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1: Barriers to online learning in the time of COVID-19: A national survey of medical students in the Philippines
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Posted 18 Jul 2020

Barriers to online learning in the time of COVID-19: A national survey of medical students in the Philippines
172,395 downloads medRxiv medical education

Ronnie E Baticulon, Nicole Rose I Alberto, Maria Beatriz C Baron, Robert Earl C Mabulay, Lloyd Gabriel T Rizada, Jinno Jenkin Sy, Christl Jan S Tiu, Charlie A Clarion, John Carlo B Reyes

INTRODUCTION: In March 2020, the coronavirus disease 2019 (COVID-19) pandemic forced medical schools in the Philippines to stop face-to-face learning activities and abruptly shift to an online curriculum. This study aimed to identify barriers to online learning from the perspective of medical students in a developing country. METHOD: The authors sent out an electronic survey to medical students in the Philippines from 11 to 24 May 2020. Using a combination of multiple choice, Likert scale, and open-ended questions, the following data were obtained: demographics, medical school information, access to technological resources, study habits, living conditions, self-assessment of capacity for and perceived barriers to online learning, and proposed interventions. Descriptive statistics were calculated. Responses were compared between student subgroups using nonparametric tests. RESULTS: Among 3,670 medical students, 3,421 (93%) owned a smartphone and 3,043 (83%) had a laptop or desktop computer. To access online resources, 2,916 (79%) had a postpaid internet subscription while 696 (19%) used prepaid mobile data. Under prevailing conditions, only 1,505 students (41%) considered themselves physically and mentally capable of engaging in online learning. Barriers were classified under five categories: technological, individual, domestic, institutional, and community barriers. Most frequently encountered were difficulty adjusting learning styles, having to perform responsibilities at home, and poor communication between educators and learners. CONCLUSION: Medical students in the Philippines confronted several interrelated barriers as they tried to adapt to online learning. By implementing student-centered interventions, medical schools and educators play a significant role in addressing these challenges during the COVID-19 pandemic and beyond.

2: Calculated grades, predicted grades, forecasted grades and actual A-level grades: Reliability, correlations and predictive validity in medical school applicants, undergraduates, and postgraduates in a time of COVID-19
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Posted 05 Jun 2020

Calculated grades, predicted grades, forecasted grades and actual A-level grades: Reliability, correlations and predictive validity in medical school applicants, undergraduates, and postgraduates in a time of COVID-19
6,945 downloads medRxiv medical education

Chris McManus, Katherine Woolf, Dave Harrison, Paul Tiffin, Lewis Paton, Kevin Yet Fong Cheung, Daniel Smith

Calculated A-level grades will replace actual, attained A-levels and other Key Stage 5 qualifications in 2020 in the UK as a result of the COVID 19 pandemic. This paper assesses the likely consequences for medical schools in particular, beginning with an overview of the research literature on predicted grades, concluding that calculated grades are likely to correlate strongly with the predicted grades that schools currently provide on UCAS applications. A notable absence from the literature is evidence on whether predicted grades are better or worse than actual grades in predicting university outcomes. This paper provides such evidence on the reduced predictive validity of predicted A-level grades in comparison with actual A-level grades. The present study analyses the extensive data on predicted and actual grades which are available in UKMED (United Kingdom Medical Education Database), a large-scale administrative dataset containing longitudinal data from medical school application, through undergraduate and then postgraduate training. In particular, predicted A-level grades as well as actual A-level grades are available, along with undergraduate outcomes and postgraduate outcomes which can be used to assess predictive validity of measures collected at selection. This study looks at two UKMED datasets. In the first dataset we compare actual and predicted A-level grades in 237,030 A-levels taken by medical school applicants between 2010 and 2018. 48.8% of predicted grades were accurate, grades were over-predicted in 44.7% of cases and under-predicted in 6.5% of cases. Some A-level subjects, General Studies in particular, showed a higher degree of over-estimation. Similar over-prediction was found for Extended Project Qualifications, and for SQA Advanced Highers. The second dataset considered 22,150 18-year old applicants to medical school in 2010 to 2014, who had both predicted and actual A-level grades. 12,600 students entered medical school and had final year outcomes available. In addition there were postgraduate outcomes for 1,340 doctors. Undergraduate outcomes are predicted significantly better by actual, attained A-level grades than by predicted A-level grades, as is also the case for postgraduate outcomes. Modelling the effect of selecting only on calculated grades suggests that because of the lesser predictive ability of predicted grades, medical school cohorts for the 2020 entry year are likely to under-attain, with 13% more gaining the equivalent of the current lowest decile of performance, and 16% fewer gaining the equivalent of the current top decile, effects which are then likely to follow through into postgraduate training. The problems of predicted/calculated grades can to some extent, although not entirely, be ameliorated, by taking U(K)CAT, BMAT, and perhaps other measures into account to supplement calculated grades. Medical schools will probably also need to consider whether additional teaching is needed for entrants who are struggling, or might have missed out on important aspects of A-level teaching, with extra support being needed, so that standards are maintained.

