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1.  Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review 
PLoS Medicine  2011;8(5):e1001037.
A systematic review of published studies reveals that undergraduate medical students may experience substantial exposure to pharmaceutical marketing, and that this contact may be associated with positive attitudes about marketing.
The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%–71%) were more likely than preclinical students (29%–62%) to report that promotional information helps educate about new drugs.
Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.
Please see later in the article for the Editors' Summary
Editors' Summary
The complex relationship between health professionals and the pharmaceutical industry has long been a subject of discussion among physicians and policymakers. There is a growing body of evidence that suggests that physicians' interactions with pharmaceutical sales representatives may influence clinical decision making in a way that is not always in the best interests of individual patients, for example, encouraging the use of expensive treatments that have no therapeutic advantage over less costly alternatives. The pharmaceutical industry often uses physician education as a marketing tool, as in the case of Continuing Medical Education courses that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical industry marketing messages is that doctors' attitudes towards the pharmaceutical industry may form early in their careers. The socialization effect of professional schooling is strong, and plays a lasting role in shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited students' and faculties' contact with industry, but some have argued that these restrictions are detrimental to students' education. Given the controversy over the pharmaceutical industry's role in undergraduate medical training, consolidating current knowledge in this area may be useful for setting priorities for changes to educational practices. In this study, the researchers systematically examined studies of pharmaceutical industry interactions with medical students and whether such interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate search terms for all relevant quantitative and qualitative studies published before June 2010. Using strict inclusion criteria, the researchers then selected 48 articles (from 1,603 abstracts) for full review and identified 32 eligible for analysis—giving a total of approximately 9,850 medical students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry but contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational material. The highest level of exposure occurred in the US. In most studies, the majority of students in their clinical training years found it ethically permissible for medical students to accept gifts from drug manufacturers, while a smaller percentage of preclinical students reported such attitudes. Students justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. In addition, although most students believed that education from industry sources is biased, students variably reported that information obtained from industry sources was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives but also reported that fellow medical students or doctors are influenced by such encounters. Eight studies reported a relationship between exposure to the pharmaceutical industry and positive attitudes about industry interactions and marketing strategies (although not all included supportive statistical data). Finally, student opinions were split on whether physician–industry interactions should be regulated by medical schools or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical marketing, even in the preclinical years, and that the extent of students' contact with industry is generally associated with positive attitudes about marketing and skepticism towards any negative implications of interactions with industry. Therefore, strategies to educate students about interactions with the pharmaceutical industry should directly address widely held misconceptions about the effects of marketing and other biases that can emerge from industry interactions. But education alone may be insufficient. Institutional policies, such as rules regulating industry interactions, can play an important role in shaping students' attitudes, and interventions that decrease students' contact with industry and eliminate gifts may have a positive effect on building the skills that evidence-based medical practice requires. These changes can help cultivate strong professional values and instill in students a respect for scientific principles and critical evidence review that will later inform clinical decision-making and prescribing practices.
Additional Information
Please access these Web sites via the online version of this summary at
Further information about the influence of the pharmaceutical industry on doctors and medical students can be found at the American Medical Students Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware campaign, the nonprofit organization Healthy Skepticism, and the Web site of No Free Lunch.
PMCID: PMC3101205  PMID: 21629685
2.  Undergraduate medical research: the student perspective 
Medical Education Online  2010;15:10.3402/meo.v15i0.5212.
Research training is essential in a modern undergraduate medical curriculum. Our evaluation aimed to (a) gauge students' awareness of research activities, (b) compare students' perceptions of their transferable and research-specific skills competencies, (c) determine students' motivation for research and (d) obtain students' personal views on doing research.
Undergraduate medical students (N=317) completed a research skills questionnaire developed by the Centre for Excellence in Teaching and Learning in Applied Undergraduate Research Skills (CETL-AURS) at Reading University. The questionnaire assessed students' transferable skills, research-specific skills (e.g., study design, data collection and data analysis), research experience and attitude and motivation towards doing research.
The majority of students are motivated to pursue research. Graduate entrants and male students appear to be the most confident regarding their research skills competencies. Although all students recognise the role of research in medical practice, many are unaware of the medical research activities or successes within their university. Of those who report no interest in a career incorporating research, a common perception was that researchers are isolated from patients and clinical practice.
Students have a narrow definition of research and what it entails. An explanation for why research competence does not align more closely with research motivation is derived from students' lack of understanding of the concept of translational research, as well as a lack of awareness of the research activity being undertaken by their teachers and mentors. We plan to address this with specific research awareness initiatives.
