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1.  A Qualitative Assessment of The Small Group Teaching at Hawler College of Medicine 
Context: Although the medical schools in Iraq recently started to increasingly use the small group teaching approach, only little is known about the students’ perceptions toward this approach. Therefore, the aim of this study was to assess small group teaching as a method of teaching at Hawler College of Medicine, from the students’ perspectives.
Setting: This study was a qualitative study which was based on six focus group discussions which involved a sample of students from the three last years at the Hawler College of Medicine. A topic guide was used to lead the discussions and it covered questions on the positive aspects and the problems of small group teaching in the college, in addition to recommendations for its improvement. The qualitative data analysis involved a content analysis, followed by a thematic analysis.
Results: The participants were generally happy with the application of the small group teaching approach and they recognized many positive aspects which were related to this experience, which included, increasing the focus on the study subjects, enhancing the student-teacher interaction, building a better student-teacher relationship, encouraging the students’ attendance, providing a better opportunity to apply a student-centered learning, enhancing a more efficient use of time and assisting in a better understanding of the subjects. The main problems which were faced, included a poor infrastructure and teaching facilities, problems which were related to examinations and the mark distribution, an improper syllabus preparation and problems which were related to the teachers’ commitments and performances. The main suggestions which were put forth to improve this system, included, changing the assessment system with the focus more on the end of the course assessment, the students’ involvement in the curriculum design, improving the infrastructure and teaching facilities and a better organization and management of the system.
Conclusions: The concept of the small group teaching approach was well received by the students and many positive aspects of this approach have been highlighted. However, this experience witnessed many problems and faced different challenges that need better preparation, organization of the resources and the orientation of students and teachers, for insuring its success.
doi:10.7860/JCDR/2013/5455.2966
PMCID: PMC3681061  PMID: 23814734
Medical education; Small group teaching
2.  Patient Outcomes with Teaching Versus Nonteaching Healthcare: A Systematic Review 
PLoS Medicine  2006;3(9):e341.
Background
Extensive debate exists in the healthcare community over whether outcomes of medical care at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertaining to this question.
Methods and Findings
We reviewed all studies that compared teaching versus nonteaching healthcare structures for mortality or any other patient outcome, regardless of health condition. Studies were retrieved from PubMed, contact with experts, and literature cross-referencing. Data were extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnoses considered, adjusting covariates, and estimates of effect for mortality and for each other outcome. Overall, 132 eligible studies were identified, including 93 on mortality and 61 on other eligible outcomes (22 addressed both). Synthesis of the available adjusted estimates on mortality yielded a summary relative risk of 0.96 (95% confidence interval [CI], 0.93–1.00) for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99–1.10) for minor teaching versus nonteaching ones. There was considerable heterogeneity between studies (I2 = 72% for the main analysis). Results were similar in studies using clinical and those using administrative databases. No differences were seen in the 14 studies fully adjusting for volume/experience, severity, and comorbidity (relative risk 1.01). Smaller studies did not differ in their results from larger studies. Differences were seen for some diagnoses (e.g., significantly better survival for breast cancer and cerebrovascular accidents in teaching hospitals and significantly better survival from cholecystectomy in nonteaching hospitals), but these were small in magnitude. Other outcomes were diverse, but typically teaching healthcare structures did not do better than nonteaching ones.
Conclusions
The available data are limited by their nonrandomized design, but overall they do not suggest that a healthcare facility's teaching status on its own markedly improves or worsens patient outcomes. Differences for specific diseases cannot be excluded, but are likely to be small.
Published data do not suggest that the teaching status of a hospital or other healthcare facility alone influences the outcome of patients treated in that facility.
Editors' Summary
Background.
When people need medical treatment they may be given it in a “teaching hospital.” This is a place where student doctors and other trainee healthcare workers are receiving part of their education. They help give some of the treatment that patients receive. Teaching hospitals are usually large establishments and in most countries they are regarded as being among the very best hospitals available, with leading physicians and surgeons among the staff. It is usually assumed that patients who are being treated in a teaching hospital are lucky, because they are getting such high-quality healthcare. However, it has sometimes been suggested that, because some of the people involved in their care are still in training, the patients may face higher risks than those who are in nonteaching hospitals.
Why Was This Study Done?
The researchers wanted to find out which patients do best after treatment—those who were treated in teaching hospitals or those who were in nonteaching hospitals. This is a difficult issue to study. The most reliable way of comparing two types of treatment would be to decide at random which treatment each patient should receive. (For more on this see the link below for “randomized controlled trials.”) In practice, it would be difficult to set up a study where the decision on which hospital a patient should go to was made at random. One problem is that, because of the high reputation of teaching hospitals, the patients whose condition is the most serious are often sent there, with other patients going to nonteaching hospitals. It would not be a fair test to compare the “outcome” for the most seriously ill patients with the outcome for those whose condition was less serious.
