Opportunities for pedagogical change in Turkish medical education revealed in the wake of the COVID-19 pandemic.

Phenomenon: As the first stage of a large-scale educational design research (EDR) study focused on the complex problem of providing authentic experiential "hands-on, minds-in" learning opportunities online during a pandemic or other exigency, we conducted a literature review and we interviewed Turkish academic staff and students about their experiences during the first year of the COVID-19 Pandemic. ApproachWe interviewed faculty members, faculty members of medical education departments, and medical students from both public and private medical schools in Türkiye between October 1 and December 31, 2020. Working in pairs, we analyzed the transcripts of 49 interviews using open qualitative coding methods with satisfactory levels of coefficients of agreement. FindingsWe defined six major themes from the qualitative analysis: 1) Fear and concern were the most common reactions when first encountering the pandemic; 2) Teaching methods during the pandemic were primarily unidirectional from faculty to students. This largely one way transmission of information occurred both synchronously and asynchronously; 3) Technological support during the pandemic shutdowns was found to be challenging for both faculties and students; 4) Evaluation of learning during the pandemic was opportunistic and had questionable rigor; 5) Healthy communication was valued by both faculty and students using an array of different tools including social media; and 6) The pandemic had both negative and positive impacts on the educational processes experienced by students and provided by faculty and resulted in recommendations for new approaches to teaching and learning in the future. Medical students were primarily concerned about the susceptibility to COVID-19 of themselves and others, and how the pandemic would affect their progress toward completing their studies. Faculty were primarily concerned about the capacity of online learning to provide clinical learning opportunities and the difficulties of assessing student clinical skills using online modalities. Medical education specialists were primarily concerned about the quality of educational opportunities offered online. InsightsOur findings were similar to other studies conducted in the USA, China, United Kingdom, and other countries. However, the interviews revealed interest among faculty and medical education specialists for further investigation of experiential or active learning models that could be applied in medical education regardless of whether the delivery mode is face-to-face, online, or most likely, blended. In the next stage of our larger scale EDR study, we will design and construct prototype learning environments that incorporate experiential, active, and authentic learning design principles.

From the lens of the clinical residents: undergraduate to postgraduate medical education and the transition process.

The concept of continuity in medical education reflects the progressive professional and personal development that physicians need in education. The aim of this study is investigating the views of the residents about the adequacy of undergraduate and postgraduate education in the context of preparing them for the next stage and their perceptions about the transition period. This phenomenological study was conducted at Hacettepe University Medical School. The study group consisted of medical and surgical sciences residents in the first year and last year of postgraduate medical education. Four focus group interviews were held with the participation of 21 residents. The participants emphasised that practising with real patients under supervision by taking an active role in healthcare teams was important for their preparation for the next stage in their carrier. However, their educational experiences during undergraduate medical education differed in community-based education, scientific research training, learning in small groups, internship and guidance of clinical educators. The transition period has been expressed with the concepts of identity change, high responsibilities and expectations required by the new identity, adaptation to the healthcare team, institution, and health system, meeting the expectations in an overly busy work environment, and feelings of incompetence. Participants pointed out that curriculum, which was declared and taught, educational environments, assessment approaches, consultancy systems and practices differed between the clinical departments. In line with the principles of competency-based education, practices related to the development and assessment of the competencies with all professional aspects in postgraduate medical education can be strengthened.

Social accountability: A national framework for Turkish medical schools.

PURPOSE: To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. METHODOLOGY OF THE STUDY: The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. RESULTS: In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. CONCLUSION: A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.

Determinants of self-regulated learning skills: the roles of tutors and students.

Problem-based learning (PBL) is an instructional method that offers students the opportunity to develop self-regulatory strategies as an explicit learning outcome. As a multifaceted PBL environment, the guidance of tutors is important to students as they develop self-regulatory learning (SRL) skills and self-efficacy, the most focused motivational element in SRL. The present study examines the relationship between academic achievement and PBL self-efficacy levels, as well as the role played by tutors. A cross-sectional study was conducted with third- year medical students (n = 257; 75%). The SRL perception (SRLP) scale, the self-efficacy for PBL scale (SPBL), tutor evaluation scale (TES), and an achievement test were used to gather data in this study. In every scale, participant scores were higher than the midpoint, which is 3. There were positive correlations between SRL, self-efficacy, and the tutoring scores of tutors. As the correlation between SRLP and achievement was not significant, achievement was removed from the regression equation, and only SPBL and TES results were used. The results of the regression analysis indicated that SPBL and TES explained 36% of the variance. The level of self-efficacy in PBL predicted the students' SRL abilities, as did tutor evaluations. The findings show that students used their SRL skills and had beliefs about their ability to learn effectively in the PBL context. Both the tutors' tutoring skills and the students' self-efficacy made important contributions to improving the students' self-regulated learning skills.