PMCID: PMC2939395  PMID: 20844608
undergraduate; research skills; translational research; training; scholarly activity programmes
3.  Deliberate Apprenticeship in the Pediatric Emergency Department Improves Experience for Third-year Students 
The Pediatric Emergency Department (PED) provides medical students with learning in a high-volume, fast-paced environment; characteristics that can be stressful for new students. Shadowing can improve transitioning, yet this alone does not facilitate students’ development of independent medical care competencies. This study evaluates if third-year medical students’ deliberate apprenticeship with senior residents increases students’ comfort and patient exposure in the PED.
This study took place over the 2011–2012 academic year, and study participants were all third-year medical students during their pediatric clerkship rotation. This was a prospective educational intervention assigning students to randomized control blocks of deliberate apprenticeship (DA) intervention or control. DA students were paired with a senior resident who oriented and worked with the student, while control students were unpaired. All students completed a 20-question structured survey at shift end, which included questions about their perception of the learning environment, comfort with, and number of patient care responsibilities performed. We used independent Mann-Whitney and t-tests to compare experiences between the groups. Statistical significance was defined as p<0.05. We used the constant comparative method to qualitatively analyze students’ comments.
Response rate was 85% (145/169). Students also rated on 5-point Likert-scale their level of comfort with defined aspects of working in the PED. DA students (n=76) were significantly more comfortable obtaining histories (4.2 versus 3.8) and formulating differential diagnoses (3.9 versus 3.4). DA students also performed more physical exams (2.9 versus 2.4). We categorized themes from the qualitative analysis of the students’ comments about their PED experience. The titles for these themes are as follows: PED provides a good learning experience; uncertainty about the medical student’s role in the PED; third-year medical students compete with other learners for teaching attention; opportunities provided to medical students for inclusion in patient care; personal knowledge deficits limit the ability to participate in the PED; PED pace affects learning opportunities.
DA constitutes a feasible approach to the clinical learning environment that increases students’ patient care experiences and may ease transitioning for undergraduate medical students to new clinical environments.
PMCID: PMC4100848  PMID: 25035748
4.  When Are Circular Lesions Square? A National Clinical Education Skin Lesion Audit and Study 
Archives of Plastic Surgery  2014;41(5):500-504.
Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies.
We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars.
There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square).
We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.
PMCID: PMC4179353  PMID: 25276641
Clinical audit; Skin neoplasms; Education; Study; Surgery, plastic
5.  Integrated modular teaching in dermatology for undergraduate students: A novel approach 
Undergraduate teaching in dermatology comprises didactic lectures and clinical classes. Integrated modular teaching is a novel approach, which integrates basic sciences with dermatology in the form of a module. Further the module also incorporates various teaching modalities, which facilitate active participation from students and promotes learning. The pre- and post-test values showed the effectiveness of the integrated module. The students feedback was encouraging.
The aim of this study was to determine the acceptance and opinion of undergraduate students regarding integrated modular teaching as a new teaching aid in dermatology.
Settings and Design:
This was a descriptive study. Varied teaching methodologies involving multiple disciplines were undertaken in six major undergraduate topics in dermatology for seventh and eighth semester students.
Materials and Methods:
A total of six modules were conducted over a period of 12 months for students of seventh and eighth semesters. The topics for the various modules were sexually transmitted diseases, acquired immunodeficiency syndrome, oral ulcers, leprosy, connective tissue disorders and psoriasis. Faculty members from different disciplines participated. Pre- and post-test were conducted before and after the modules respectively to gauge the effectiveness of the modules.
It was found that almost every student had a better score on the posttest as compared to the pretest. General feedback obtained from the students showed that all of them felt that modular teaching was a more interesting and useful teaching learning experience than conventional teaching.
Integrated modular teaching can be an effective adjunct in imparting theoretical and practical knowledge to the students. Further, various teaching methodologies can be used in integrated modules effectively with active student participation. Thus integrated modular teaching addresses two important issues in medical education, namely integration and active student participation.
PMCID: PMC4144209  PMID: 25165641
Dermatology; integrated modular teaching; undergraduate
6.  Evaluation of an interactive case simulation system in dermatology and venereology for medical students 
Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.
Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.
The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.
We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.
PMCID: PMC1590009  PMID: 16907972
7.  Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India 
Primary care physicians (PCPs) encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas.
The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist.
Materials and Methods:
Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients’ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ) statistics.
Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4) was seen in the diagnosis of psoriasis and eczema.
Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.
PMCID: PMC4314882  PMID: 25657912
Dermatologist; diagnostic agreement; primary care physician
8.  Are care workers appropriate mentors for nursing students in residential aged care? 
BMC Nursing  2014;13(1):44.
The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector’s capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant knowledge in the performance of hygiene care in a residential aged care facility.
