Medical Students Who Prepare for a Lecture Learn More Than Those Who Do Not: An Experimental Study

Purpose: Medical students tend to attend lectures unprepared before studying the literature for an examination. Would students not profit more from lectures if they study the literature first?Method: One hundred and two students from a Saudi-Arabian medical school were included in the study. Half of them received a four-page text to be studied before a 15-minutes lecture; the other half received the lecture first and then the text. Knowledge level was tested using a concept retrieval test at three points in time, before the experiment, after reading the text, and after attending the lecture. This enabled studying the effects of the various treatments separately.Results: The mean student-scores were as follows: After lecture-only: 54.7±23.5, after reading-only: 45.7±11.2, lecture-then-reading: 69.9±15.8 and reading-then-lecture: 78.2±17.4. The combination of lecture and reading in both groups was statistically significantly different from lecture-only. Reading-then-lecture was significantly better than lecture-then-reading.Conclusion: In contrast to existing practices of students in medical education, it is better to study first before attending a lecture. Keywords: Lectures; self-study; concept retrieval test. DOI: 10.7176/JEP/11-8-06 Publication date:March 31st 202

Assessing students in community settings: the role of peer evaluation

The assessment of students in community settings faces unique difficulties. Since students are usually posted in small groups in different community settings and since the learning (largely) takes place outside the classroom, assessing student performance becomes an intrinsically complex endeavor. In this article, the proposition is made and tested that peers may be used to accurately assess particular aspects of performance, in particular those which need extensive and close observation. Examples are: Effort displayed while working in a community, quality of the interaction with that community, display of leadership, and subject-matter contributions

Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study

The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students’ and clinical teachers’ perceptions and interpretations of factors influencing students’ study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students’ study strategies: “clinical supervisors and supervision”, “stress and anxiety” and “assessment”. The three themes we identified played a role in students’ adoption of different study strategies in the “community of clinical practice”. It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students

Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents

Context: "Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. Aims: The aim of this study was to assess medical residents′ perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. Materials and Methods: A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. Results: A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9) compared to emergency medicine, which had 70.7 (16.2), P value (0.03). The reliability of the questionnaire was Cronbach′s alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability); thus, accounting for 51% variance in the data. Conclusion: Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training

Overconfidence, Time-on-Task, and Medical Errors:Is There a Relationship?

Background: Literature suggest that physicians’ high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy. Methods: Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded. Results: The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups. Conclusion: In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.</p

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum

The Wicked role of the medical education department

 Purpose: This paper aims to describe the role of the Medical Education unit/department (MED) from a world-wide perspective, how it qualifies as a wicked issue, and provide tips on how to tame it. Methods: The authors reviewed the regional and international literature to obtain a framework of functions and then used brainstorming and focus group discussions to define the scope of functions of the MED. Telephone interviews with present or previous chairs of medical education departments in the Kingdom and the region helped define the challenges that are faced. Results: The functions of the MED were found to fall under 10 domains (Table 1) and 40 functions (Table 2). Chal?lenges facing MED role include governance and organizational structure, financial support, manpower, intersection with the roles of other structural entities, and dual reporting of MED staff. Ten tips are described to deal with these challenges. Conclusion: The MED role is complex and faced with many challenges. It has changing and dynamic boundaries, and is entangled with other entities in the college or university. Ten tips are proposed to tackle these challenges and tame the wickedness of the MED role. </p

The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance

Purpose: Practicing medicine is a cognitively demanding task that consists of the ability to assess the patient, judge the nature of his or her complaints, and make an appropriate diagnosis. A number of factors have the potential to affect the physician׳s diagnostic performance negatively. Two of these factors are time pressure and case complexity. However, the empirical evidence that supports this negative influence is scant. This study experimentally investigated the effect of time pressure and the complexity of clinical cases on diagnostic accuracy. Method: Thirty-seven senior internal medicine residents participated in this study. These residents were randomly allocated to two experimental groups (with time pressure vs. without time pressure). These residents were instructed to diagnose 8 case scenarios (4 straightforward and 4 complex cases) presented on a computer by using E-Prime® 2.0. The time pressure group received feedback after each case that they were behind schedule, whereas the control group did not receive such information. The dependent variables were the mean diagnostic accuracy and the mean processing time spent on each case during diagnosis. Results: Participants under time pressure spent nearly the same time as the group without time pressure in diagnosing the clinical cases. The diagnostic accuracy scores did not differ significantly between the experimental and control group (F(1,35)=0.07, P=0.79, and η2=0.002). Conversely, a main effect of case complexity was found (F(1,35)=203.19, P<0.001, and η2=0.85). Participants processed straightforward cases faster and more accurately compared with complex cases. No interaction was found between time pressure and case complexity on diagnostic accuracy (F(1,35)=0.003, P=0.96, and η2<0.001). Conclusions: Time pressure did not impact the diagnostic performance, whereas the complexity of the clinical case negatively influenced the diagnostic accuracy. Further studies with the enhanced experimental manipulation of time pressure are needed to reveal the effect of time pressure, if any, on a physician׳s diagnostic performance