Turkish validity and reliability of Multidimensional Health Locus of Control Scale Form A.

AIM: The aim of this study was to assess the validity and reliability of the Turkish version of Multidimensional Health Locus of Control Scale Form A. METHODS: The research is a methodological instrument validation study, and the study sample consisted of 275 participants. The data collection phase of the study was completed between 15 July and 15 September 2016. The study used data collection tools including a Personal Information Form, the Multidimensional Health Locus of Control Scale Form A, and the Internal-External Locus of Control Scale. Data on sociodemographic variables are presented as percentages and means. Confirmatory factor analysis and correlation analyses were used. RESULTS: The Cronbach α values of the subdimensions of the Multidimensional Health Locus of Control Scale Form A were determined as acceptable for the internal control, the chance, and powerful other subscales. The confirmatory factor analysis showed acceptable values and acceptable fit for the model fit statistics. CONCLUSION: The Turkish version of Multidimensional Health Locus of Control Scale Form A was accepted as valid and reliable.

Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers?

Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. APPROACH: This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. FINDINGS: Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important point was that sufficient tutor training and preparation was crucial for the success of models.

Preparation for a postgraduate specialty examination by medical students in Turkey: processes and sources of anxiety.

UNLABELLED: PHENOMENON: Interns in Turkey must endeavor to study for a specialty exam during their internship. The preparation process for the specialty exam and the effect of this process on the students' anxiety has not been studied comprehensively. The purpose of this study was to evaluate the interns' preparation time for the specialty exam, their perception of how the preparation process affects their training, and which factors are related to their test anxiety. APPROACH: A cross-sectional study was conducted with 6th-year students (interns). A questionnaire asked participants to report health status, academic achievement, exam-related anxiety, and trait anxiety. Two open-ended questions asked about views regarding the specialty exam. Multiple linear regression was used to identify the significant predictors of anxiety level due to the exam. FINDINGS: The average duration of exam preparations of participating interns (n = 214) was 16.8 months and 14.3 hours/week. Participating interns' health status, economic level, perception of academic achievement, time allocated to study for the exam, time remaining until the exam, and trait anxiety level demonstrated a relationship with anxiety level due to the exam (R =.35, R(2) =.13, p <.001). In the open-ended questions, the most frequent opinion regarding the importance of the Examination for Specialty in Medicine was "Value attributed to specialization" (43%). The most frequent response regarding the contribution of studying for the specialty exam to their general professional skills was "Rehearsal/recall." INSIGHTS: Participating interns spent an appreciable amount of time preparing for the specialty exam. Although participating interns value this exam, they appear to believe that preparing for it will contribute only moderately to their professional competencies, while increasing their anxiety level. The internship curriculum, requirements, and timing of the specialty exam should be reconsidered.

A novel Medical Achievement Self-efficacy Scale (MASS): a valid and reliable tool.

In search for an instrument to measure overall curriculum impact, we developed a Medical Achievement Self-efficacy Scale (MASS) and presented it to medical students enrolled in the different years of the integrated Ghent curriculum. The research aim was to study the validity and reliability of this new scale. MASS items were constructed based on the end terms of the Ghent curriculum, as it is related to the general competency frameworks of CanMEDs and the Five-star Doctor. The scale includes at least two items for each CanMEDS competency domain. Items were examined by seven experts in view of content and face validity. This resulted in an MASS version, containing 18 items, to be rated on a five-point Likert scale. This version was piloted on 94 undergraduate medical students enrolled at the Catholic University of Leuven. The final version was presented to 1066 undergraduate medical students enrolled at Ghent University. Reliability of the MASS scale was high (α=0.89). As expected, self-efficacy scores increased significantly over the years (F=39.11, p<0.001). In view of determining predictive validity, regression analysis was carried out to predict students' academic achievement from self-efficacy scores. As expected, MASS scores significantly predicted Maastricht Progress Test scores (F=108.18, p<0.001).