This study was designed as an action research study. A cycle of reflection, planning, action, and evaluation is described to illustrate the carer mentor capacity to engage with and contribute to the learning of nursing students. Participants were second year student nurses (n = 10) on a four-week placement in a Tasmanian aged care facility in 2013 and their nurse/carer mentors (n = 17). Mentors participated in six action research meetings, and nursing students engaged in a parallel series of four feedback meetings during the placement.
At the beginning of the placement, nursing students exhibited a disregard for the clinical value of care provision. Students considered provision of hygiene care, in particular, the preserve of care workers and an inappropriate training exercise in the context of an undergraduate nursing qualification. To assist students to make links between core nursing competencies and hygiene care as well as to engender respect for their role within the aged care facility, carer mentors developed the Carer Assessment and Reporting Guide. Once implemented during the final weeks of the placement, the Guide improved student perceptions of resident hygiene care (reframed as assessment) and the role of facility care workers, as well as reinforcing carer self-esteem.
Hygiene care is replete with nursing competencies that are valuable for undergraduate learners, including assessments of skin integrity, mobility, cognitive function, bowels and urine, and basic hygiene. Nurse education programs should strive to address student misconceptions about care work in facilities to account for population level increases in care needs.
PMCID: PMC4271505  PMID: 25530713
Aged care; Nursing; Clinical placement; Carer; Hygiene; Action research
9.  Diagnosing and Managing Cutaneous Pigmented Lesions: Primary Care Physicians Versus Dermatologists 
Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists.
To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions.
A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003.
Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves.
Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P < 0.001) and appropriately managing pigmented lesions (AUC. 84 vs 0.76, P < 0.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions.
Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.
PMCID: PMC1924688  PMID: 16808765
diagnosis; cancer; cancer screening; dermatology; primary care
10.  Writing to Learn: An Evaluation of the Calibrated Peer Review™ Program in Two Neuroscience Courses 
Although the majority of scientific information is communicated in written form, and peer review is the primary process by which it is validated, undergraduate students may receive little direct training in science writing or peer review. Here, I describe the use of Calibrated Peer Review™ (CPR), a free, web-based writing and peer review program designed to alleviate instructor workload, in two undergraduate neuroscience courses: an upper- level sensation and perception course (41 students, three assignments) and an introductory neuroscience course (50 students; two assignments). Using CPR online, students reviewed primary research articles on assigned ‘hot’ topics, wrote short essays in response to specific guiding questions, reviewed standard ‘calibration’ essays, and provided anonymous quantitative and qualitative peer reviews. An automated grading system calculated the final scores based on a student’s essay quality (as determined by the average of three peer reviews) and his or her accuracy in evaluating 1) three standard calibration essays, 2) three anonymous peer reviews, and 3) his or her self review. Thus, students were assessed not only on their skill at constructing logical, evidence-based arguments, but also on their ability to accurately evaluate their peers’ writing. According to both student self-reports and instructor observation, students’ writing and peer review skills improved over the course of the semester. Student evaluation of the CPR program was mixed; while some students felt like the peer review process enhanced their understanding of the material and improved their writing, others felt as though the process was biased and required too much time. Despite student critiques of the program, I still recommend the CPR program as an excellent and free resource for incorporating more writing, peer review, and critical thinking into an undergraduate neuroscience curriculum.
PMCID: PMC3592621  PMID: 23493247
peer review, writing to learn; web-based learning; learning technology; Calibrated Peer Review
11.  Impact of Specialist Consultations on Inpatient Admissions for Dermatology-Specific and Related DRGs 
Journal of General Internal Medicine  2013;28(11):1477-1482.
Studies of dermatologic inpatients are important, given the rise in the number of admissions and of Medicare spending for dermatology-specific and dermatology-related diagnosis related groups (DRGs) in recent years. Yet inpatient studies of patients admitted for skin conditions have mainly focused on dermatology consults, which neglect the experiences of patients not seen by dermatology. Identifying patients based on DRG codes includes all patients admitted for skin conditions and therefore allows for a more comprehensive analysis of the dermatologic care delivered.
Our primary aim was to characterize the care of all patients admitted for a skin-related condition using dermatology DRGs. Our secondary aim was to assess the impact of a dermatology consult for those patients for whom a consult was called.
We conducted a retrospective chart review of 512 inpatient admissions assigned a dermatology-specific or dermatology-related DRG over fiscal year 2009 at an academic medical center in Boston. Comparisons were made between patients with and without dermatology consults.
Dermatology DRG admission and consult rates. For consults, frequency of dermatologic procedures performed, treatment recommendations made, changes in diagnoses, and readmissions.