3: IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH OF MEDICAL STUDENTS:A CROSS-SECTIONAL STUDY USING GAD-7 AND PHQ-9 QUESTIONNAIRES
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Posted 25 Jun 2020

IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH OF MEDICAL STUDENTS:A CROSS-SECTIONAL STUDY USING GAD-7 AND PHQ-9 QUESTIONNAIRES
2,588 downloads medRxiv medical education

Carlos Izaias SartorĂ£o Filho, Wilson Conti de Las Villas Rodrigues, Ricardo Beauchamp de Castro, Arlete Aparecida Marcal, Shirlene Pavelqueires, Luiz Takano, Wilson Luis de Oliveira, Carlos Izaias Sartorao Neto

Aim: to evaluate anxiety and depression disorders among medical students during COVID-19 pandemic. Methods: cross-sectional study of medical students conducted in May 2020 with questionnaires regarding social and demographic status and GAD-7 for anxiety and PHQ-9 for depression questionnaires. Results: participated 340 (97.98%) students. Average GAD-7 score was 9.18 (M = 9.18; SD = 4.75); average PHQ-9 score was 12.72 (M = 12.72; SD = 6.62). Results indicate a positive significant relationship between GAD-7 and females, and social distancing affecting finances. Using cut-off score of 10 for GAD-7, 157 (46.17%) students were identified with moderated or severe symptoms of anxiety. For PHQ-9 score, using cut-off of 10, 219 (64.41%) students were identified with moderate or severe symptoms of depression; results indicate a positive significant relationship between PHQ-9 and females and between social distancing affecting finances. Conclusion: analysis demonstrated a higher prevalence of moderated and severe anxiety and depression symptoms among medical students during COVID-19 pandemic, significantly among women and on medical students relating financial impairment related to COVID-19 epidemic.

4: The development of competency frameworks in healthcare professions: a scoping review.
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Posted 01 Aug 2019

The development of competency frameworks in healthcare professions: a scoping review.
2,389 downloads medRxiv medical education

Alan M Batt, Walter Tavares, Brett Williams

BackgroundCompetency frameworks serve many roles including outlining characteristics of a competent workforce, to provide clarity to complex constructs, to facilitate professional mobility, and to help structure analysis, evaluation or assessment of professional expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. MethodsThe Arksey and OMalley framework was applied to undertake this scoping review. Six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) were searched using keywords related to competency frameworks. Studies of all types were included that described the development of a competency framework in a healthcare profession. Studies were screened for inclusion, and data were extracted independently by two reviewers. Data synthesis was both quantitative and qualitative. ResultsAmong 5,710 citations, 190 were selected for analysis. The majority of studies were conducted in medicine and nursing professions. Group techniques were utilised in 140 studies (74%), literature reviews were conducted in 112 (59%), and 81 (43%) outlined some form of stakeholder deliberation. We found a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, form, choice, sequence, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. ConclusionsThis review observed significant variation within the conduct and reporting of the competency framework development process. Such variation is a cause for concern, potentially resulting in the development of frameworks that may not have captured the complexities of clinical practice, which are therefore of limited value to the profession, and may unwillingly create and legitimise artificial outcomes. The results of this review suggest there is a need for improved guidance in the process for developing and reporting competency frameworks.

5: The attitudes, perceptions and experiences of medical school applicants following the closure of schools and cancellation of public examinations in 2020 due to the COVID-19 pandemic
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Posted 05 Jun 2020

The attitudes, perceptions and experiences of medical school applicants following the closure of schools and cancellation of public examinations in 2020 due to the COVID-19 pandemic
2,076 downloads medRxiv medical education

Katherine Woolf, Dave Harrison, Chris McManus

Objective To describe medical applicants' experiences of education and their views on changes to medical school admissions, including the awarding of calculated grades, following the 2020 closure of schools and universities, and the cancellation of public examinations in the United Kingdom due to the COVID-19/coronavirus pandemic. To understand how applicants from diverse social backgrounds might differ in these regards. Design Cross-sectional questionnaire study forming part of the longitudinal United Kingdom Medical Applicant Cohort Study (UKMACS). Setting United Kingdom medical school admissions. Participants 2887 participants (68% female; 64% with at least one degree-educated parent; 63% with at least one parent in the highest socioeconomic group) completed an online questionnaire between 8th and 22nd April 2020. To be invited to complete the questionnaire, participants had to have registered to take the University Clinical Admissions Test (UCAT) in 2019 and to have agreed to be invited to take part in the study, or they needed to have completed one or more previous UKMACS questionnaires. They also need to have been seriously considering applying to study medicine in the UK for entry in 2020 between May and October 2019, and be resident in the UK or Islands/Crown Dependencies. Main outcome measures Views on calculated grades, views on potential changes to medical school admissions and teaching in 2020 and 2021, reported experiences of education following the closure of educational institutions in March 2020. Results Respondents had concerns about the calculated grades that will replace A-level examinations, especially female applicants and applicants from Black Asian and Minority Ethnic (BAME) backgrounds who felt teachers would find it difficult to grade and rank students accurately, as well as those from non-selective state schools and those living in deprived areas who had some concerns about the grade standardisation process. Calculated grades were not considered fair enough by a majority to use in the acceptance or rejection of medical offer-holders, but several measures - including interview and aptitude test scores - were considered fair enough to use in combination. Respondents from non-selective state (public) schools reported less use of and less access to educational resources compared to their counterparts at private/selective schools. In particular they reported less online teaching in real time, and reported spending less time studying during the lockdown. Conclusions The coronavirus pandemic will have significant and long term impacts on the selection, education and performance of our future medical workforce. It is important that the views and experiences of medical applicants from diverse backgrounds are taken into consideration in decisions affecting their futures and the future of the profession.