Assessment and Evaluation of Cardiology Residency Training in Türkiye: A National Survey.

BACKGROUND: Workplace-based assessment methods are essential in the assessment and evaluation of competency-based cardiology residency training. This study aims to determine the assessment and evaluation methods used in cardiology residency training in Türkiye and to reach the opinions of the institutions on the applicability of the workplace-based assessments. METHODS: In this descriptive study, a Google Survey was sent to the heads/trainers of residency educational centers and their opinions about the currently used assessment and evaluation methods, applicability of cardiology competency exams, and the workplace-based assessments were asked. RESULTS: Responses were received from 65 (76.5%) of 85 training centers. Of the centers, 89.2% reported using resident report cards, 78.5% case-based discussion, 78.5% direct observation of procedural skills, 69.2% multiple-choice questions, 60% traditional oral exams, and less commonly other exam types. About 74% of responders gave a positive opinion on the requirement of being successful in the Turkish Cardiology Competency knowledge exam before specialty. Case-based discussion was the most common work-place-based assessments that the centers think could be applied as suggested by the current literature. A common idea was the adaptation of workplace-based assessments based on international standards and our national norms. The trainers supported a nationwide examination for all training centers to ensure standardization. CONCLUSION: In Türkiye, it was promising to see that the trainers are positive about the applicability of workplace-based assessments, but they commonly thought that the proposed workplace-based assessments should be adapted before nationwide applicability. Medical educators and field experts need to work together on this issue.

I'm a mother, therefore I question": Parents' legitimation sources of and hesitancy towards early childhood vaccination.

This study was conducted with mothers living in Ankara and registered in the year 2019 with the Immunization Services Unit of the Provincial Directorate of Health as cases of vaccine refusal. This qualitative study used semi-structured interviews to understand how mothers decide about child vaccination and the attitudes, perceptions, and beliefs underlying these decisions. A total of 23 interviews were conducted by two of the authors between March and September 2019. Each of the 23 participants had at least one child aged five years or younger and were living in Ankara. The study shows that mothers with vaccine hesitancy constitute a heterogeneous group whose members have differing levels of hesitation and concern about the vaccination of their children. It is also observed that the most important factor that affects their decisions is related to trust.

The construct validity and reliability of the Turkish version of Spreitzer's psychological empowerment scale.

BACKGROUND: Today, many organizations have adopted some kind of empowerment initiative for at least part of their workforce. Over the last two decades, two complementary perspectives on empowerment at work have emerged: structural and psychological empowerment. Psychological empowerment is a motivational construct manifested in four cognitions: meaning, competence, self-determination and impact. The aim of this article is to examine the construct validity and reliability of the Turkish translation of Spreitzer's psychological empowerment scale in a culturally diverse environment. METHODS: The scale contains four dimensions over 12 statements. Data were gathered from 260 nurses and 161 physicians. The dimensionality of the scale was evaluated by exploratory factor analyses. To investigate the multidimensional nature of the empowerment construct and the validity of the scale, first- and second-order confirmatory factor analysis was conducted. Furthermore, Cronbach alpha coefficients were assessed to investigate reliability. RESULTS: Exploratory factor analyses revealed that four factors in both solutions. The first- and second-order factor analysis indicated an acceptable fit between the data and the theoretical model for nurses and physicians. Cronbach alpha coefficients varied between 0.81-0.94 for both groups, which may be considered satisfactory. CONCLUSIONS: The analyses indicated that the psychometric properties of the Turkish version of the scale can be considered satisfactory.

Metacognitive awareness and self-regulated learning skills of medical students in different medical curricula.