Dermatology was consulted in 51 % of cases for dermatology-specific DRGs and in 3 % of cases for dermatology-related DRGs. Dermatology was consulted mainly for common dermatoses such as drug eruptions and cellulitis; among all cellulitis patients, 5 % received a dermatology consult. The most frequent interventions performed were skin biopsies, topical steroid recommendations, and nursing education on skin care. Dermatology consults changed the diagnosis in 45 % of cases.
Dermatologists were often not consulted for the care of patients with dermatology-related DRGs. When dermatologists were consulted, we found an impact on both diagnosis and management.
PMCID: PMC3797349  PMID: 23709404
inpatient dermatology; dermatology diagnosis related groups; dermatology consults; dermatology admissions; hospital dermatology
12.  A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills 
BMC Medical Education  2013;13:135.
Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology.
Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos (TV), or to revision as usual (RAU). The skills demonstrated on video were history taking in diabetes mellitus (DMH), examination for diabetes lower limb complications (LLE), and examination for signs of thyroid disease (TE). Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status.
For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% (n = 11/12) of students randomized to the video were rated globally as competent at the skill compared with 40% (n = 4/10) of students not randomized to the video (p = 0.024). For the DMH, 83.3% (n = 10/12) of students randomized to the video were rated globally as competent at the skill compared with 20% (n = 2/10) of students not randomized to the video (p = 0.007).
Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when used as an adjunct to clinical skills face-to-face tutorials and deliberate practice of skills in a blended learning format. Video demonstrations can provide an enduring, on-demand, portable resource for revision, which can even be used at the bedside by learners. Such resources are cost-effectively scalable for large numbers of learners.
PMCID: PMC3851453  PMID: 24090039
Video; Clinical skills; Medical student; Endocrinology; Medical education; E-learning
13.  Medical students’ perceptions of an emergency medicine clerkship: an analysis of self-assessment surveys 
No studies have been performed that evaluate the perceptions of medical students completing an emergency medicine (EM) clerkship. Given the variability of exposure to EM in medical schools nationwide, assessment of the student rotation may inform the structure and content of new and existing clerkships, particularly in relation to student’s acquisition of the core competencies.
To investigate whether undergraduate medical students rotating through an EM clerkship improved their understanding and abilities in core content areas and common procedural skills; to evaluate whether improvement was affected by rotation length.
All students participating in an EM clerkship over a 12-month period were asked to complete an anonymous voluntary pre- and post-rotation survey. Confidence with patient assessment, diagnosis, and management plans; trauma and medical resuscitations; formal and informal presentations; basic procedure skills and understanding of the modern practice of EM were self assessed using a Likert scale. Group mean scores on each question on the pre- and post-clerkship surveys were calculated and compared. The mean scores on each survey item, both pre- and post-clerkship, were compared between 2- and 4-week clerkship rotation groups.
Two hundred thirty-nine students participated in the rotation during the 12 months of the study. One hundred sixty-one (161), or 67.4%, completed the pre-rotation survey, and 96 (40.2%) completed the post-rotation survey. Overall, students showed significant mean gains in confidence with initial patient assessment, diagnosis, and management plans (p < 0.01, 0.02, <0.01) and with basic procedure skills (p < 0.01 for all). Students completing a 2-week rotation did not differ significantly from f4week rotators in confidence levels, except in the area of formal presentation skills (p = 0.01), where the 4-week students demonstrated a statistically significant advantage. The 2-week clerkship participants were significantly less confident in all procedures except EKG interpretation, splinting, and venipuncture (p = 0.28, 0.22, 0.05). Regardless of rotation length, students generally felt they had sufficient exposure to patients and opportunities for hands-on learning and practice, and overwhelmingly would recommend the EM clerkship to a fellow student, regardless of their chosen specialty.
Medical students show significant gains in confidence with acute care knowledge, disease management, and procedure skills after completion of an EM clerkship. Although a 4-week clerkship may be preferable to expose students to the widest variety of patients and procedures, all students can benefit and improve in core competencies after an EM undergraduate experience.
PMCID: PMC3419087  PMID: 22647269
14.  Student perception about working in rural Nepal after graduation: a study among first- and second-year medical students 
The Federal Democratic Republic of Nepal is a developing country in South Asia with a population of 29.8 million. In September 2011, there were 18 medical schools with 14 being in the private sector. KIST Medical College is a private school in Lalitpur district. The present study was conducted to obtain information on student perceptions about working in rural Nepal after graduation.
The study was conducted among first- and second-year undergraduate medical students using a semi-structured questionnaire developed by the authors using inputs from the literature and their experiences of teaching medical students. Year of study, gender, method of financing of medical education, place of family residence and occupation of parents were noted. Participant responses were analysed, grouped together and the number of respondents stating a particular response was noted.