6: Examination of Racial Bias in Alpha Omega Alpha Inductions: A Single-Center 15-Year Retrospective Study.
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Posted 29 Apr 2020

Examination of Racial Bias in Alpha Omega Alpha Inductions: A Single-Center 15-Year Retrospective Study.
2,009 downloads medRxiv medical education

Ruoqi Gao

ImportanceWith USMLE Step 1 becoming pass/fail, subjective clinical evaluations will hold greater weight in residency applications. However, no longitudinal studies exist that examine the role of race in clinical success during medical training. ObjectiveUtilizing Alpha Omega Alpha (AOA) as an objective marker of clinical achievement, I investigated the relationship between race and AOA membership at Northwestern University Feinberg School of Medicine over a span of 15 years. Design, Setting, and ParticipantsTo accomplish this retrospective, single center, multi-year cohort study, names of all Feinberg graduates between 2003 and 2018 were collected via the schools public website. Images for each student were gathered by social media, assigned an ethnic identity by a blind evaluator, and confirmed by an unblinded evaluator. Finally, each name was verified against the AOA database to determine membership status. Main Outcomes and MeasuresAOA membership among medical students of various racial groups at Feinberg. ResultsFrom a 2,466 student body, there were 546 (22.1%) Eastern/Southeastern Asian, 123 (5.0%) African-American, 102 (4.1%) Hispanic/Latino, 399 (16.2%) South Asian, 59 (2.4%) Other, and 1205 (48.9%) Caucasian students, with 32 (1.3%) exclusions. Within this collective group, 428 students were inducted to AOA: 62 (14.5%) Eastern/Southeastern Asian, 4 (0.9%) African-American, 10 (2.3%) Hispanic/Latino, 70 (16.4%) South Asian, 10 (2.3%) Other, and 270 (63.1%) Caucasian students, with 2 (0.5%) exclusions. By class/year, the percentage of Caucasians inducted into AOA were higher than the class percent in 15 out of 16 classes, compared to 1 by Eastern/Southeastern Asians and 7 by South Asians. Odds ratio analysis demonstrated Eastern/Southeastern Asian (OR, 0.44; 99.67% CI, 0.28 - 0.69) and African-American (OR, 0.12; 99.67% CI, 0.03 - 0.53) students were at disadvantage relative to Caucasians for AOA membership. ConclusionI revealed Eastern/Southeastern Asian and African-American students were statistically less likely to be selected for AOA compared to Caucasian counterparts. Additionally, Eastern/Southeastern Asian students were under-represented almost every year despite being the most represented minority demographic. These results demonstrate subjective bias in AOA membership for both under- and over-represented minorities and suggests the recent Step I paradigm shift may disproportionately affect certain students over others. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhich minority groups are disadvantaged compared to Caucasian counterparts for AOA membership? FindingsIn this longitudinal, retrospective cohort study spanning fifteen years at Northwestern Feinberg School of Medicine, I found Caucasian students were 2 and 8 times more likely to obtain AOA membership than Eastern/Southeastern Asian and African-American medical students respectively. MeaningCertain bias underlying AOA admission may exist and are possibly stable over time, which is concerning given the recent Step 1 policy changes and thus eventual shift away from objective evaluations in residency applications.

7: Checklists to Detect Potential Predatory Biomedical Journals: A Systematic Review
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Posted 16 Sep 2019

Checklists to Detect Potential Predatory Biomedical Journals: A Systematic Review
1,697 downloads medRxiv medical education

Samantha Cukier, Lucas Helal, Danielle B Rice, Justina Pupkaite, Nadera Ahmadzai, Mitchell Wilson, Becky Skidmore, Manoj M. Lalu, David Moher

BackgroundWe believe there is a large number of checklists to help authors detect predatory journals. It is uncertain whether these checklists contain similar content. PurposePerform a systematic review to identify checklists to detect potential predatory journals and to examine their content and measurement properties. Data SourcesMEDLINE, Embase, PsycINFO, ERIC, Web of Science and Library, Information Science & Technology Abstracts (January 2012 to November 2018), university library websites (January 2019), YouTube (January 2019). Study SelectionOriginal checklists used to detect potential predatory journals published in English, French or Portuguese, with instructions in point form, bullet form, tabular format or listed items, not including lists or guidance on recognizing "legitimate" or "trustworthy" journals. Data ExtractionPairs of reviewers independently extracted study data and assessed checklist quality and a third reviewer resolved conflicts. Data SynthesisOf 1528 records screened, 93 met our inclusion criteria. The majority of included checklists were in English (n = 90, 97%), could be completed in fewer than five minutes (n = 68, 73%), had an average of 11 items, which were not weighted (n = 91, 98%), did not include qualitative guidance (n = 78, 84%) or quantitative guidance (n = 91, 98%), were not evidence-based (n = 90, 97%) and covered a mean of four (of six) thematic categories. Only three met our criteria for being evidence-based. LimitationsLimited languages and years of publication, searching other media. ConclusionsThere is a plethora of published checklists that may overwhelm authors looking to efficiently guard against publishing in predatory journals. The similarity in checklists could lead to the creation of evidence-based tools serving authors from all disciplines. Funding SourceThis project received no specific funding. David Moher is supported by a University Research Chair (University of Ottawa). Danielle Rice is supported by a Canadian Institutes of Health Research Health Systems Impact Fellowship; Lucas Helal is supported by Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) - Finance Code 001, PDSE - 88881.189100/2018 - 01. Manoj Lalu is supported by The Ottawa Hospital Anesthesia Alternate Funds Association.