What Did the Researchers Do and Find?
The researchers conducted a thorough search for studies that had already been done, which met criteria which the researchers had specified in advance. This type of research is called a “systematic review.” They found 132 studies that had compared the outcomes of patients in teaching or nonteaching hospitals. None of these studies was a trial. (They were “observational studies” where researchers had gathered information on what was already taking place, rather than setting up an experiment.) However, in 14 studies, extensive allowances had been made for differences in such factors as the severity of the patients' condition, and whether or not they had more than one type of illness when they were treated. There was a great deal of variability in the results between the studies but, overall, there was no major difference in the effectiveness of treatment provided by the two types of hospital.
What Do These Findings Mean?
There is no evidence to support that it is better to be given treatment in a teaching or a nonteaching hospital. The authors do note that a limitation in their analysis is that it was based on studies that were not randomized controlled trials. They also raise the question that differences might be found if considering specific diseases one by one, rather than putting information on all conditions together. However, they believe that any such difference would be small. Their findings will be useful in the continuing debate on the most effective ways to train doctors, while at the same time providing the best possible care for patients.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030341.
Wikipedia entry on teaching hospitals (note: Wikipedia is a free online encyclopedia that anyone can edit)
Information on randomized clinical trials from the US National Institutes of Health
A definition of systematic reviews from the Cochrane Collaboration, an organization which produces systematic reviews
All of the above include links to other Web sites where more detailed information can be found.
doi:10.1371/journal.pmed.0030341
PMCID: PMC1564172  PMID: 16968119
3.  Challenges for medical educators: Results of a survey among members of the German association for medical education  
Background: Despite the increasing interest in medical education in the German-speaking countries, there is currently no information available on the challenges which medical educators face. To address this problem, we carried out a web-based survey among the members of the Association for Medical Education (Gesellschaft für medizinische Ausbildung, GMA).
Methods: A comprehensive survey was carried out on the need for further qualifications, expertise and the general conditions of medical educators in Germany. As part of this study, the educators were asked to list the three main challenges which they faced and which required urgent improvement. The results were analysed by means of qualitative content analysis.
Results: The questionnaire was completed by 147 of the 373 members on the GMA mailing list (response rate: 39%). The educators named a total of 346 challenges and emphasised the following areas: limited academic recognition for engagement in teaching (53.5% of educators), insufficient institutional (31.5%) and financial support (28.4%), a curriculum in need of reform (22.8%), insufficient time for teaching assignments (18,9%), inadequate teacher competence in teaching methods (18.1%), restricted faculty development programmes (18.1%), limited networking within the institution (11.0%), lack of teaching staff (10.2%), varying preconditions of students (8.7%), insufficient recognition and promotion of medical educational research (5.5%), extensive assessment requirements (4.7%), and the lack of role models within medical education (3.2%).
Conclusion: The medical educators found the biggest challenges which they faced to be limited academic recognition and insufficient institutional and financial support. Consequently, improvements should be implemented to address these issues.
doi:10.3205/zma000881
PMCID: PMC3778529  PMID: 24062818
medical education; medical educators; needs assessment; faculty development
4.  The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study 
BMC Medical Education  2014;14:55.
Background
Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner.
Methods
A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators.
Results
52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.
A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners’ perspective.
Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed “GP consultant teacher”). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning.
Conclusions
Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.
doi:10.1186/1472-6920-14-55
PMCID: PMC3995295  PMID: 24645670
Postgraduate training; Workplace based learning; General Practice Education; Teaching innovation; Vertical integration of GP education; Multi-level learning; Learning culture
5.  Comparison of the Quality Assessment of the Medical Education by students of Bologna and the Old System of Studying 
Medical Archives  2014;68(2):132-136.
Introduction:
The quality of teaching at the universities in Bosnia and Herzegovina as well as abroad depends on many factors, among which are: adequate space for teaching, teaching staff, equipment and technical aids to assist the teaching process, which are in accordance with existing standards and norms. Opinion of students plays an important role in measuring the quality of education.
The goal:
was to compare the quality of the teaching process students which study according to the Bologna system and students who are studying according to the old system.
Material and methods:
We used a questionnaire containing variables relevant to test the success of the teaching process at the Faculty of Medicine in Sarajevo. The survey was conducted among the students of the sixth year of the Medical Faculty in Sarajevo. The study included 138 students of which 85 students who are studying according to the Bologna system and 53 students who are studying according the old system.
