Simulated patient videos to supplement integrated teaching in competency-based undergraduate medical curriculum.

The competency-based undergraduate medical curriculum in the preclinical years requires clinical topics to be taught using a linker clinical case for students to appreciate the clinical application of basic sciences. The objective of this study was to evaluate student and faculty satisfaction regarding the construct and delivery of an aligned and integrated curriculum that involved the use of linker clinical cases. We aimed at evaluating the perceptions and performance of students when paper cases were supplemented with a simulated patient (SP) video. This interventional study was conducted by inviting 250 medical students from the first professional phase from the 2020-2021 batch. Integrated modules were prepared for two clinical conditions: myocardial infarction (MI) and nephrotic syndrome (NS). The topic NS was taught with a paper-based case while the topic MI was supplemented with an SP video. Feedback from students and faculty was collected using a newly developed and validated questionnaire and focused group discussions. The students performed significantly better in the assessment conducted after the topic MI compared to NS. The majority of the students (80%) expressed a preference for the video to understand the clinical relevance when compared to the paper case. Overall, the students (83-87%) expressed satisfaction with integrated teaching sessions using clinical cases. Using linker clinical cases in an aligned and integrated preclinical curriculum allowed students to interrelate the subjects and apply them to clinical contexts. The SP videos prepared from an authentic setting facilitated learner engagement with a better understanding of the clinical relevance of the basic sciences.NOTE & NOTEWORTHY In this study, we have introduced linker cases to teach clinical correlation of basic sciences for integrated modules in the competency-based undergraduate medical curriculum. The novelty of our study is the inclusion of simulated patient video that was internally prepared and validated to supplement linker clinical paper cases in integrated modules.

Simulation-based structured training for developing laparoscopy skills in general surgery and obstetrics & gynecology postgraduates.

BACKGROUND: Simulation-based training is an important strategy for skill development in a competency-based curriculum, especially so for laparoscopic surgery given its unique learning curve, need for practice, and patient safety concerns. The study was conducted for postgraduates in two surgical disciplines in a medical college tertiary care center. The study evaluates the acceptability and utility of structured simulation-based training for laparoscopic skills. Simulations provide deliberate practice in the leaner supportive environment. MATERIALSAND METHODS: The educational intervention was carried out among the 16 postgraduates from year 2 and year 3 of general surgery and obstetrics and gynecology. A structured training and assessment module was designed and validated, and a 12-week structured training on laparoscopic box trainers was given to postgraduates under faculty guidance. Feedback from postgraduates and faculty was obtained using separate validated questionnaires. The pre- and post-training assessment scores were compared applying the Wilcoxon matched-pairs signed-rank (2-tailed) test using the SPSS Windows Version 20.0 (IBM Corporation). RESULTS: Sixteen postgraduates participated in the study. The median satisfaction score of the postgraduates was 4 (range 3-5), a scale of a maximum of 5. The group identified faculty feedback, stepwise skills learning, supportive learning environment, and trainers' motivation as enabling factors in the training. The faculty observed that the trainees were effectively engaged. The group mean improvement scores in percentage were 40.08 for task 1, 42.08 for task 2, 43.13 for task 3, and 45.63 for task 4. CONCLUSIONS: It is feasible to incorporate faculty-guided sessions of simulation training in basic laparoscopy skills for postgraduates in our setup. It is well accepted by the key stakeholders, and we recommend it to be incorporated in the formal training program.

Admission to Undergraduate and Postgraduate Medical Courses: Looking Beyond Single Entrance Examinations.

