Communication in problem based learning

Problem Based Learning (PBL) is one of the many ways that undergraduates are supported to learn in Norwich Medical School. PBL is an instructional design model that was first introduced into medical schools in Canada in the 1960s. Theoretical arguments were put forward in the medical education literature that claimed PBL was a revolutionary, new and superior learning method. The method attracted considerable enthusiasm, but it also attracted controversy. Descriptions of the process were diverse and the pedagogy was illusive. Never the less, it subsequently spread worldwide, and thousands of medical students now learn in PBL groups. The purpose of my research was to explore PBL at Norwich medical school and to find ways to improve it. My focus was on communication in PBL tutorials, and the aim was to identify communicative elements that realised and hindered effective dialogue. The objectives were to 1) Consider the theoretical framework of PBL and explore enablers and barriers to effective dialogue, 2) Consider the learning environment of the PBL tutorial, particularly brainstorming, and identify ways in which to maximise the learning opportunities, 3) Determine how this knowledge can be used to facilitate effective dialogue to take place between learners in PBL. The main research question was; What communicative strategies can be used by tutors to enhance elaborative dialogue to take place in brainstorming in Problem Based Learning tutorials? Using elements of Conversation Analysis (CA), I explored communication in PBL. Focusing particularly on brainstorming, I identified specific communicative elements that were used by tutors to facilitate elaborative dialogue. Elaborative dialogue, in which students explain their thinking, appears to be of particular importance in the learning and understanding of concepts. Elaboration includes; a) Verbalising conceptual understanding, b) Identifying conflicting information, c) Co-construction of understanding, d) Answering/ asking relevant questions, It is clear that the extent to which students benefit from working in small groups depends on the quality of interaction between students within the group. I identified communicative elements that were inhibitory to elaborative dialogue. In addition, I identified that there were contextual factors that inhibited communication between students in the tutorials for example, students were expected to chair tutorials, but they struggled to perform the role. The findings from my study are useful for PBL tutors who can use these elements of conversation analysis to examine their own practices; for example, tutors can audio record a section of a PBL tutorial, and identify their own questioning techniques that have promoted useful dialogue between learners, and reflect on their practice. This conversation analysis method can be applied to other small group teaching methods in other disciplines and by other organisations. I hope this will serve as a starting point to encourage individual tutors and institutions to explore ways to enhance communication in PBL tutorial groups and enrich the learning experiences for students

Clinical characteristics and outcomes of pregnancy related patients admitted to the intensive care unit: a 1 year review

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed (O&G) Johannesburg January 2017Background and objectives Pregnancy can be associated with life threatening complications of pregnancy specific disease and delivery, as well as the exacerbation of preexisting comorbid disease, which requires multidisciplinary critical care. Studies have shown that advancement in medical care and access to intensive care units have been instrumental in the global decline in maternal mortality rates, particularly in developed countries. The aim of this study was to describe the admissions to ICU of all pregnant women including those with pregnancy related complications at CHBAH tertiary hospital in South Africa. Methods The study was a retrospective review of pregnant women, including pregnancy related complications, admitted to CHBAH ICU for the year of 2012. Baseline demographic data, admission diagnosis, laboratory information and acute physiological and chronic health evaluation score (APACHE II), intervention and outcomes were recorded using ICU records and general hospital records. Descriptive statistical analysis employed. Results In 2012 there were 21765 deliveries at CHBAH with 76 pregnancy related admissions to the ICU. Complete ICU data was available in 73 women. The incidence of ICU admission at the hospital was 3.5 per 1000 deliveries. The mortality rate in this group in ICU was 8.2%. The most common indication for admission was haemorrhage (43.8%) followed by medical and surgical disorders (23.3%), then sepsis (21.9%) and hypertensive disorders of pregnancy (11%). The majority of the women (98.3%) were admitted in the postpartum period. Mechanical ventilation was required in 77% of the women, inotropic support in 29% and 59% received blood transfusion products. APACHE II scoring system overestimated the possible mortality rate giving a predicted mortality rate of 15%. Conclusion Haemorrhage was the most common indication for admission to ICU. This does not concur with previous South African studies where hypertension was the most common reason for admission followed by haemorrhage. The study showed an overall mortality concurrent with some first world studies and significantly lower than cited South African studies.MT201

Developing a new empathy-specific admissions test for applicants to medical schools: A discourse-pragmatic approach.