Results:
The results showed that the students of both groups assessed similarly basic elements of the teaching process. A statistically significant difference is found in the evaluation of the relationship of teachers, assistants, the number of students and the evaluation of space for teaching, practice and studying. Students of the Bologna system believe that assistants should offer more empirical examples and that the exercises are not well designed, unlike the old system students who are satisfied with the concept of practical exercises. A small number of students, in both groups had the opportunity to exercise on the model how to administer injections, while the model for intubation and simulation model used more students of the Bologna system. From the baseline 55% of Bologna students and 48% of students which study according to old system, considered that they are ready to work independently.
Discussion:
Quality of medical education at the Faculty of Medicine, University of Sarajevo evaluated by students studying under the old system was not satisfactory in a number of variables that has been shown in this study. Students who are studying according to the Bologna system are more satisfied and most of the variables that were used in this research were evaluated positively.
Conclusion:
Although in this study is pointed to the many positive features of the Bologna system, in Bosnia and Herzegovina still exist many shortcomings in this study system. It is necessary to carry out many of the changes in our universities through the Bologna process. Primary it is necessary changes to studies curricula, their alignment with the programs of other European universities, modernization of facilities and their alignment with the programs of other European universities, a new method of selection of teachers and their engagement at the university.
doi:10.5455/medarh.2014.68.132-136
PMCID: PMC4272501  PMID: 24937940
Bologna process of education; Faculty of medicine of Sarajevo University; students
6.  Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers 
BMJ : British Medical Journal  1999;319(7218):1168-1171.
Objective
To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice.
Design
Qualitative semistructured interview study.
Setting
General practices throughout north London.
Subjects
30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice.
Results
The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching.
Conclusions
Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with.
Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education
PMCID: PMC28267  PMID: 10541508
7.  Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement 
Background
As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system.
Methods
A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis.
Results
Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring.
Conclusions
This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.
doi:10.1186/1472-698X-12-21
PMCID: PMC3492068  PMID: 23016849
Primary care; Care providers; Focus group; Service delivery; Kurdistan region
8.  Peer Teaching in Paediatrics - Medical Students as Learners and Teachers on a Paediatric Course 
Background: Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students.
Methods: Medical student peers in their 6th year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5th year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies.
Results: The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training.
Conclusions: The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors. Paediatric doctors seem to be more motivated for their own teaching tasks if they are assisted by student peer teachers. More research is needed to investigate the influence of peer teaching on the motivation of paediatric doctors to teach medical students und the academic performance of the student peers.
doi:10.3205/zma000708
PMCID: PMC3140377  PMID: 21818216
Peer assisted learning; clinical skills training in paediatrics; student evaluation; student self assessment
9.  A trial of patient-oriented problem-solving system for immunology teaching in China: a comparison with dialectic lectures 
BMC Medical Education  2013;13:11.
Background
The most common teaching method used in China is lecturing, but recently, efforts have been widely undertaken to promote the transition from teacher-centered to student-centered education. The patient-oriented problem-solving (POPS) system is an innovative teaching-learning method that permits students to work in small groups to solve clinical problems, promotes self-learning, encourages clinical reasoning and develops long-lasting memory. To our best knowledge, however, POPS has never been applied in teaching immunology in China. The aim of this study was to develop POPS in teaching immunology and assess students’ and teachers’ perception to POPS.
Methods
321 second-year medical students were divided into two groups: I and II. Group I, comprising 110 students, was taught by POPS, and 16 immunology teachers witnessed the whole teaching process. Group II including the remaining 211 students was taught through traditional lectures. The results of the pre- and post-test of both groups were compared. Group I students and teachers then completed a self-structured feedback questionnaire for analysis before a discussion meeting attended only by the teachers was held.
Results
Significant improvement in the mean difference between the pre- and post-test scores of those in Groups I and II was seen, demonstrating the effectiveness of POPS teaching. Most students responded that POPS facilitates self-learning, helps them to understand topics and creates interest, and 88.12% of students favored POPS over simple lectures. Moreover, while they responded that POPS facilitated student learning better than lectures, teachers pointed out that limited teaching resources would make it difficult for wide POPS application in China.
Conclusions
While POPS can break up the monotony of dialectic lectures and serve as a better teaching method, it may not be feasible for the current educational environment in China. The main reason for this is the relative shortage of teaching resources such as space, library facilities and well-trained teachers.
doi:10.1186/1472-6920-13-11
PMCID: PMC3570451  PMID: 23356717
Patient-oriented problem-solving; Medical education; Immunology; China
10.  Institutional capacity for health systems research in East and Central Africa schools of public health: enhancing capacity to design and implement teaching programs 
Background
The role of health systems research (HSR) in informing and guiding national programs and policies has been increasingly recognized. Yet, many universities in sub-Saharan African countries have relatively limited capacity to teach HSR. Seven schools of public health (SPHs) in East and Central Africa undertook an HSR institutional capacity assessment, which included a review of current HSR teaching programs. This study determines the extent to which SPHs are engaged in teaching HSR-relevant courses and assessing their capacities to effectively design and implement HSR curricula whose graduates are equipped to address HSR needs while helping to strengthen public health policy.
