attending the ED at the end of their lives.

A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62.

Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.

Twelve tips for the effective use of videos in medical education.

Videos can promote learning by either complementing classroom activities, or in self-paced online learning modules. Despite the wide availability of online videos in medicine, it can be a challenge for many educators to decide when videos should be used, how to best use videos, and whether to use existing videos or produce their own. We outline 12 tips based on a review of best practices in curriculum design, current research in multimedia learning and our experience in producing and using educational videos. The 12 tips review the advantages of using videos in medical education, present requirements for teachers and students, discuss how to integrate video into a teaching programme, and describe technical requirements when producing one's own videos. The 12 tips can help medical educators use videos more effectively to promote student engagement and learning.

Online training module for micro suturing incorporating motor imagery and mental practice: a design and development research study.

INTRODUCTION: There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and one form of this is through mental practice and motor imagery. The study aimed to design and develop an online basic micro suturing training module for skill acquisition for self-regulated learning using a low-fidelity rubber glove model. METHODS: This study utilized a design and developmental research framework and Mayer's multimedia theory guidelines. The primary author created an online instructional module on micro suturing based on the ADDIE instructional design model. This module was then evaluated in a pilot study comparing the new training model to traditional methods of learning using an experimental design. RESULTS: This study describes the use of Design and Development Research to create a new model for surgical skill training and a tool for producing instructional materials and learning products for online learning. The product was evaluated using an experimental design and showed a significant effect on the quality of motor skill outcome and the richness of motor imagery using the resource developed in the research. CONCLUSION: This study describes the methodological approach of a design and developmental framework to create an online training module for micro suturing which has significant utility in hand surgery.

The Flipped Classroom and Simulation: a Primer for Simulation Educators.

The flipped classroom has become part of the lexicon in discussion of pedagogies in healthcare education. When reviewing the simulation literature, however, the term is only recently being mentioned. We determined there was a need for this article based on workshops held at the annual International Meeting for Simulation in Healthcare (IMSH), which were facilitated by the authors. In the workshops, most of the participants had heard the term and had first-hand experience with the flipped model in simulation; however, there were varied interpretations of the flipped model and several concerns related to implementation of the model. In this article, we define the flipped classroom model, review the existing work on using the flipped model in healthcare education, and provide five recommendations regarding use of the flipped model in simulation. The framework for summarizing the work and presenting the recommendations is based on a brief review of the literature and from the participant discussions at the IMSH workshops.

How we taught medical students in a tertiary hospital during a pandemic.

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A model for surgical volunteerism: a qualitative study based in Cambodia.

Medical volunteerism continues to attract many doctors from high-income nations to low- or middle-income countries (LMIC). In spite of the wealth of positive experiences of these volunteers documented in the literature, there is little evidence concerning the impact and effectiveness of their activity. We documented our model of five-year experience in the delivery of hand surgery in Cambodia, attempting a qualitative approach with attempts to understand the perceptions of local and volunteer surgeons. We conducted independent qualitative interviews with five visiting and 12 Cambodian surgeons who participated in our community-based and outcome-oriented hand surgery training programme between 2013 and 2015. Data were coded and analysed using a content analysis method and then individually grouped into categories; software was used to generate frequencies and quotations of codes. Our results highlighted factors contributing to the success of the medical volunteering programme, to its success, with suggestions for sustainability, motivation and commitment to such a programme. A clearly defined strategy by the volunteer group and a commitment to time and resources by both partners were found to be effective.

Parental knowledge and beliefs on the use of child car restraints in Singapore: a qualitative study.

INTRODUCTION: Road traffic injuries and fatalities represent a significant public health problem. In Singapore, compliance with appropriate child car restraints (CCRs) is poor. We aimed to understand parental knowledge, beliefs and barriers regarding the use of CCRs. METHODS: In this qualitative study, we conducted five focus group discussions with parents who drive with their children in private cars. Participants were recruited using the KK Women's and Children's Hospital's social media page. Guiding questions were derived by consensus following literature review and adaptation to the Singapore context, exploring parental perceptions of CCR use. Focus group interviews were then transcribed and analysed. RESULTS: 33 participants were recruited, with an age range of 28‒46 (mean age 35.5) years. They had a total of 46 children with ages ranging from 2.5 months to 14 years (mean age 4.2 years). Three key themes were identified: parental knowledge regarding CCRs, barriers to CCR use, and suggestions to increase CCR compliance. Barriers to compliance included lack of knowledge, difficult child behaviour and cultural norms. A multipronged approach was proposed to increase CCR use, including educating the public, reinforcing positive behaviour, legal enforcement as a deterrent to non-compliance, increasing CCR installation services, providing CCRs for taxi users and offering financial incentives. CONCLUSION: Non-compliance to CCR use is multidimensional, including multiple potentially modifiable factors. This study could inform ongoing collaborative injury prevention efforts among healthcare professionals, industry partners and the traffic police, using public education and outreach to reduce the burden of road traffic injuries.

Impact of faculty development programs for positive behavioural changes among teachers: a case study.