Of the 200 students, 185 (92.5%) participated with 95 being from the first year and 90 from the second. Most students were self-financing and from urban areas. Regarding the question of working in rural Nepal after graduation, 134 (72.4%) said they will work after their undergraduate course. Students preferred to work in the government or nongovernmental sector. Student felt doctors are reluctant to serve in rural Nepal due to inadequate facilities, low salary, less security, problems with their professional development, less equipment in health centres, decreased contact with family and difficulties in communicating with an illiterate, rural population. About 43% of respondents felt medical education does not adequately prepare them for rural service. Repeated rural exposure, postings in rural hospitals and health centres, and training students to diagnose and treat illness with less technology were suggested. The median monthly salary expected was 60 000 Nepalese rupees (US$ 820) and was significantly higher among first-year students.
The majority of respondents were in favour of working in rural Nepal after graduation. They wanted facilities in rural areas and health centres to be improved. Changes in the education system were suggested. Providing relatively better facilities for rural doctors compared with urban doctors and reorienting medical education for producing doctors for rural Nepal can be considered. Further studies are required in other private medical schools.
PMCID: PMC3464161  PMID: 22938089
Curriculum changes; Developing countries; Financing; Medical students; Nepal; Rural service; Scholarship; Self-financing
15.  Telemedicine experience in the Brazilian Amazon 
The development of telecommunication technologies and the diffusion of its eHealth applicability have enabled the implementation of a wide range of telemedicine systems, supporting clinical practices in different regions of the world. Distant and poorer areas of the globe, often characterized by difficult access and hazardous environments, are those that can most benefit from availability of remote consultations. This is due to the high costs associated with the transportation of specialized health teams and medical equipment between major cities and small villages, sometimes essential for the provision of adequate health care. Brazil is a country of continental dimensions with socioeconomic inequalities and uneven distribution of specialized health care, making it an ideal environment for establishment of eHealth initiatives.
The main objectives were (1) to develop an efficient method for acquiring and delivering patient medical information in remote areas using local Internet and (2) to assist urban and Indian populations in the Brazilian Amazon presenting with skin lesions and cardiovascular diseases.
Ethical approval was granted by the research and Ethics Committees of PUCRS, Porto Alegre, Brazil. The project comprised: (1) triage and patient interview; (2) digital ECG and skin picture acquisition; (3) data management, storage and transmission; (4) delivery of expert second opinion based on development of a secure and confidential communication system between the receiving and delivering sites. Upon internet availability, the system was programmed to connect to the Microgravity Centre’s main server and to synchronise all collected data. Specialist health professionals accessed this server and the electronic patient records via a secure application installed on personal computers. Patient information, images, and exams were analysed by health specialists at the delivering site, and an opinion and treatment suggestion was offered. Cases that proved inconclusive were due to a lack of available information or the need for further laboratory exams. The opinions were secured in an encrypted PDF envelope and returned to the receiving site, where final diagnosis and treatment remained the responsibility of the local health team.
Telecardiology (n=98): 59 (60.2%) normal ECGs, whilst 39 (39.8%) were altered, showing arrhythmias, conductive alterations and signs of ventricular hypertrophy. No patients presented signs of acute ischemia. In teledermatology (n=110): 57 (51.8%) patients did not present any skin disease. Among the patients with dermatological problems (n=53; 48.2%), the most common diagnoses were eczema, pityriasis versicolor, tinea, onychomycosis, and superficial mycosis. In five patients, the dermatologist suspected a cancerous lesion and recommended further investigation.
The telemedicine tools and the telecommunication system developed for this project proved to have a great applicability for diagnosis of dermatological skin conditions and for assessment of patient cardiovascular diseases. It was possible to remotely diagnose dermatological and cardiovascular conditions in a short period of time, at low cost and without the need for transportation of patients to other locations. It is believed that the eHealth assistance model applied in this project can be transferred to other places that have access to an Internet connection.
PMCID: PMC3571176
telecardiology; teledermatology; PUCRS; Brazilian Amazon; telemedicine experience
16.  Fostering cultural inclusiveness and learning in culturally mixed business classes 
SpringerPlus  2014;3:242.
Business educators have advocated that in order to build faculty’s intercultural capability, it is vital to provide them with professional development in using intercultural training resources and with “community of practice” support in adapting such resources for enhancing their students’ intercultural learning. This approach has been adopted in an Australian action research project titled “Internationalisation at Home” (IaH), which involved providing faculty with professional development adapted from an established intercultural training resource - the EXCELL (Excellence in Cultural Experiential Learning and Leadership) Program.