In India, a single national level entrance examination for admission to undergraduate and postgraduate medical courses has been introduced. This is largely an effort towards alleviating financial corruption in admission process, improving logistics and ease of examination for students, and resource-efficacy in conduct of examination. Unfortunately, the possible educational impact of such single high-stakes examination has not been overtly discussed. A major handicap in doing so is the lack of documentation and analysis of our own experience with multiple entrance examinations over many years. One adverse aspect of a single high-stakes examination, especially the Postgraduate entrance examination, is that the students' learning priorities get redefined to being 'examination-oriented' rather than 'competency-development oriented'. Hence, we must draw lessons from admission processes in other countries that have gone through similar course. Two key effective practices in these countries include giving weightage to prior academic performance, and use of a combination of some form of cognitive testing, aptitude testing and non-cognitive assessment, for taking selection decisions. It is prudent to modify our existent examination processes utilizing the same principles. There is a need to improve the formative assessments and the end-of-training certification examinations, and possibly also include them as inputs for the admission process.

Qualitative Assessment of Learning Strategies among Medical Students Using Focus Group Discussions and In-depth Interviews.

BACKGROUND: Globally, students with top academic performance and high intellectual capacity usually opt to study medicine. However, once students get enrolled, their academic performance varies widely. Such variations appear to be determined by various factors, one of them being types of learning strategies adopted by students. The learning strategies utilized by the students with better academic performance are likely to be more effective learning strategies. AIMS AND OBJECTIVES: The objective is to identify effective learning strategies used by medical students. METHODOLOGY: This study was carried out among the MBBS students of Final Professional Part I. Students were categorized into three groups namely: high, average, and low rankers based on overall academic performance in second Professional University examination. First, a questionnaire consisting of closed- and open-ended questions was administered to students, to find their learning strategies. Subsequently, focus group discussion and in-depth interviews were conducted for high- and low-rankers. Discussions were audio-recorded, transcribed, and analyzed. Key statements were highlighted, collated, and categorized into general themes and sub-themes. RESULTS: Evident themes which emerged as effective strategies were hard work in the form of regularity of studies, meticulous preparation of notes, constructive use of time, utilization of e-learning, learning styles and deep learning approach and regular ward visits. Intrinsic motivation, family support, balancing physical activities and studies, guidance by seniors, teachers, dealing with nonacademic issues such as language barriers and stress were also identified as important strategies. CONCLUSIONS: Disseminating effective learning strategies in a systematic manner may be helpful to students in achieving better academic outcomes. Furthermore, educationists need to modulate their teaching strategies based on students' feedback.

Teaching and Assessing Communication Skills in Medical Undergraduate Training.

Good communication skills are essential for an optimal doctor-patient relationship, and also contribute to improved health outcomes. Although the need for training in communication skills is stated as a requirement in the 1997 Graduate Medical Education Regulations of the Medical Council of India, formal training in these skills has been fragmentary and non-uniform in most Indian curricula. The Vision 2015 document of the Medical Council of India reaffirms the need to include training in communication skills in the MBBS curriculum. Training in communication skills needs approaches which are different from that of teaching other clinical subjects. It is also a challenge to ensure that students not only imbibe the nuances of communication and interpersonal skills, but adhere to them throughout their careers. This article addresses the possible ways of standardizing teaching and assessment of communication skills and integrating them into the existing curriculum.

Teaching and Assessing Clinical Reasoning Skills.

Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.

Involving postgraduate's students in undergraduate small group teaching promotes active learning in both.

BACKGROUND: Lecture is a common traditional method for teaching, but it may not stimulate higher order thinking and students may also be hesitant to express and interact. The postgraduate (PG) students are less involved with undergraduate (UG) teaching. Team based small group active learning method can contribute to better learning experience. AIM: To-promote active learning skills among the UG students using small group teaching methods involving PG students as facilitators to impart hands-on supervised training in teaching and managerial skills. METHODOLOGY: After Institutional approval under faculty supervision 92 UGs and 8 PGs participated in 6 small group sessions utilizing the jigsaw technique. Feedback was collected from both. OBSERVATIONS: Undergraduate Feedback (Percentage of Students Agreed): Learning in small groups was a good experience as it helped in better understanding of the subject (72%), students explored multiple reading resources (79%), they were actively involved in self-learning (88%), students reported initial apprehension of performance (71%), identified their learning gaps (86%), team enhanced their learning process (71%), informal learning in place of lecture was a welcome change (86%), it improved their communication skills (82%), small group learning can be useful for future self-learning (75%). Postgraduate Feedback: Majority performed facilitation for first time, perceived their performance as good (75%), it was helpful in self-learning (100%), felt confident of managing students in small groups (100%), as facilitator they improved their teaching skills, found it more useful and better identified own learning gaps (87.5%). CONCLUSIONS: Learning in small groups adopting team based approach involving both UGs and PGs promoted active learning in both and enhanced the teaching skills of the PGs.