Methods
This study used a cross-sectional study design employing both quantitative and qualitative approaches. An organizational profile tool was administered to senior staff across the seven SPHs to assess existing teaching programs. A self-assessment tool included nine questions relevant to teaching capacity for HSR curricula. The analysis triangulates the data, with reflections on the responses from within and across the seven SPHs. Proportions and average of values from the Likert scale are compared to determine strengths and weaknesses, while themes relevant to the objectives are identified and clustered to elicit in-depth interpretation.
Results
None of the SPHs offer an HSR-specific degree program; however, all seven offer courses in the Master of Public Health (MPH) degree that are relevant to HSR. The general MPH curricula partially embrace principles of competency-based education. Different strengths in curricula design and staff interest in HSR at each SPH were exhibited but a number of common constraints were identified, including out-of-date curricula, face-to-face delivery approaches, inadequate staff competencies, and limited access to materials. Opportunities to align health system priorities to teaching programs include existing networks.
Conclusions
Each SPH has key strengths that can be leveraged to design and implement HSR teaching curricula. We propose networking for standardizing HSR curricula competencies, institutionalizing sharing of teaching resources, creating an HSR eLearning platform to expand access, regularly reviewing HSR teaching content to infuse competency-based approaches, and strengthening staff capacity to deliver such curricula.
doi:10.1186/1478-4505-12-22
PMCID: PMC4072483  PMID: 24888353
Curriculum design; Health systems research; Teaching health systems research; Training in health systems research
11.  Bedside teaching in medical education: a literature review 
Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles regarding the above-mentioned subjects were included. Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents. Patients, students/residents and teachers all seem to favour bedside teaching, for varying reasons. Despite this, the practice of bedside teaching is declining. Reasons to explain this decline include the increased patient turnover in hospitals, the assumed violation of patients’ privacy and an increased reliance on technology in the diagnostic process. Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials. Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills.
doi:10.1007/s40037-013-0083-y
PMCID: PMC3976479  PMID: 24049043
Bedside teaching; Decline; Clinical skills; Satisfaction; Future directions/solutions
12.  Clinical instructors' perception of a faculty development programme promoting postgraduate year-1 (PGY1) residents' ACGME six core competencies: a 2-year study 
BMJ Open  2011;1(2):e000200.
Objective
The six core competencies designated by Accreditation Council for Graduate Medical Education (ACGME) are essential for establishing a patient centre holistic medical system. The authors developed a faculty programme to promote the postgraduate year 1 (PGY1) resident, ACGME six core competencies. The study aims to assess the clinical instructors' perception, attitudes and subjective impression towards the various sessions of the ‘faculty development programme for teaching ACGME competencies.’
Methods
During 2009 and 2010, 134 clinical instructors participated in the programme to establish their ability to teach and assess PGY1 residents about ACGME competencies.
Results
The participants in the faculty development programme reported that the skills most often used while teaching were learnt during circuit and itinerant bedside, physical examination teaching, mini-clinical evaluation exercise (mini-CEX) evaluation demonstration, training workshop and videotapes of ‘how to teach ACGME competencies.’ Participants reported that circuit bedside teaching and mini-CEX evaluation demonstrations helped them in the interpersonal and communication skills domain, and that the itinerant teaching demonstrations helped them in the professionalism domain, while physical examination teaching and mini-CEX evaluation demonstrations helped them in the patients' care domain. Both the training workshop and videotape session increase familiarity with teaching and assessing skills. Participants who applied the skills learnt from the faculty development programme the most in their teaching and assessment came from internal medicine departments, were young attending physician and had experience as PGY1 clinical instructors.
Conclusions
According to the clinical instructors' response, our faculty development programme effectively increased their familiarity with various teaching and assessment skills needed to teach PGY1 residents and ACGME competencies, and these clinical instructors also then subsequently apply these skills.
Article summary
Article focus
In order to train PGY1 residents, we need to help clinical instructors to become familiar with the teaching and assessment skills that form the Accreditation Council for Graduate Medical Education six core-competencies.
Our study used a self-reported questionnaires based analysis to evaluate the clinical instructors' perception to our faculty development programme.
Key messages
Participants reported that their most commonly used skills were learnt from itinerant and circuit bedside teaching, and mini-clinical evaluation exercise evaluation demonstration in our programme.