Case description
In this paper, we present two case studies of the implementation of the IaH Project in business schools at the University of Canberra and at Griffith University. Lessons learned from the first study were incorporated in the design and evaluation of the second one. Faculty leaders will describe how they engage and support colleagues in adapting components of EXCELL to foster cultural inclusiveness and facilitate students’ intercultural competence development. As part of project evaluation, we hypothesised that students who participated in IaH courses would report greater levels of (1) cultural inclusiveness in their educational environment, and (2) cultural learning development, compared with students who were not enrolled in IaH courses. Research participants in the Canberra case study comprised an intervention group of 140 business undergraduates enrolled in an IaH course, and a control group of 59 non-IaH undergraduates. At Griffith, participants were 211 first year management students in the intervention group and 84 students enrolled in a non-IaH first year course.
Discussion and evaluation
In each case study, an end-of-semester survey showed that students who had completed courses with the IaH project intervention reported significantly greater levels of perceived cultural inclusiveness in multicultural classes, and of cultural learning development, than students in the control group. Faculty’s reflections on project processes and outcomes further suggest that implementing strategic, structured active learning interventions such as in the IaH Project, could bring about more productive social interactions in multicultural classes and benefit domestic and especially international students. We will discuss implications of the findings for students’ intercultural learning, faculty’s needs for continual professional development, and the role of institutional support in intercultural competence development.
PMCID: PMC4028467  PMID: 24851200
17.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
PMCID: PMC4196737  PMID: 25314155
18.  Relation between contemplative exercises and an enriched psychology students' experience in a neuroscience course 
Frontiers in Psychology  2014;5:1296.
This article examines the relation of contemplative exercises with enhancement of students' experience during neuroscience studies. Short contemplative exercises inspired by the Buddhist tradition of self-inquiry were introduced in an undergraduate neuroscience course for psychology students. At the start of the class, all students were asked to participate in short “personal brain investigations” relevant to the topic presented. These investigations were aimed at bringing stable awareness to a specific perceptual, emotional, attentional, or cognitive process and observing it in a non-judgmental, non-personal way. In addition, students could choose to participate, for bonus credit, in a longer exercise designed to expand upon the weekly class activity. In the exercise, students continued their “personal brain investigations” for 10 min a day, 4 days a week. They wrote “lab reports” on their daily observations, obtained feedback from the teacher, and at the end of the year reviewed their reports and reflected upon their experiences during the semester. Out of 265 students, 102 students completed the bonus track and their final reflections were analyzed using qualitative methodology. In addition, 91 of the students answered a survey at the end of the course, 43 students participated in a quiz 1 year after course graduation, and the final grades of all students were collected and analyzed. Overall, students reported satisfaction from the exercises and felt they contributed to their learning experience. In the 1-year follow-up, the bonus-track students were significantly more likely than their peers to remember class material. The qualitative analysis of bonus-track students' reports revealed that the bonus-track process elicited positive feelings, helped students connect with class material and provided them with personal insights. In addition, students acquired contemplative skills, such as increased awareness and attention, non-judgmental attitudes, and better stress-management abilities. We provide examples of “personal brain investigations” and discuss limitations of introducing a contemplative approach.
PMCID: PMC4235268  PMID: 25477833
contemplative pedagogy; contemplative neuroscience; pedagogical psychology; pedagogical neuroscience
19.  Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial 
BMC Medical Education  2012;12:85.
The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.
Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.
The ASK-group (n = 70, age 23.4 (20–36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20–53) yrs.) and the CON-group (n = 88, 22.8 (20–33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).
The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
PMCID: PMC3473305  PMID: 22958784
Arthroscopy; Education, Anatomic competence, Randomized controlled trial, Knee joint, Shoulder joint, Students; Medical, Musculoskeletal ultrasound
20.  (S)Partners for Heart Health: a school-based program for enhancing physical activity and nutrition to promote cardiovascular health in 5th grade students 
BMC Public Health  2008;8:420.
The American Heart Association Position Statement on Cardiovascular Health Promotion in Public Schools encourages school-based interventions for the primary prevention of cardiovascular disease (CVD) through risk factor prevention or reduction in children with an emphasis on creating an environment that promotes healthy food choices and physical activity (PA). In an effort to address issues related to CVD risk factors including obesity in Michigan children, a multi-disciplinary team of Michigan State University (MSU) faculty, clinicians, and health profession students was formed to "(S)partner" with elementary school physical education (PE) teachers and MSU Extension staff to develop and implement a cost-effective, sustainable program aimed at CVD risk factor prevention and management for 5th grade students. This (S)partnership is intended to augment and improve the existing 5th grade PE, health and nutrition curriculum by achieving the following aims: 1) improve the students' knowledge, attitudes and confidence about nutrition, PA and heart health; 2) increase the number of students achieving national recommendations for PA and nutrition; and 3) increase the number of students with a desirable CVD risk factor status based on national pediatric guidelines. Secondary aims include promoting school staff and parental support for heart health to help children achieve their goals and to provide experiential learning and service for MSU health profession students for academic credit.