8: Self-learning on COVID-19 among medical students and their preparedness to participate in government's COVID-19 response in Bhutan: a cross-sectional study
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Posted 09 Sep 2020

Self-learning on COVID-19 among medical students and their preparedness to participate in government's COVID-19 response in Bhutan: a cross-sectional study
1,320 downloads medRxiv medical education

Thinley Dorji, Saran Tenzin Tamang, TVSVGK Tilak

Background: Bhutan lacks a medical school and all their medical students are trained outside in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic let to closure of medical schools in these countries, the Bhutanese medical students were repatriated in March-April 2020. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and attitude as part of preparedness towards participation in government's health response to COVID-19. Method: This was a cross-sectional study among medical students who had returned to the country. This survey was conducted through an online questionnaire while the students were in 21-day facility quarantine. The sample size calculated was 129 and a convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Cumulative score of score of >=80% was categorized as "good knowledge", score of >=60-79% was considered "satisfactory knowledge", and score <60% was considered "poor knowledge." Correlation between knowledge score and duration of clinical clerkship was tested using Pearson's correlation coefficient. Attitude of students towards their willingness to participate in the national COVID-19 response were tested using rating scales. Data were analysed using Stata 13.1. Results: 120 medical students responded to this survey (response rate = 93%). Eighty-eight (74%) had good knowledge, 28 (23%) had satisfactory knowledge and only four (3%) had poor knowledge on COVID-19. The students scored high on the symptomatology, mode of transmission, prevention and treatment options and on local epidemiology; and scored low on the forms of mechanical ventilations and on the home-management of non-critical cases. The knowledge score correlated with duration of clinical clerkship (r = 0.326, p = 0.001). The primary source of information were social media sites (102, 85%), television (94, 78%) and newspapers (76, 63%). The majority (78, 65%) were willing to participate in the government's COVID-19 response but could not identify what roles they could play. The fear of contracting COVID-19 was reported in only in 8.7%. Conclusions: The medical students had good knowledge on COVID-19 and were self-learned through social media, television and newspapers. The students held positive attitude towards participation in the government's COVID-19 response.

9: Paradigms about the COVID-2 pandemic: knowledge, attitudes and practices from medical students
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Posted 26 May 2020

Paradigms about the COVID-2 pandemic: knowledge, attitudes and practices from medical students
1,137 downloads medRxiv medical education

Eddy Lincango-Naranjo, Paola Solis-Pazmino, Santiago Rodriguez-Villafuerte, Jose Lincango-Naranjo, Paul Vinueza-Moreano, Giuseppe Barberis-Barcia, Carlos Ruiz-Sosa, Giovanni Rojas-Velasco, Derek Gravholt, Nataly Espinoza-Suarez, Elizabeth Golembiewski, Percy Soto-Becerra

Background: As the disease caused by the new coronavirus has spread globally, economic instability in healthcare systems has been significant, and the lack of knowledge, positive attitudes and appropriate practices among people has led to the magnification of this disease. This reality is especially accentuated in Ecuador where, although many healthcare workers have been called to help in the regions most affected, the shortage of them combined with cultural and macroeconomic factors have led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation on the front line of final year medical students is indispensable. For that reason, appropriate training on COVID-19 for final year medical students is an urgent need that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes and practices in Ecuadorian final year medical students in order to identify the knowledge gaps, perceptions and behavior patterns which could guide the design of better medical education curricula regarding COVID-19. Methods: This was a cross-sectional 33-item online survey conducted between April 6 to April 20 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final year medical students. It was sent by email and by Facebook and WhatsApp. Results: A total of 309 students responded to the survey. 88% of students scored high (> 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 in Ecuador and volunteering during the outbreak (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment or training in their health facilities. Conclusions: The high level of students knowledge, with coexisting negative attitudes, suggests Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Creating a national curriculum may be one of the most effective ways for all students to be trained, while simultaneously focusing on the students most pressing concerns. Hopefully with this, negative attitudes will improve and students will be better qualified. Keywords: Ecuador, medical students, COVID-19.