Participants also reported that the 40 h basic training course improved their abilities to train and assess PGY1 residents in patient care, interpersonal and communication skills, and medical knowledge domains whereas postcourse training workshop and videotape session enhanced their ability in system-based practice, practice-based learning and improvement, and professionalism domains.
A serial follow-up questionnaire suggested that the degree of participant application of skills learnt from our programme increased progressively after finishing the 40 h basic training course, the postcourse training workshop and videotape session.
Strengths and limitations of this study
According to the clinical instructors' responses, our programme effectively increased their familiarity with teaching and assessment skills needed when teaching PGY1 residents' Accreditation Council for Graduate Medical Education competencies and that these skills were subsequently applies.
This study was limited by the fact that questionnaire used to track and assess the effectiveness of the training programme may have had information and recall bias. In addition, this study had a relatively small sample size and did not contain a control group. However, no controlled educational trials on this subject have been published as yet.
doi:10.1136/bmjopen-2011-000200
PMCID: PMC3225591  PMID: 22116089
13.  Student perceptions of GP teachers' role in community-based undergraduate surgical education: a qualitative study 
JRSM Short Reports  2012;3(8):51.
Objectives
To evaluate medical students' perceptions of a new community-based surgical module being delivered as part of a third-year clinical methods teaching (CMT) course at Imperial College, London.
Design
A qualitative study using focus group interviews with medical students who had recently completed the surgical module. Focus group discussions were recorded, transcribed and analysed to identify key categories that reflected the positive and negative aspects of the student's perspectives.
Setting
Imperial College, London
Participants
Two groups of fourth-year medical students were invited to participate in the focus groups. The first group consisted of seven students from the surgery and Anaesthesia BSc course. The second group consisted of a random sample of five students from other BSc courses at Imperial College.
Main Outcome Measures
These were not defined pre-study as the purpose of the study was to obtain student perceptions of the surgical module. Facilitators were given guide questions to aid consistency and prompted discussion where required using an inductive approach to the topics discussed by the students.
Results
Student opinions of surgical teaching delivered in the community compared favourably with the surgical teaching delivered in hospitals. Students identified the key benefits as: having protected time to learn, regular access to suitable patients, and teaching that was more learner-centred. Challenges identified by students included the GPs' lack of specialist knowledge and teaching that was dictated by individual interests rather than the syllabus.
Conclusions
Community-based teaching has been widely used to deliver teaching traditionally taught in hospital settings. However, surgical skills are still taught largely by surgical specialists within hospitals. Our study suggests that students are receptive to GPs teaching surgical topics in the community and perceive GPs as competent teachers. This study suggests that there may be benefits in delivering traditional surgical modules in community settings. Providing training for teachers may be a key factor in ensuring quality of surgical teaching for all students.
doi:10.1258/shorts.2012.012015
PMCID: PMC3434433  PMID: 23301139
14.  Online discussion for block teaching in postgraduate health professionals’ curriculum: the Ethiopian experience 
BMC Medical Education  2014;14:29.
Background
Online discussions as a method of instruction are a new approach in Ethiopia. There is no previous study in the Ethiopian context that has assessed students’ engagement and learning experience using this instruction method, which may offer a valuable complement to other instruction methods for intensive block teaching in a resource-limited environment. The aim of this study was to assess the value of online discussions in supporting students’ engagement and interaction with their peers and teachers in a block teaching postgraduate health professionals’ curriculum.
Methods
The research was conducted at Addis Ababa University College of Health Sciences, School of Medical Laboratory Sciences (SMLS), which has structured the curriculum around intensive block teaching. Between December 2011 and February 2012, two groups of full-time (N = 21) and part-time (N = 52) postgraduate students participated in online discussions as part of a Biostatistics and Research Methods module, in addition to other instructional methods. Every week, the course instructor initiated the online discussion by posting an assignment and articles with a few discussion questions. To evaluate the participants’ collective learning experience, the content of the email messages generated during these online discussions was analyzed qualitatively.
Result
A total of 702 emails were exchanged during the three week module, of which 250 emails (35.6%) were posted by full-time students and 452 emails (64.4%) by part-time Continuing Education Program (CEP) students. During the online discussion forum, students identified different statistical data analysis tools and their application for given data sets. In terms of message contents, 67% of full-time and 64% of part-time students’ messages were classified as learning experiences. However, a slightly higher proportion of part-time students’ posts were social messages. The majority of students in both groups reported high levels of satisfaction with their online experience.
Conclusion
Online discussion could be a valuable addition to face-to-face classroom teaching to improve students’ engagement and interaction in an intensive block teaching postgraduate curriculum where learners are engaged in a full work load with academic studies.
doi:10.1186/1472-6920-14-29
PMCID: PMC3924913  PMID: 24521146
Online discussion; Block teaching; Ethiopia
15.  A needs assessment of surgical residents as teachers 
Canadian Journal of Surgery  2000;43(4):295-300.