This pilot effectiveness study was approved by the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year.
This paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multi-level intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams.
PMCID: PMC2628664  PMID: 19102777
21.  Computer literacy among first year medical students in a developing country: A cross sectional study 
BMC Research Notes  2012;5:504.
The use of computer assisted learning (CAL) has enhanced undergraduate medical education. CAL improves performance at examinations, develops problem solving skills and increases student satisfaction. The study evaluates computer literacy among first year medical students in Sri Lanka.
The study was conducted at Faculty of Medicine, University of Colombo, Sri Lanka between August-September 2008. First year medical students (n = 190) were invited for the study. Data on computer literacy and associated factors were collected by an expert-validated pre-tested self-administered questionnaire. Computer literacy was evaluated by testing knowledge on 6 domains; common software packages, operating systems, database management and the usage of internet and E-mail. A linear regression was conducted using total score for computer literacy as the continuous dependant variable and other independent covariates.
Sample size-181 (Response rate-95.3%), 49.7% were Males. Majority of the students (77.3%) owned a computer (Males-74.4%, Females-80.2%). Students have gained their present computer knowledge by; a formal training programme (64.1%), self learning (63.0%) or by peer learning (49.2%). The students used computers for predominately; word processing (95.6%), entertainment (95.0%), web browsing (80.1%) and preparing presentations (76.8%). Majority of the students (75.7%) expressed their willingness for a formal computer training programme at the faculty.
Mean score for the computer literacy questionnaire was 48.4 ± 20.3, with no significant gender difference (Males-47.8 ± 21.1, Females-48.9 ± 19.6). There were 47.9% students that had a score less than 50% for the computer literacy questionnaire. Students from Colombo district, Western Province and Student owning a computer had a significantly higher mean score in comparison to other students (p < 0.001). In the linear regression analysis, formal computer training was the strongest predictor of computer literacy (β = 13.034), followed by using internet facility, being from Western province, using computers for Web browsing and computer programming, computer ownership and doing IT (Information Technology) as a subject in GCE (A/L) examination.
Sri Lankan medical undergraduates had a low-intermediate level of computer literacy. There is a need to improve computer literacy, by increasing computer training in schools, or by introducing computer training in the initial stages of the undergraduate programme. These two options require improvement in infrastructure and other resources.
PMCID: PMC3517310  PMID: 22980096
Computer literacy; Medical undergraduates; Sri Lanka; Developing country
22.  Evaluation of Pre-Service Training on Integrated Management of Neonatal and Childhood Illness in Ethiopia 
The Integrated Management of Newborn and Childhood Illness strategy equips health workers with essential knowledge and skills to effectively manage sick children with common neonatal and childhood diseases. Since in-service training is very demanding to achieve the desired coverage of training of health workers, pre-service training is taken as a solution. At the time of the survey, most public and some private health professionals' training institutions were conducting pre-service training. However, several concerns have been expressed on the training. Therefore, this survey was conducted to assess the status of pre-service Integrated Management of New-born and Childhood Illness training.
A cross sectional survey on health professional training institutes/schools to evaluate pre-service Integrated Management of Newborn and Childhood Illness training was conducted in November 2007. Data was collected using pre-tested questionnaires, focused group interviews with teachers and students, observation of students while managing sick children using Integrated Management of Newborn and Childhood Illness guidelines, and reviews of pediatric course outlines and other teaching/learning materials. Data was entered in computer and analyzed using SPSS for Windows version 12.0.1.
Twenty nine health professionals' training institutions (34 academic programs) which have started pre-service training were included in the survey. Of the 34 programs 22 were diploma nursing, 6 Bachelor of Sciences nursing, 4 health officer and the remaining two medicine. Thirty (88.2%) programs have integrated it in their curriculum. All academic programs had at least one fulltime staff for Integrated Management of Newborn and Childhood Illness classroom instruction. Twenty nine (85.3%) programs had staff trained in case management skills. All the 34 academic programs taught health workers skills, 28(82.3%) used mixed approach. Integrated Management of Newborn and Childhood Illness was either incorporated for 21 (61.8%) or added to the previous teaching 11 (32.3%). The instructor to student ratio was low for most of the schools. Main challenges encountered in the pre-service teaching were constraints with trained staff and other resources each by 28 (82.3%) programs. Integrated Management of Newborn and Childhood Illness was included in student evaluation by all programs (100%). All students and instructors (100%) rated that Integrated Management of Newborn and Childhood Illness concept is very relevant or extremely relevant but majority said the time given was short. The over all mean score of students clinical practice was 63.5%.