10: Medical students perceptions and motivations in time of COVID-19 pandemic
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Posted 30 May 2020

Medical students perceptions and motivations in time of COVID-19 pandemic
1,066 downloads medRxiv medical education

Patricia Tempski, Fernanda M Arantes-Costa, Renata Kobayasi, Marina AM Siqueira, Matheus M Torsani, Bianca QRC Amaro, Maria Eduarda FM Nascimento, Saulo L Siqueira, Itamar S Santos, Milton A Martins

Background: There has been a rapid increase in the number of cases of COVID19 in Latin America, Africa and Asia, in many countries that have an insufficient number of physicians and other health care personnel, and the need for the inclusion of medical students as part of the health teams is a very important issue. It has been recommended that medical students work as volunteers, have appropriate training, do not undertake any activity beyond their level of competence, have continuous supervision and adequate personal protective equipment. However, motivation of medical students must be evaluated in order to make volunteering a more evidence-based initiative. The aim of our study was to evaluate motivation of medical students to be part of the health team to help in the COVID19 pandemic. Methods and Findings: We developed a questionnaire specifically to evaluate medical students perceptions about participating in care of patients with suspected infection due to coronavirus during the COVID19 pandemic. The questionnaire had two parts: a) individual characteristics, year and geographic location of medical school; b) twenty eight statements responded on a 5 point Likert scale (totally agree, agree, neither agree nor disagree, disagree and totally disagree). To develop the questionnaire, we performed consensus meetings of a group of faculty and medical students. The questionnaire was sent to student organizations of 257 medical schools in Brazil and answered by 10,433 students. We used multinomial logistic regression models to analyse the data. Statements with greater odds ratios for participation of medical students in COVID19 pandemic were related to sense of purpose or duty (It is the duty of the medical student to put himself at the service of the population in the pandemic), altruism (I am willing to take risks by participating in practical in the context of pandemic), perception of good performance and professional identity (I will be a better health professional for having experienced the pandemic). Males had higher odds ratios than females (1.36 [95% CI: 1.24 to 1.49] to 1.68 [95% CI: 1.47 to 1.91]). Conclusions: Medical students are motivated by sense of purpose or duty, altruism, perception of good performance and values of professionalism more than their interest in learning. These results have implications in the developing of programs of volunteering and in the design of health force policies in the present pandemic and in future health emergencies.

11: Reflection of connectivism in medical education and learning motivation 4 during COVID-19
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Posted 08 Jul 2020

Reflection of connectivism in medical education and learning motivation 4 during COVID-19
932 downloads medRxiv medical education

Noor A.S. Ismail, Jun Xin Lee, Ahmad Hathim Ahmad Azman, Jing Yi Ng

The COVID-19 pandemic has not only affected the global healthcare and economy but threatened the world of education altogether. Malaysia is not spared from this pandemic as all universities were forced to close and initiate online learning with the implementation of Movement Control Order since mid-March 2020.The abrupt shift from conventional medical education to fully virtual learning definitely deserves a reflection on how it affects the learning motivation among medical students. Hence, this is the first study that compares the effect of digital learning on learning motivation among medical students in Universiti Kebangsaan Malaysia (UKM) prior to and during the COVID-19 pandemic period. A modified Students Motivation towards Science Learning (SMTSL) was used to assess the learning motivation of UKM medical students throughout Year 1-5. The number of students that use digital learning during COVID-19 is significantly higher compared to before COVID-19 (p<0.05). However, there is no significant difference (p=0.872) in learning motivation among medical students before and during COVID-19 crisis. Higher frequency in digital learning usage frequency does not exert a great impact on learning motivation. Reflections from each participant were collated to justify the current situation. This could be due to motivation coming from the very choice to pursue medicine as a doctor, which is mainly influenced by intrinsic motivation, and ability to adapt in difficult situations. Thus, medical educators should be creative in enhancing extrinsic motivation by making use of digital learning as a platform so that medical students are able to independently fish for information in the vast pool of digital information and apply in actual medical practice in the future for life-long learning.

12: Defining predatory journals and responding to the threat they pose: a modified Delphi consensus process
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Posted 02 Nov 2019

Defining predatory journals and responding to the threat they pose: a modified Delphi consensus process
856 downloads medRxiv medical education

Samantha Cukier, Manoj M. Lalu, Gregory L. Bryson, Kelly D. Cobey, Agnes Grudniewicz, David Moher

BackgroundPosing as legitimate open access outlets, predatory journals and publishers threaten the integrity of academic publishing by not following publication best practices. Currently, there is no agreed upon definition of predatory journals, making it difficult for funders and academic institutions to generate practical guidance or policy to ensure their members do not publish in these channels. MethodsWe conducted a modified three-round Delphi survey of an international group of academics, funders, policy makers, journal editors, publishers and others, to generate a consensus definition of predatory journals and suggested ways the research community should respond to the problem. ResultsA total of 45 participants completed the survey on predatory journals and publishers. We reached consensus on 18 items out of a total of 33, to be included in a consensus definition of predatory journals and publishers. We came to consensus on educational outreach and policy initiatives on which to focus, including the development of a single checklist to detect predatory journals and publishers, and public funding to support research in this general area. We identified technological solutions to address the problem: a one-stop-shop website to consolidate information on the topic and a predatory journal research observatory to identify ongoing research and analysis about predatory journals/publishers. ConclusionsIn bringing together an international group of diverse stakeholders, we were able to use a modified Delphi process to inform the development of a definition of predatory journals and publishers. This definition will help institutions, funders and other stakeholders generate practical guidance on avoiding predatory journals and publishers.