AIM: The aim of this study was to investigate the acquisition of metacognitive awareness and self-regulated learning skills in medical schools using different curricular models. METHODS: The study was carried out in four medical schools implementing different curricular models. Eight hundred and sixty two medical students took part in the study and two scales (self-regulated learning perception scale--SRLPS and metacognitive awareness inventory--MAI) were used. Cronbach's alpha was 0.93 for the MAI, and 0.88, 0.91, 0.83, and 0.76 for the four dimensions of the SRLPS. RESULTS: There were no statistically significant differences in MAI scores according to gender, curricular language, or previous exposure or not to a learner-centered method during secondary school, but the differences in scores according to the phase and curricular model were found to be significant. With regard to SRLPS total scores, no difference was found according to gender, but significant differences were found according to phase, curricular language, and curricular model. MAI and SRLPS scores of students from the medical school using a learner-centered curriculum were higher than the other schools' students. CONCLUSION: This study suggests that students who experience a learner-centered curriculum, such as PBL during their medical education demonstrate improved metacognitive awareness and self-regulated learning skills.

A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students.

Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training.

Cooperative learning: a new application of problem-based learning in mental health training.

Interaction in problem-based learning (PBL) tutorials is not necessarily cooperative, which may account for variation in learning outcomes. Therefore, a cooperative assessment structure was introduced in a PBL course and the difference examined between this method and individual, lecture-based learning in mental health training. Experimental student groups gained more knowledge between pre- and post-test than did control groups, and the experimental students who scored low on the pre-test made the greatest gains. Groups that reported greater cooperation tended to have higher achievement scores. Experimental students felt that cooperation helped them learn but it also took more time and was sometimes chaotic.

Medical students' self-efficacy in problem-based learning and its relationship with self-regulated learning.

BACKGROUND: Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students' motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students' self-reported SRL skills and their self-efficacy in PBL. METHODS: A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. RESULTS: The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students' views on benefiting from PBL. The female students' mean score was higher for the 'planning and goal setting' subscale of SRLP (p=0.017), and the second-year students' mean score was higher than that of the third-year students for the 'lack of self-directedness' subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the 'responsibility' subscale of SPBL (p=0.003; Cohen's d=0.26). CONCLUSIONS: The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students' development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning environment, individual differences, and how these can affect the SRL process.

Development and evaluation of the evidence-based medicine program in surgery: a spiral approach.

BACKGROUND: Evidence-based medicine (EBM) aims to provide skills that help physicians answer clinically important questions, determine new evidence, and incorporate the acquired knowledge in practice. EBM skills are necessary for the practice of modern medicine, since physicians should use up-to-date knowledge and information to justify their medical decisions. PURPOSE: We aimed to evaluate the EBM program implemented at Hacettepe University School of Medicine. METHODS: In 2004, a spiral program for the teaching and practice of EBM was developed for the first 3 years of medical school. Following this program, a practice of EBM was included in the fourth year during the surgery clerkship, after an introductory lecture. The students worked within collaborative teams of 3-5 and practiced EBM with actual cases seen in the surgical service in which they were involved. Each student was asked to complete a questionnaire that evaluated the more theoretical program from the first 3 years and the practical application in the fourth year. RESULTS: Nearly half of the students stated that the preclinical years of the EBM program were 'adequate', but only 30% of the students indicated that the program was practical. They stated that 'more practical approaches were used in the fourth year, whereas more theory-based approaches were used during the preclinical years'. More than 75% of the students declared that the practice of EBM in the fourth year was useful and appropriate for team-based learning. CONCLUSIONS: The EBM program was evaluated as 'adequate'. EBM courses should be included in the entire curriculum in an integrated manner. The students understand the main philosophy of EBM in the clinical year when involved in its practical application with actual patients.

Self-regulated learning strategies used in surgical clerkship and the relationship with clinical achievement.