This study demonstrated that Integrated Management of Newborn and Childhood Illness was introduced into the teaching programs of most health professional training institutions. The most preferred teaching style was the mixed approach. Group discussion and demonstration were commonly used methods and Integrated Management of Newborn and Childhood Illness questions were included in students' evaluation in almost all programs. Shortage of IMNCI trained staff and teaching materials were major challenges. The use of teaching materials prepared for pre-service training like handbook and model chapter was limited. Instructors and students attitude towards IMNCI was very good. The students overall performance in managing sick child as per the IMNCI guidelines was above average. We recommend that the respective bodies at every level make every effort to strengthen IMNCI pre-service teaching through revisiting curricula, facilitating staff training, availing teaching materials and allocating adequate time. Exploring for an alternative/innovative and sustainable training approach is an assignment for all.
PMCID: PMC3275900  PMID: 22434956
IMNCI; pre-service; Ethiopia
23.  What are the learning outcomes of a short postgraduate training course in dermatology for primary care doctors? 
BMC Medical Education  2011;11:20.
There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common dermatological problems in the community. This study examined the learning outcomes of a short postgraduate course in dermatology for primary care doctors.
A self-reported questionnaire developed by the research team was sent to the Course graduates. A retrospective design was adopted to compare their clinical practice characteristics before and after the Course. Differences in the ratings were analysed using the nonparametric Wilcoxon signed rank test to evaluate the effectiveness of the Course in various aspects.
Sixty-nine graduates replied with a response rate of 42.9% (69/161). Most were confident of diagnosing (91.2%) and managing (88.4%) common dermatological problems after the Course, compared to 61.8% and 58.0% respectively before the Course. Most had also modified their approach and increased their attention to patients with dermatological problems. The number of patients with dermatological problems seen by the graduates per day showed significant increase after the Course, while the average percentage of referrals to dermatologists dropped from 31.9% to 23.5%. The proportion of graduates interested in following up patients with chronic dermatological problems increased from 60.3% to 77.9%.
Graduates of the Course reported improved confidence, attitudes and skills in treating common dermatological problems. They also reported to handle more patients with common dermatological problems in their practice and refer fewer patients.
PMCID: PMC3121723  PMID: 21575191
continuing medical education; dermatology; learning outcomes; postgraduate training; primary care doctors
24.  Assessment of Elementary School Students’ Sun Protection Behaviors 
Pediatric dermatology  2009;27(2):182-188.
Emerging studies suggest that excessive sun exposure in childhood contributes to the development of skin cancer later in life. Children rarely wear a wide-brimmed hat when outside although these hats offer the best protection to the areas on the face where children are most likely to be sunburned. The current study explores 4th grade student assessment of their sun protection behaviors outside at school and at times other than when they are at school.
This study utilized baseline data collected in the Fall of 2006 for the Sun Protection for Florida’s Children (SPF) project. In brief, the SPF project is a group randomized trial to test the effectiveness of a school based intervention promoting sun protection in general, and hat use in particular. The project targets all 4th grade students in Hillsborough County Schools, FL. The data reported in this study were collected at baseline before any intervention activities was initiated. Approximately 2,086 4th grade students completed self-report surveys evaluating sun protection behaviors. Trained research assistants carried out 99 direct observations of physical education classes over a five week period during Fall 2006 in Tampa, Florida.
In general, the self-reported use of various methods of sun protection was low. Approximately one third of students reported that they wore sunscreen (32.8%) or sunglasses (32.3%) before leaving home for school. Only a small percentage of students wore long sleeves (15.0%) or a hat with a brim (16.4%) before leaving for school. In addition, few students wore a hat with a wide brim when outside but not at school (16.4%). Students spent an average of 59.1 minutes per week outdoors while attending school and 35.5 minutes during peak sun exposure. In general, female students and Hispanic, African American, and students of other racial and ethnic groups were more likely to practice sun protection behaviors at school than white or male students. Students who attended schools with a mandatory uniform policy were less likely to wear hats with brims.
A single sunburn heightens a child’s risk of developing skin cancer later on in life. Sun exposure at school poses a significant risk to student health and more needs to be done to promote the use of a wide-brimmed hat and limiting student sun exposure. A wide brimmed hat shows the most promise in helping students to protect the face at neck areas where sunburns are most likely to develop. More needs to be done to promote hat use and limiting sun exposure while children are at school.
PMCID: PMC3683831  PMID: 19686304
25.  Are medical educators following General Medical Council guidelines on obesity education: if not why not? 
BMC Medical Education  2013;13:53.
Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools.
Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions.
Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies.
Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically.
PMCID: PMC3641974  PMID: 23578257
Qualitative; Interviews; UK; Undergraduate education; Curriculum; Obesity

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