13: Early experience with COVD-19 patients at tertiary care teaching hospital in southwestern United states
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Posted 18 May 2020

Early experience with COVD-19 patients at tertiary care teaching hospital in southwestern United states
806 downloads medRxiv medical education

Rahul Shekhar, Shubhra Upadhyay, Abubaker Sheikh, Jeanette Atencio, Devika Kapuria

Abstract Importance: There is limited information about presenting characteristics, treatment and outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) serving underserved population in southwestern United states. Objective: To describe the clinical characteristics and outcomes of patients with COVID-19, hospitalized in a tertiary care teaching hospital in southwestern United states serving Underserved population. Methods: Case series of first 50 adults admitted at the University of New Mexico (UNM) Health Science center, the only tertiary care teaching hospital in the state of New Mexico between Jan 19th to April 24th 2020 via retrospective and prospective chart review. Main outcomes and measures: Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results: A total of 50 patients were included (median age, 55.5; 20-85-year-old, 54% were female). Obesity was the most common comorbidity in 20/39 (51%), followed by diabetes in 18/50 (36%) and hypertension 17/50(34%). Mean onset of symptoms duration before admission 7.39 days (range 1-21days). Most common symptoms on presentation included subjective fevers 40/42 (95.2%), cough 43/46 (93%) 43/46 and shortness of breath 40/46(87%). At triage only 24% were febrile and 46% patient did not have a single febrile episode throughout hospitalization, 56% had respiratory rate > 20 and 66% had a heart rate > 90. 80% patients required oxygen and 20%required intubation on presentation. On differential analysis 46% had elevated neutrophil counts, and 48% had low lymphocytes counts. Median D dimer, Ferritin, CRP, LDH were all elevated at presentation. 10% of patients had a negative initial chest x ray. 19.3% patients have coinfection with another respiratory viral pathogen. 34 (68%) patient required ICU level of care at some point during hospitalization. More than 70% of patients were treated with antibiotics mainly directed towards community acquired pneumonia but 97.5% patient has negative blood culture and 93.3% has negative sputum cultures. Of admitted patients, 34% (17/50) were directly admitted to ICU and. Of these ICU patients 82.4% (28/34) required invasive mechanical ventilation. Patients spent a median of 2 days on the floor prior to ICU transfer, median length of stay in the ICU was 7 days. On comparing characteristics of patients, patients with diabetes, and higher lactate dehydrogenase on admission were more likely to require ICU level of care. No patient deaths were reported on the floor. Of 34 patients in the ICU 13 died while 6 are still receiving care in the hospital, with an overall mortality of 30.2% (13/43). Out of 13 patients who died, 2 were on HD, 11/13(84%) patients had acute kidney injury and required CRRT or HD. The median length of stay is 7 days (Range 1-31days), for floor patients 4 days and ICU patients 13 days. Out of 43 patients who completed their clinical course 24/43(58.1%) were discharged home, 5/43(11.6%) went to rehabilitation facilities and 30.2% died. 16/30(53.3%) required oxygen on discharge. Conclusion: This case series provides characteristics and early experience in treating patient admitted to tertiary care teaching hospital in state of NEW Mexico.

14: Impacts of lack of pocket money on undergraduate students' clinical learning activities
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Posted 29 Oct 2019

Impacts of lack of pocket money on undergraduate students' clinical learning activities
803 downloads medRxiv medical education

Marema Jebessa Kumsa, Bizuayehu Nigatu Lemu, Taklehaimanot Mezgebe Ketema

BackgroundIn Ethiopia, There is a poor understanding of university expenses, regardless of the challenges that undergraduate students faced due to lack of pocket money and its tremendous impacts on learning activities. In addition, undergraduate health sciences students need additional money when they start clinical placement learning. ObjectivesTo explore the economic challenges that clinical year undergraduate health sciences students face with limited pocket money; and students perceive of how limited pocket money affects their learning activities and how they react to challenges. MethodsThe descriptive qualitative study was conducted at Addis Ababa University (AAU), College of Health Sciences(CHS) Medical Radiology Technology (MRT) department at Addis Ababa University. Ten participants recruited through purposive and snowball method; and the semi-structured interviews took place from January 28, 2019 to February 1, 2019. The Semi-structured questions explored participants experiences and perceptions regarding challenges of lack of pocket money and its impacts on their learning activities, and their reaction to financial challenges. ResultsFour themes emerged from the interviews based on the research objectives, and they are challenges of getting pocket money, difficulty of affording important needs, self-management; and social life. ConclusionBased on the data, the underlying causes that lead students to face financial hardships can be solved by making public awareness regarding university expenses, clarifying the cost sharing system to the public, redesigning the cost sharing policy, improving university administration. In addition, giving short training to students on self-management and money management skills and, as well giving special attention to clinical practice facilities primarily concluded from the participants descriptions.

15: A Quantitative and Narrative Evaluation of Goodman and Gilmans Pharmacological Basis of Therapeutics
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Posted 29 Sep 2019

A Quantitative and Narrative Evaluation of Goodman and Gilmans Pharmacological Basis of Therapeutics
800 downloads medRxiv medical education

Brian J. Piper, Alexandria A. Alinea, John R Wroblewski, Sara M. Graham, Daniel Y. Chung, Livia R.M. McCutcheon, Melissa A Birkett, Steven S. Kheloussi, Vicky M. Shah, Qais K. Zalim, John A. Arnott, William A. McLaughlin, Pamela A. Lucchessi, Kimberly A. Miller, Gabi N. Waite, Michael Bordonaro