Objective
To determine the needs of surgical residents as teachers of clinical clerks.
Design
A needs assessment survey.
Setting
Department of Surgery, University of Toronto.
Participants
Clinical clerks and surgical residents and staff surgeons.
Methods
Three stakeholder groups were defined: staff surgeons, surgical residents and clinical clerks. Focus-group sessions using the nominal group technique identified key issues from the perspectives of clerks and residents. Resulting information was used to develop needs assessment surveys, which were administered to 170 clinical clerks and 190 surgical residents. Faculty viewpoints were assessed with semi-structured interviews. Triangulation of these 3 data sources provided a balanced approach to identifying the needs of surgical residents as teachers.
Results
Response rates were 64% for clinical clerks and 66% for surgical residents. Five staff surgeons were interviewed. Consensus was noted among the stakeholder groups regarding the importance of staff surgeon role modelling and feedback, resident attitude, time management, knowledge of clerks’ formal learning objectives, and appropriate times and locations for teaching. Discrepancies included a significant difference in opinion regarding the residents’ capacity to address clerks’ individual learning needs and to foster good team relationships. Residents indicated that they did not receive regular feedback regarding their teaching and that staff did not place an emphasis on their teaching role.
Conclusions
This study has, from a multi-source perspective, assessed the needs of surgical residents as teachers. These needs include enhancing residents’ education regarding how and what to teach medical students on a surgical rotation, and a need for staff surgeons to increase feedback to residents regarding their teaching.
PMCID: PMC3695219  PMID: 10948691
16.  Patient safety education for undergraduate medical students: a systematic review 
BMC Medical Education  2011;11:33.
Background
To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China.
Methods
We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person.
Results
This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty knowledge and background in patient safety, other resources and outcome evaluation in these reports. The outcomes from including patient safety in the curriculum as measured by medical students' knowledge, skills, and attitudes varied between the studies.
Conclusions
There are only a few relevant published studies on the inclusion of patient safety education into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges.
doi:10.1186/1472-6920-11-33
PMCID: PMC3128569  PMID: 21669007
17.  Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital 
Background
Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.
Methods
Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.
Results
Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.
Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.
Conclusions
Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.
doi:10.1186/1472-698X-11-S1-S7
PMCID: PMC3059479  PMID: 21411007
18.  Using an ACTIVE teaching format versus a standard lecture format for increasing resident interaction and knowledge achievement during noon conference: a prospective, controlled study 
BMC Medical Education  2014;14:129.
Background
The traditional lecture is used by many residency programs to fulfill the mandate for regular didactic sessions, despite limited evidence to demonstrate its effectiveness. Active teaching strategies have shown promise in improving medical knowledge but have been challenging to implement within the constraints of residency training. We developed and evaluated an innovative structured format for interactive teaching within the residency noon conference.
Methods
We developed an ACTIVE teaching format structured around the following steps: assemble (A) into groups, convey (C) learning objectives, teach (T) background information, inquire (I) through cases and questions, verify (V) understanding, and explain (E) answer choices and educate on the learning points. We conducted a prospective, controlled study of the ACTIVE teaching format versus the standard lecture format, comparing resident satisfaction, immediate knowledge achievement and long-term knowledge retention. We qualitatively assessed participating faculty members’ perspectives on the faculty development efforts and the feasibility of teaching using the ACTIVE format.
Results
Sixty-nine internal medicine residents participated in the study. Overall, there was an improvement in perceived engagement using the ACTIVE teaching format (4.78 vs. 3.80, P < 0.01), with no increase in stress or decrement in break time. There was an improvement in initial knowledge achievement with the ACTIVE teaching format (overall absolute score increase of 11%, P = 0.04) and a trend toward improvement in long-term knowledge retention. Faculty members felt adequately prepared to use the ACTIVE teaching format, and enjoyed teaching with the ACTIVE teaching format more than the standard lecture.
Conclusions
A structured ACTIVE teaching format improved resident engagement and initial knowledge, and required minimal resources. The ACTIVE teaching format offers an exciting alternative to the standard lecture for resident noon conference and is easy to implement.
doi:10.1186/1472-6920-14-129
PMCID: PMC4105558  PMID: 24985781
Medical education; Graduate medical education; Conference; Active teaching; Lecture
19.  Distribution of Chronotypes among a Sample of Iraqi Kurdish Medical Students 
Objectives:
The aim of this study was to assess the distribution of chronotypes in a sample of Iraqi Kurdish medical students.
Methods:
A descriptive cross-sectional study was conducted at the Hawler Medical University College of Medicine in Erbil City, Iraq, between 1st January and 31st March 2013. A total of 580 students were given the reduced version of the Horne and Ostberg Morningness-Eveningness Questionnaire (MEQr), a close-ended self-administered questionnaire.
Results:
Of the 580 students, 130 (22.4%) were male and 450 (77.6%) were female. The mean age ± standard deviation was 20.3 ± 1.45 years, with a range of 17–24 years. Most of the students (52.6%) were in the intermediate class, followed by morning type (24.1%) and evening type (23.3%). Significant gender differences were detected in the proportion of morning, intermediate and evening types (P <0.001). The mean scores for the female students were 14.8 ± 2.2 and the mean scores for the male students were 14.6 ± 7.3, with no statistically significant differences (P = 0.45).
Conclusion:
Students in the College of Medicine were mostly classified as intermediate types. The morning type was more common among this student population, particularly male students, than has been reported in similar age groups in some Western countries. There was a significant gender difference in the proportion of MEQr types.
PMCID: PMC4117661  PMID: 25097771
Chronobiology Phenomena; Circadian Rhythm; Sleep; Iraq
20.  Cultural diversity teaching and issues of uncertainty: the findings of a qualitative study 
Background
There is considerable ambiguity in the subjective dimensions that comprise much of the relational dynamic of the clinical encounter. Comfort with this ambiguity, and recognition of the potential uncertainty of particular domains of medicine (e.g. – cultural factors of illness expression, value bias in diagnoses, etc) is an important facet of medical education. This paper begins by defining ambiguity and uncertainty as relevant to clinical practice. Studies have shown differing patterns of students' tolerance for ambiguity and uncertainty that appear to reflect extant attitudinal predispositions toward technology, objectivity, culture, value- and theory-ladeness, and the need for self-examination. This paper reports on those findings specifically related to the theme of uncertainty as relevant to teaching about cultural diversity. Its focus is to identify how and where the theme of certainty arose in the teaching and learning of cultural diversity, what were the attitudes toward this theme and topic, and how these attitudes and responses reflect and inform this area of medical pedagogy.
Methods
A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified.
Results
There were diverse views about what the term cultural diversity means and what should constitute the cultural diversity curriculum. There was a need to provide certainty in teaching cultural diversity with diversity teachers feeling under considerable pressure to provide information. Students discomfort with uncertainty was felt to drive cultural diversity teaching towards factual emphasis rather than reflection or taking a patient centred approach.
Conclusion
Students and faculty may feel that cultural diversity teaching is more about how to avoid professional, medico-legal pitfalls, rather than improving the patient experience or the patient-physician relationship. There may be pressure to imbue cultural diversity issues with levels of objectivity and certainty representative of other aspects of the medical curriculum (e.g. – biochemistry). This may reflect a particular selection bias for students with a technocentric orientation. Inadvertently, medical education may enhance this bias through training effects, and accommodate disregard for subjectivity, over-reliance upon technology and thereby foster incorrect assumptions of objective certainty. We opine that it is important to teach students that technology cannot guarantee certainty, and that dealing with subjectivity, diversity, ambiguity and uncertainty is inseparable from the personal dimension of medicine as moral enterprise. Uncertainty is inherent in cultural diversity so this part of the curriculum provides an opportunity to address the issue as it relates to pateint care.
doi:10.1186/1472-6920-7-8
PMCID: PMC1871589  PMID: 17462089
21.  Need to teach family medicine concepts even before establishing such practice in a country 
Background
The practice of family medicine is not well established in many developing countries including Sri Lanka. The Sri Lankan Government funds and runs the health facilities which cater to the health needs of a majority of the population. Services of a first contact doctor delivered by full time, vocationally trained, Family Physicians is generally overshadowed by outpatient departments of the government hospitals and after hours private practice by the government sector doctors and specialists. This process has changed the concept of the provision of comprehensive primary and continuing care for entire families, which in an ideal situation, should addresses psychosocial problems as well and deliver coordinated health care services in a society. Therefore there is a compelling need to teach Family Medicine concepts to undergraduates in all medical faculties.
Discussion
A similar situation prevails in many countries in the region. Faculty of Medicine Peradeniya embarked on teaching family medicine concepts even before a department of Family Medicine was established. The faculty has recognized CanMed Family Medicine concepts as the guiding principles where being an expert, communicator, collaborator, advocate, manager and professional is considered as core competencies of a doctor. These concepts created the basis to evaluate the existing family medicine curriculum , and the adequacy of teaching knowledge and skills, related to family medicine has been confirmed. However inadequacies of teaching related to communication, collaboration, management, advocacy and professionalism were recognized. Importance of inculcating patient centred attitudes and empathy in patient care was highlighted. Adopting evaluation tools like Patient Practitioner Orientation Scale and Jefferson’s Scale of Empathy was established. Consensus has been developed among all the departments to improve their teaching programmes in order to establish a system of teaching family medicine concepts among students which would lead them to be good Family Physicians in the future.