PURPOSE: Faculty development (FD) is essential to prepare faculty members to become effective teachers to meet the challenges in medical education. Despite the growth of FD programmes, most evaluations were often conducted using short questionnaires to assess participants' satisfaction immediately after they attended a programme. Consequently, there were calls for more rigorous evaluations based on observed changes in participants' behaviours. Hence, this study aims to explore how the FD workshops run by the Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore have impacted behavioural changes in the educators. METHODS: We followed up with the educators at least half a year after they have attended the workshops. With limited literature as reference, we initiated a small-scale case-study research design involving semi-structured interviews with six educators which was triangulated with three focus group discussions with their students. This allowed us to explore behavioural changes among the educators as well as evaluate the feasibility of this research methodology. RESULTS: We identified three emerging categories among the educators: ignorance to awareness, from intuition to confirmation and expansion, and from individualism to community of practice. CONCLUSION: Although FD have placed much emphasis on teaching and learning approaches, we found that the teacher-student interaction or human character components (passionate, willing to sacrifice, are open to feedback) in becoming a good educator are lacking in our FD workshops.

Adaptive Learning in Medical Education: The Final Piece of Technology Enhanced Learning?

Technology enhanced learning (TEL) is now common practice in the field of medical education. One of the primary examples of its use is that of high fidelity simulation and computerised mannequins. Further examples include online learning modules, electronic portfolios, virtual patient interactions, massive open online courses and the flipped classroom movement. The rise of TEL has occurred primarily due to the ease of internet access enabling the retrieval and sharing of information in an instant. Furthermore, the compact nature of internet ready devices such as smartphones and laptops has meant that access to information can occur anytime and anywhere. From an educational perspective however, the current utilisation of TEL has been hindered by its lack of understanding of learners' needs. This is concerning, particularly as evidence highlights that during medical training, each individual learner has their own learning requirements and often achieves competency at different rates. In view of this, there has been interest in ensuring TEL is more learner aware and that the learning process should be more personalised. Adaptive learning can aim to achieve this by ensuring content is delivered according to the needs of the learner. This commentary highlights the move towards adaptive learning and the benefits of such an intervention.

Resilience training for healthcare providers: an Asian perspective.

The level of burnout has been found to be high in medical students, alongside maladaptive coping behaviours such as heightened alcohol and drug intake and mental health issues in the US, Europe and other developed countries. While burnout and resilience in healthcare have been researched in the West, there is a paucity of data in Asia pertaining to these factors. In this article, we review stressors in medicine, specifically during medical school training, the consequences of burnout on physicians' health and patient care, and the interventions that might expound resilience among students. Finally, we present potential solutions within an Asian context.

Spaced Education and the Importance of Raising Awareness of the Personal Data Protection Act: A Medical Student Population-Based Study.

BACKGROUND: The Personal Data Protection Act (PDPA) of Singapore was first passed in 2012, with subsequent enforcement regulations effective in 2014. Although medical education via digital platforms is not often used in medical schools in Singapore as of yet, many current means of communication at all levels in the medical community from medical schools to clinics to hospitals are unsecure and noncompliant with the PDPA. OBJECTIVE: This pilot study will assess the effectiveness of MyDoc, a secure, mobile telehealth application and messaging platform, as an educational tool, secure communications tool, and a tool to raise awareness of the PDPA. METHODS: By replacing current methods of communication with MyDoc and using weekly clinical case discussions in the form of unidentifiable clinical photos and questions and answers, we raised awareness the PDPA among medical students and gained feedback and determined user satisfaction with this innovative system via questionnaires handed to 240 medical students who experienced using MyDoc over a 6-week period. RESULTS: All 240 questionnaires were answered with very positive and promising results, including all 100 students who were not familiar with the PDPA prior to the study attributing their awareness of it to MyDoc. CONCLUSIONS: Potential uses of MyDoc in a medical school setting include PDPA-compliant student-to-student and student-to-doctor communication and clinical group case discussions with the sharing of patient-sensitive data, including clinical images and/or videos of hospital patients that students may benefit from viewing from an educational perspective. With our pilot study having excellent results in terms of acceptance and satisfaction from medical students and raising awareness of the PDPA, the integration of a secure, mobile digital health application and messaging platform is something all medical schools should consider, because our students of today are our doctors of tomorrow.

Using LinkedIn for Continuing Community of Practice Among Hand Surgeons Worldwide.

BACKGROUND: Hand surgeons need continuing professional development due to rapid advancement in the field. Traditional approaches have proven to be challenging due to the nature of surgical practice and other demands. Social media sites have shown the potential to build an online community of practice. METHODS: One of the authors (VR) started Hand Surgery International on LinkedIn in February 2011. RESULTS: The number of members increased from 38 in the beginning to 4106 members by August 13, 2015, with members from all over the world. Half of them are from plastic surgery, with 16.8% hand and 17.8% orthopedic surgery; 63.8% of them are consultants. There were 151 discussion topics, which generated 1238 comments at an average of 8.2 comments per discussion thread. The topics focused on management of difficult patients, seeking consensus, and searching information. The features participants found most useful included case-based discussion, polls/surveys, and network opportunity. Members perceived the LinkedIn community as user-friendly and easy to use. It does not require significant technical knowledge. For the question "How would you rate the overall ease of using this platform?" 42% answered "strongly agree" and 37% "agree". CONCLUSION: The LinkedIn group serves as an effective means for continuing professional development for hand surgeons.