ObjectiveGoodman and Gilmans The Pharmacological Basis of Therapeutics (GGPBT) has been a cornerstone in the education of pharmacists, physicians, and pharmacologists for decades. The objectives of this report were to describe and evaluate the 13th edition of GGPBT including: 1) author characteristics; 2) recency of citations; 3) conflict of interest (CoI) disclosure, and 4) expert evaluation of chapters. MethodsContributors (N = 115) sex, professional degrees, and presence of undisclosed potential CoI as reported by the Center for Medicare and Medicaids Open Payments (2013 to 2017) were examined. Year of publication of citations were extracted relative to comparison textbooks (Katzungs Basic and Clinical Pharmacology (KatBCP), and DiPiros Pharmacotherapy: A Pathophysiologic Approach (DiPPAPA). Content experts in pharmacy and pharmacology education provided chapter reviews. ResultsThe percent of GGPBT contributors that were female (20.9%) was equivalent to those in KatBCP (17.0%). Citations in GGPBT (11.5 {+/-} 0.2 years) were significantly older than those in KatBCP (10.4 {+/-} 0.2) and DiPPAPA (9.1 {+/-} 0.1, p < .0001). Contributors to GGPBT received three million in undisclosed remuneration from pharmaceutical companies (Maximum author = $743,718). In contrast, DiPPAPA made CoI information available. However, self-reported disclosures were not uniformly congruent with Open Payments reported data. Reviewers noted several strengths but also some areas for improvement. ConclusionGGPBT will continue to be an important component of the biomedical curriculum. Areas of improvement include more diverse authorship, improved conflict of interest transparency, and greater inclusion of more recent citations.

16: Thoughts on Higher Medical Education Under Major Public Health Emergencies: Thinking Ahead After COVID-19 Outbreak
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Posted 07 Apr 2020

Thoughts on Higher Medical Education Under Major Public Health Emergencies: Thinking Ahead After COVID-19 Outbreak
767 downloads medRxiv medical education

Wei Lin, Gang Chen, Songchang Shi, Jixing Liang, Huibin Huang, Liantao Li, Liangchun Cai, Liyao Zong, Nengying Wang, Junping Wen, Gang Chen

ImportanceThe spread of coronavirus disease 2019 (COVID-19) has posed great threat to peoples health and several medical schools in the world suspended classes as a precaution against the virus. China has also adopted precautionary measures to keep medical schools running without suspending classes. Thinking ahead after COVID-19 Outbreak is important. ObjectiveTo explore the most suitable teaching and learning pattern in medical school during COVID-19 Outbreak. DesignThis study is a case-control study. We had tried to apply a new blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction to the students before the outbreak and then universities responded to the COVID-19 outbreak by closing campuses and shifting to other forms of distance learning. In other word, the courses started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Five Point Likert Scale Questionnaires which contains 20 items were used, and the effect of the two kinds of teaching patterns was compared by evaluating the indicators of core competencies of students including professionalism, attitude towards learning, knowledge and learning skills, teamwork skills, motivation in learning, adaptability and acceptance of the courses and network environment. SettingOur study based on a single center. ParticipantsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled in the study. Exposure(s) (for observational studies)The teaching and learning patter started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Main Outcome(s)According to the descriptive statistical analysis of the first part of the questionnaire (question 1-16), the average score of adaptability and acceptance of the courses is 2.60 lower than 3, indicating that students are more adapted to other forms of distance learning during COVID-19 outbreak; the average score of the rest of the questions is higher than 3, indicating that blended teaching model based on 5G network is superior to other forms of distance learning. The number of male students who are inclined to the blended teaching model based on 5G network is 0.13 times as much as that of female students (95%CI:0.028[~]0.602, p=0.009). ResultsOnline forms of distance learning were accepted by the students. Female students had higher expectations on the course and were more likely to adapt well to the change during the COVID-19 outbreak. However, all students preferred the blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction before the pandemic. ConclusionIt indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online. Chinas experience in online higher medical education may serve as a reference to other countries during the pandemic. Key pointO_ST_ABSQuestionsC_ST_ABSWhat are the reflections on approaches to teaching and learning during COVID-19 Outbreak? FindingsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled. Five Point Likert Scale Questionnaires which contains 20 items were used. This study indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online during COVID-19 outbreak. MeaningChinas experience in online higher medical education may serve as a reference to other countries during the pandemic.

17: Knowledge, attitudes, and practices among the general population during COVID-19 outbreak in Iran: A national cross-sectional survey
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Posted 11 Jun 2020

Knowledge, attitudes, and practices among the general population during COVID-19 outbreak in Iran: A national cross-sectional survey
691 downloads medRxiv medical education

Edris Kakemam, DJavad Ghoddoosi-Nejad, Zahra Chegini, Khalil Momeni, Hamid Salehinia, Soheil Hassanipour, Hosein Ameri, Morteza Arab-Zozani