Competency-based Medical Education, Entrustment and Assessment.

The realization that medical graduates are failing to serve the health needs of the society has compelled the medical educationists and regulatory authorities worldwide to review the medical training. A medical curriculum oriented towards developing the key competencies that enable a fresh graduate to be delivering socially responsive health care is seen as a promising step towards alleviating this problem. This calls for a departure from the traditional approach of organizing the curricular components around educational objectives, to a competency-based approach for planning the curriculum. The present article discusses the concept of competency-based medical education in Indian context, the steps in planning and implementing such a curriculum, and the key aspects of assessment for its effective implementation.

Teaching and assessing professionalism in the Indian context.

Developing professional values and behaviour is an indispensable part of training of medicine. Societal values have changed and there are increasing reports of unprofessional behaviour by physicians. It is now agreed that professionalism must also be 'taught' besides being 'caught'. Most regulatory documents in India mention professionalism in a cursory manner, and do not specify details of how it should be taught and assessed in the curriculum. Teaching-learning methods, assessment and the training schedule for professionalism need to be specified in the undergraduate and postgraduate curriculum for it to be taken seriously. This article discusses the concept of professionalism, its definitions and the various teaching and assessment methods that can be applied in the Indian context.

Workplace based assessment: a step to promote competency based postgraduate training.

There has been an increasing emphasis on defining outcomes of medical education in terms of performance of trainees. This is a step beyond the description of outcomes in terms of competence that encompasses mostly potential abilities rather than the actual performance. The contextual adaptations and behavior judgments of the trainees are best assessed by a program of in-training assessment. Workplace based assessment (WPBA) is one of the modalities, which assesses the trainee in authentic settings. Though Postgraduate (PG) medical training in India is said to be competency-based, most institutions do not have any formative or in-training assessment program for the same. The two cardinal elements of WPBA are direct observation and conducted in work place in addition to provision of feedback to the trainee. The WPBA conforms to the highest (Level 4: Does) of Millers pyramid and also has the potential to assess at all four levels. Some of the tools used for WPBA are: Logbooks, Clinical Encounter Cards (CEC), mini-Clinical Evaluation Exercise (mini-CEX), Case based discussions, Direct Observation of Procedural Skills (DOPS), Multisource feedback (peers, co-workers, seniors, patients) etc. These can be documented in the form of a portfolio that provides a longitudinal view of experiences and progress of the trainee. The WPBA scores high on validity and educational impact by virtue of being based on direct observation in real situation and contextual feedback. The feasibility and acceptability is enhanced by making appropriate choices of tools, advance planning, building of mutual trust, and training of assessors. Given the established benefits of WPBA in shaping clinical learning, there is an imminent need for including this mode of assessment in our clinical training programs especially PG training.

The quarter model: a proposed approach for intraining assessment of undergraduate students in Indian medical schools.

In-training Assessment (ITA) has the potential to test a wide range of competencies which are not testable by the year-end examination. However, despite high validity, educational impact and feasibility; its implementation is flawed. This paper proposes a quarter model of intraining assessment for implementation in the undergraduate medical curriculum in India. The model proposes that assessments be carried out at least quarterly; no teacher should contribute more than 25% of the marks for any student; no single assessment tool should contribute more than 25% marks; and no assessment should contribute to more than 25% of the total marks. We believe that structuring the implementation using multiple tests on multiple content areas by multiple examiners using multiple tools in multiple settings in the proposed quarter model will not only improve the reliability and validity of internal assessment, but also its acceptability.