The ability to empathise with patients is an important professional skill for doctors. Medical students practise this skill as part of their medical education and are tested on their use of empathy within their final examination. Evidence shows that appropriate training makes a difference but natural aptitude also plays a role. Most medical schools do, therefore, probe applicants’ basic understanding of empathy at admissions interviews. The purpose of the project presented in this paper was to apply existing understanding of how empathy may be communicated in a clinical context (building on the first author’s previous literature review, 2011) to develop a new empathy-specific medical admissions interview station, probing applicants’ empathic communicative performance (not just theoretical knowledge) and fitting in the widely used Multiple Mini Interview (MMI) interview format. The paper outlines how this tool was developed, trialled and implemented by: 1) Conceptualising empathic communication in discourse-pragmatic terms, that is, as a set of specific but context-dependant empathic speech acts. 2) Formulating and trialling a written and two oral versions of a situational test, capable of probing the applicants’ ability to communicate empathically in everyday conversation and suitable for use at Norwich Medical School and other similar educational institutions

The Online Mock OSCE-a mixed methods analysis of its benefits and overall student experience

Background The social distancing requirements of the COVID-19 pandemic have resulted in an inability to deliver traditional, face-to-face Mock OSCEs; a means of clinical skill learning that has been shown to be beneficial to students. This study investigated the ability of an Online Mock OSCE to replace the in-person format and assessed whether similar benefits could be obtained by this method of delivery. Methods A student-run Online Mock OSCE was designed and rolled out to Year 2 undergraduate medical students; a questionnaire was then distributed to 43 students who consented to be involved in the research. Both quantitative and qualitative data were collected, with interpretation carried out via paired sample t-tests and supplementary thematic analysis. Results Comparison of pre-and-post-OSCE scores demonstrated a significant decrease in anxiety both towards summative OSCEs with similar stations and with different stations. Student confidence levels and self-reported retention of clinical skills showed statistically significant increases as a result of the Online Mock OSCE. Students had a strongly positive opinion of the process; analysis of written responses identified the provision of useful feedback on clinical skills, allowance of recognition of knowledge gaps, and enablement of increased familiarity with the assessment process as common justifications for this. Conclusions The Online Mock OSCE represents an excellent alternative to face-to-face delivery; it is well-received by students and offers a number of benefits, including decreased anxiety levels, increased confidence and improved self-reported retention of clinical skills, alongside logistical advantages of the online process. This study gives evidence for its continuing adaptation and inclusion within the medical curriculum even as in-person practice becomes feasible once more, such are the extensive assets it offers, and the potential for the method to be utilised within blended learning

Online medical education using a Facebook peer-to-peer learning platform during the COVID-19 pandemic: a qualitative study exploring learner and tutor acceptability of Facebook as a learning platform

Background In recent years, higher education institutions have been moving teaching online, accelerated by the pandemic. The Remote Learning Project (RLP), based at the Norwich Medical School (NMS) in the United Kingdom (U.K.), was a peer-to-peer teaching program developed to supplement medical school teaching during the pandemic. The teaching was delivered through Facebook using peer-to-peer teaching. Tutors were final year medical students, teaching medical student learners in lower years. Tutors and learners perception of peer-to-peer online learning delivered through the Facebook Social Media (SoMe) platform was investigated. Methods This qualitative study recruited tutor and learner participants from NMS by email, participation in the study was voluntary. Online semi-structured interviews of both tutors and learners in the remote learning project were conducted. The data was analysed using thematic analysis. Results Seven participants were interviewed. Five themes were identified; education (learning/teaching), productivity, data security, professionalism, and usability of the platform. Learners enjoyed the asynchronous nature of the platform and both learners and tutors enjoyed the peer-to-peer nature of the RLP, including the ability to immediately and easily answer on Facebook comments. Some learners felt distracted on Facebook, whilst others enjoyed the reminders. The mix of social and professional on the platform was met with caution from tutors. Both learners and tutors enjoyed the familiarity of the platform. Conclusions The study found that SoMe may be a credible platform to deliver online peer-to-peer teaching. Educators should consider the ergonomics of SoMe platforms when designing online curriculums. Guidelines for educators should be developed to better guide educators on the effective and safe use of SoMe as a learning tool

Success or failure of primary second/foreign language programmes in Asia: What do the data tell us?

Primary school second/foreign language (SL/FL) programmes in Asia, as well as in other parts of the world, are becoming more common, with many targeting English as the SL or FL. The pressures for such English language programmes come from top-down notions that in a globalised world English is required for societies to be competitive, especially with Asian neighbours, and bottom-up pressures from parents who see English as the key to educational success for their children. In many polities, these forces have resulted in support for policies that introduce early primary school English teaching curricula for all students and have led to parents spending large sums of money on private tutoring or out-of-school tuition. This study reviews the results of nine language planning studies from the Asian region that set out to examine questions such as 'Is this trend towards early primary SL or FL education (mainly English) realistic or is it unattainable and a waste of resources? Do children really benefit from these programmes? What needs to be done to foster learners' success?' These issues are viewed from a language planning and policy perspective through an examination of the language-in-education policy types required for the development of successful programmes. The policies of a number of Asian countries are used as case studies to illustrate this issue

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication