Producing a socially accountable medical school: AMEE Guide No. 109

Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the “Social Accountability of Medical Schools” – a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve.

Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.     

Establishing a new medical school: A contemporary approach to personalizing medical education

Abstract

Objective: To borrow a public health concept, there has been a global outbreak, perhaps a pandemic, of new medical schools during the last 20 years, resulting in a diverse range of programs in many different contexts. The question posed was: how should the task of establishing a new medical program be approached in 2018?

Methods: Based on involvement with several new medical programs, this paper presents a highly idealistic commentary on what a new medical program might look like. The paper adopts the organizational structure of the World Federation of Medical Education Basic Medical Education standards as a scaffold, because accreditation both locally and globally is intended.

Results: The program design reflects both progress in learning technology and the challenges faced in a changing world, where disruption appears inevitable, and innovation may be necessary to produce the medical graduates needed to improve the health status of an expanding, ageing and ailing global population.

Conclusion: The program model described represents a combination of educational design, emerging technology and a focus on future health care needs.     

How to identify,address and report students’ unprofessional behaviour in medical school

Abstract

This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students’ unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the ‘failure to fail’ phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.     

The effectiveness of webcast compared to live lectures as a teaching tool in medical school

Objective: The purpose of this study is to investigate whether webcast lectures are comparable to live lectures as a teaching tool in medical school.

Methods: Three Otolaryngology-Head&Neck Surgery (OTO-HNS) lectures were given to third year medical students through their regular academic curriculum with one group receiving lectures in a live lecture format and the other group in a webcast format. All lectures (live or webcast) were given by the same lecturer and contained identical material. Three outcome measures were used: a student satisfaction survey, performance on the OTO-HNS component of their written examination, and performance on an OTO-HNS OSCE station in the general end of year OSCE examination session.

Results: Students performance on the written examination was equal between the two groups. The webcast group outperformed the live lecture group in the OSCE station. The majority of students in the webcast group felt it was an effective learning tool for them. Most viewed the lectures more than once, and felt that this was beneficial to their learning.

Conclusion: Webcasts appear equally effective to live lectures as a teaching tool.     

Medical student beliefs: spirituality's relationship to health and place in the medical school curriculum

The relationship between spirituality and health is receiving increased attention; consequently medical schools have begun asking how and in what manner these issues should be addressed in medical education. Unfortunately, student beliefs concerning spirituality and health have not been adequately assessed. This study examined medical student beliefs regarding the relationship between spirituality and health and the level of instruction spirituality should receive in the curriculum. Questionnaire results from 254 medical students indicated that religiousness and spirituality are important, with spirituality more important than religiousness. Spiritual practices were seen as more helpful for acute and mental health conditions than for chronic or terminal conditions and believed to be more helpful for coping with a health condition than healing tissue. Students believed that patients could benefit from spiritual practices more than they could for their own health conditions. Most students endorsed a lecture or one- to two-week seminar with instruction in the first or second year of medical school. Student spirituality was the only predictor of required level of instruction in the medical school curriculum.     

Using the DREEM questionnaire to gather baseline information on an evolving medical school in Sri Lanka

The recent introduction of the Dundee Ready Education Environment Measure (DREEM) has fulfilled a long-felt need for a test instrument specifically meant to evaluate health professions education institutions. It was intended in this study to ascertain the overall DREEM score for the newly established Faculty of Medical Sciences of University of Sri Jayewardenepura (FMS/USJ), Sri Lanka and to compare the DREEM score of the students in the pre-, para- and clinical phases of the traditional curriculum practiced in this school. A total of 339 students belonging to the pre- (n = 147), para- (n = 116) and clinical (n = 76) phases of the medical course participated in this study. The DREEM questionnaire was administered face-to-face after one of their routine lectures to each group of students. The age of the students ranged from 20 to 28 years and the gender distribution was almost equal. The overall DREEM score was 108 (54%) for the pooled data for all three phases. There was no significant difference on the overall DREEM score obtained by each phase of students. The overall DREEM scores of pooled data and also for each domain indicated that the position of the FMS/USJ qualifies to be placed just on the third grade (one below the best) within the overall DREEM scale. However, on analysis of the responses for each domain, Students' Perception of Teachers (SPT), Students' Academic Self-Perceptions (SAP) and Students' Social Self-Perceptions (SSP) showed significant difference between the pre-, para- and clinical phases. Similarly, 22 out of the 50 items showed significant differences between the pre- and clinical phases. Overall, the DREEM demonstrated compatibility of its scores along with the gradual development that took place at this medical school over the last 10 years. Thus, the DREEM could be utilized in a variety of situations.     

Impact of educational preparation on medical students in transition from final year to PRHO year: a qualitative evaluation of final-year training following the introduction of a new year 5 curriculum in a London medical school

This study is a qualitative evaluation of PRHOs' perceptions of a new final year of the MB BS programme at Guy's, King's and St Thomas' (GKT) School of Medicine, undertaken in 2001 as a precursor to a prospective study. One-to-one interviews were carried out with 16 PRHOs two to four months after starting. These were independently thematically analysed, cross-referenced and joint agreement on the themes reached. PRHOs felt they were well prepared in clinical skills, history taking and examination. They reported lack of knowledge in pathology and therapeutics. The initial 1-4 weeks were stressful because of new responsibility for patients. Relationship with patients and staff changed through acquisition of a definite professional role. They adopted a number of coping strategies to control demands of the post. The PRHOs perceived the course as relevant and good preparation for their posts, with a better balance than the previous curriculum. Greater appreciation of aspects of professionalization in the final year may help the transition further.