Summary
Teaching Family Medicine concepts could be initiated even before establishing departments of family medicine in medical faculties and establishing the practice of family medicine in society. Family medicine competencies could be inculcated among graduates while promoting the establishment of the proper practice of Family Medicine in the society.
doi:10.1186/1447-056X-13-1
PMCID: PMC3904475  PMID: 24397851
Family medicine concepts; Undergraduate curriculum; Communication; Patient; Centeredness; Empathy
22.  Integrating patient safety into health professionals’ curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives 
BMJ Quality & Safety  2013;23(3):257-264.
Background
As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the ‘front-lines’ of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners.
Methods
Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives.
Results
Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners.
Conclusions
Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings.
doi:10.1136/bmjqs-2013-001900
PMCID: PMC3932978  PMID: 24299734
Patient safety; Nurses; Medical education; Continuing education, continuing professional development; Pharmacists
23.  Residents as teachers in Canadian paediatric training programs: A survey of program director and resident perspectives 
Paediatrics & Child Health  2008;13(8):675-679.
BACKGROUND:
The importance of the teaching role of residents in medical education is increasingly being recognized. There are little data about how this role is perceived within training programs or how residents develop their teaching skills. The aims of the present study were to explore the perspectives of Canadian paediatric program directors and residents on the teaching role of residents, to determine how teaching skills are developed within these programs, and to identify specific areas that could be targeted to improve resident teaching skills and satisfaction.
METHODS:
Program directors and residents in Canadian paediatric residency programs were surveyed about the scope of teaching performed by residents, resident teaching ability and resources available for skill development.
RESULTS:
Responses were received from 11 of 13 program directors contacted. Nine programs agreed to have their residents surveyed, and 41% of residents in these programs responded. Directors and residents agreed that residents taught the most on general paediatric wards, and that medical students and residents were the most frequent recipients of resident teaching. While 72% of directors reported that instruction in teaching was provided, only 35% of residents indicated that they had received such training. Directors believed that residents needed improvement in providing feedback, while residents wanted help with teaching at the bedside, during rounds and in small groups. Teaching performance was included in rotational evaluations in most programs, but residents were often uncertain of expectations and assessment methods.
CONCLUSION:
There is a general consensus that residents play an important teaching role, especially on the inpatient wards. Residents’ ability to fill this role could be enhanced by clearer communication of expectations, timely and constructive feedback, and targeted training activities with the opportunity to practice learned skills.
PMCID: PMC2606073  PMID: 19436520
Medical education; Paediatrics; Residency
24.  A randomised-controlled trial of two educational modes for undergraduate evidence-based medicine learning in Asia 
Background
As the overall evidence for the effectiveness of teaching of evidence based medicine (EBM) is not strong, and the impact of cultural and societal influences on teaching method is poorly understood, we undertook a randomised-controlled trial to test the effectiveness and learning satisfaction with two different EBM teaching methods (usual teaching vs. problem based learning (PBL)) for undergraduate medical students.
Methods
A mixed methods study that included a randomised-controlled crossover trial with two intervention arms (usual teaching and PBL) and a nested qualitative study with focus groups to explore student perceptions of learning and to assess the effectiveness and utility of the two teaching methods.
All 129 second-year medical students at the University of Hong Kong in 2007.
The main outcomes measures were attitudes towards EBM; personal application and current use of EBM; EBM knowledge; future use of EBM.
Results
PBL was less effective at imparting knowledge than usual teaching consisting of a lecture followed by a group tutorial. After usual teaching students showed improvement in scores for 'attitudes towards EBM', 'personal application and current use of EBM' and 'EBM knowledge, which were not evident after PBL. In contrast to the usual teaching, students found PBL difficult as they lacked the statistical knowledge necessary to support discussion, failed to understand core concepts, and lost direction.
Conclusion
The evidence presented here would suggest that the teaching of EBM within an Asian environment should adopt a format that facilitates both the acquisition of knowledge and encourages enquiry.
doi:10.1186/1472-6920-9-63
PMCID: PMC2761870  PMID: 19785777
25.  Evaluation of a task-based community oriented teaching model in family medicine for undergraduate medical students in Iraq 
Background
The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools.
Methods
An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC) in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students) was exposed to the experimental model and the control group (56 students) received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999–2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools.
Results
The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work.
Conclusion
A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established.
doi:10.1186/1472-6920-5-31
PMCID: PMC1215485  PMID: 16115312

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