Abstract Background: COVID-19, which emerged in December 2019, is the largest pandemic ever to occur. During the early phase, little was known about public awareness relating to Coronavirus disease. This study was designed to determine knowledge, attitudes and practices (KAP) among the Iranian public towards COVID-19. Methods: A cross-sectional online survey was carried out in Iran from 2 March to 8 April 2020 using a self-administered questionnaire on 1,480 people. COVID-19-related KAP questions were adapted from other internationally validated questionnaires specific to infectious diseases. Results: All participants were aware of COVID-19. When asked unprompted, 80% of respondents could correctly cite fever, difficulty breathing and cough as signs/symptoms of COVID-19. Most of our sample population knew that by staying at home and staying isolated (95.3%, 95 % CI: 94.2-96.3) as well as constant hand washing and using disinfectants (92.5%, 95 % CI: 91.1-93.8) could prevent COVID-19. However, there was also widespread misconceptions such as the belief that COVID-19 can be transmitted by wild animals (58%, 95 % CI: 55.5-60.5) and by air (48.3%, 95 % CI: 45.7-50.8). Unprompted, self-reported actions taken to avoid COVID-19 infection included hand washing with soap and water (95.4%, 95 % CI: 94.3-96.4), avoiding crowded places (93%, 95 % CI: 91.7-94.3), cleaning hands with other disinfectants (80.9 %, 95 % CI: 78.9- 82.9), and covering mouths and noses when coughing and sneezing (76.1 %, 95 % CI: 73.9-78.2). The internet and social media (94.5%, 95 % CI: 93.3-95.6) were the main Coronavirus information sources. However, the most trusted information sources on Coronavirus were health and medical professionals (79.3%, 95 % CI: 77.2-81.3). The majority of participants (77.0%, 95 % CI: 74.8-79.1) wanted more information about Coronavirus to be available. Conclusion: Our findings suggest that people's knowledge and attitude towards COVID-19 at the time of its outbreak was of a high level. Therefore, health systems should use multiple ways, such as mass media, phone applications, electronic, print, and tele-education to increase KAP related to COVID-19.

18: Physician Suicide: A Scoping Review to Highlight Opportunities for Prevention
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Posted 29 Aug 2019

Physician Suicide: A Scoping Review to Highlight Opportunities for Prevention
607 downloads medRxiv medical education

Tiffany I Leung, Sima S. Pendharkar, Chwen-Yuen Angie Chen, Rebecca Snyder

ObjectiveThe aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide. MethodsOvid MEDLINE, PsycInfo, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English, or those that only mentioned physician burnout, mental health or substance use disorders were excluded. Data extraction was performed by two authors. ResultsThe search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles were published from 2000 to present. Authors originated from 37 countries and 143 (41.2%) were opinion articles. Most discussed were suicide risk factors and culture of practice issues, while least discussed themes included public health and postvention. ConclusionsConsistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.

19: Assessing the quality, readability and reliability of online information on COVID-19: aninfoveillance observational study
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Posted 30 May 2020

Assessing the quality, readability and reliability of online information on COVID-19: aninfoveillance observational study
598 downloads medRxiv medical education

Paulo Cardoso Lins Filho, Thuanny Silva de Macedo, Andressa Kelly Alves Ferreira, Maria Cecilia Freire de Melo, Millena Mirella Silva de Araujo, Jaciel Leandro de Melo Freitas, Thaise Urbano Caldas, Arnaldo de Franca Caldas

Objective: This study aimed to assess the quality, reliability and readability of internet-based information on COVID-19 available on Brazil most used search engines. Methods: A total of 68 websites were selected through Google, Bing, and Yahoo. The websites content quality and reliability were evaluated using the DISCERN questionnaire, the Journal of American Medical Association (JAMA) benchmark criteria, and the presence of the Health on Net (HON) certification. Readability was assessed by the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). Results: The web contents were considered moderate to low quality according to DISCERN and JAMA mean scores. Most of the sample presented very difficult reading levels and only 7.4% displayed HON certification. Websites of Governmental and health-related authorship nature showed lower JAMA mean scores and quality and readability measures did not correlate to the webpages content type. Conclusion: COVID-19 related contents available online were considered of low to moderate quality and not accessible.

20: Hospital practice in COVID-19 times: Perceptions of the midwifery interns in Peru
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Posted 09 Jun 2020

Hospital practice in COVID-19 times: Perceptions of the midwifery interns in Peru
564 downloads medRxiv medical education

Jessica Rojas-Silva, Valery Damacen-Oblitas, Diayan Castro-Gomez, Jennifer Rojas-Vega, John Barja-Ore, Randol Vila-Arevalo, Victor Hugo Moquillaza-Alcantara

Objective: To evaluate the perception of midwifery interns regarding hospital practices during COVID-19. Material and methods: Study of qualitative approach, of phenomenological design, where 80 obstetric interns from the different regions of Peru participated, who are also representatives of their hospital headquarters. An in-depth interview was applied where the perception of hospital practices was addressed according to: i) current problems and ii) solution proposals. Results: Midwifery interns have been removed from hospital practices, mainly due to the absence of personal protective equipment and health insurance, financially affecting those who must continue to make rent and food payments; Likewise, a large part of the universities have not offered proposals for solutions to the delay in internships, raising concerns about delays in administrative procedures, even more so for students from non-licensed universities. Among the proposals, those who are close to graduating suggest being exempted from the months when there were no activities, so as not to delay future processes such as tuition and rural service; likewise, suspend payment for these months and strengthen knowledge through the discussion of clinical cases, which could be virtual. Conclusions: The cessation of hospital practice responds to a lack of guarantees in the health care of the student, generating economic repercussions and a negative perception regarding university management. Finally, solutions that could be considered for the next decisions made by the institutions are reported.

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