INTRODUCTION: Self-regulated learning indicates students' skills in controlling their own learning. Self-regulated learning, which a context-specific process, emphasizes autonomy and control. Students gain more autonomy with respect to learning in the clinical years. Examining the self-regulated learning skills of students in this period will provide important clues about the level at which students are ready to use these skills in real-life conditions. OBJECTIVES: The self-regulated learning strategies used by medical students in surgical clerkship were investigated in this study and their relation with clinical achievement was analyzed. METHODS: The study was conducted during the surgery clerkship of medical students. The participation rate was 94% (309 students). Motivated Strategies for Learning Questionnaire (MSLQ), a case-based examination, Objective Structured Clinical Examination (OSCE), and tutor evaluations for assessing achievement were used. The relationship between the Motivated Strategies for Learning Questionnaire scores of the students and clinical achievement was analyzed with multilinear regression analysis. RESULTS: The findings showed that students use self-regulated learning skills at medium levels during their surgery clerkship. A relationship between these skills and OSCE scores and tutor evaluations was determined. OSCE scores of the students were observed to increase in conjunction with increased self-efficacy levels. However, as students' beliefs regarding control over learning increased, OSCE scores decreased. No significant relationship was defined between self-regulated learning skills and case-based examination scores. CONCLUSIONS: We observed that a greater self-efficacy for learning resulted in higher OSCE scores. Conversely, students who believe that learning is a result of their own effort had lower OSCE scores.

The effect of problem-based learning with cooperative-learning strategies in surgery clerkships.

BACKGROUND: Cooperative learning is used often as part of the problem-based learning (PBL) process. But PBL does not demand that students work together until all individuals master the material or share the rewards for their work together. OBJECTIVE: A cooperative learning and assessment structure was introduced in a PBL course in 10-week surgery clerkship, and the difference was evaluated between this method and conventional PBL in an acute abdominal pain module. METHODS: An experimental design was used. RESULTS: No significant differences in achievement were found between the study and control group. Both the study and control group students who scored low on the pretest made the greatest gains at the end of the education. Students in the cooperative learning group felt that cooperation helped them learn, it was fun to study and expressed satisfaction, but they complained about the amount of time the groups had to work together, difficulties of group work, and noise during the sessions. CONCLUSIONS: This study evaluated the impact of a cooperative learning technique (student team learning [STL]) in PBL and found no differences. The study confirms that a relationship exists between allocated study time and achievement, and student's satisfaction about using this technique.

The impact of clinical visits on communication skills training.

OBJECTIVE: The aim of the study is to evaluate a communication skills training program, and to investigate the relationship between communication skills and clinical visits. METHODS: This descriptive study was conducted at Hacettepe University Faculty of Medicine. 216 of the students (48.4%) took part in the study. They are evaluated at three steps of the program. Additionally, qualitative data were collected by interviewing with students and standardized patients. RESULTS: A paired t-test showed a significant difference between students' mean pretest scores (8.58+/-1.69) and posttest scores (11.26+/-1.74) (p<0.01). There was a significant difference between the progress test scores according to the site of visitation (p<0.01), but not between the posttest scores. The mean progress test scores of the students who visited the outpatient clinics (10.61+/-1.41 for group 2, 10.80+/-1.34 for group 4) were higher than those visiting the health centers (9.68+/-1.56 for group 1, 10.12+/-1.38 for group 3). CONCLUSIONS: Our study showed that the program was effective in achieving communication skills. Students can be better trained for communication skills while practicing in both skills laboratories and real settings. PRACTICAL IMPLICATIONS: The possible variations in the educational environments and the staff should be taken into account when planning the program.

The first medical humanities programme in Turkey.

THE MEDICAL HUMANITIES: The arts and humanities have been considered a recreational activity related to the interests and talents of the doctor, rather than to their practice of medicine. GOOD MEDICAL PRACTICE COURSE: At Hacettepe University, the 'good medical practice course' was added to the curriculum in September 2004. The goals of this course are to help the students achieve the skills and attitudes of a good doctor and to become competent in caring for and communicating with patients. IMPLEMENTATION: As a part of the programme, in the first 3 years students prepared 526 projects concerned with medical humanities in the broad areas of 'medicine and art', 'medicine and history' and 'man and medicine'. They presented 72 of the projects as short communications at the Medical Humanities Congress and the remaining projects as posters. Each project was also to be prepared as a portfolio. PROGRAMME EVALUATION: At the end of the programme, a questionnaire was given to both the students and the tutors to evaluate the course. The part of the programme rated most difficult was the medical humanities section, according to 67.1% of the students. They commented that it took a great deal of time to research and prepare the projects. PROPOSED CHANGES: The new concept and the extra workload, in addition to new medical knowledge, confused all the students. We have made some changes to the programme and have decided to develop a number of new activities. CONCLUSION: 'Medical humanities' is a new concept for almost all the students and the faculty; it needs to be well defined.