Human anatomy is a core module of the medical curriculum. Anatomy lecturers are expected to teach clinically-relevant content, while utilising interactive and student- centred teaching methods and approaches. This teaching and facilitation must happen in the context of decreased curriculum hours while credits remain mostly unchanged. Therefore, a dire need exists to explore the various teaching modalities currently used in medical education, to improve the teaching and facilitation of anatomy, and more specifically, neuroanatomy. Neuroanatomy tends to be challenging for students. Their inability to integrate the basic concepts with the clinical environment could lead to the development of a negative attitude or fear towards neuroanatomy (neurophobia). Neuroanatomy provides exceptional opportunities for the integration of basic- and applied concepts, however, the teaching approaches and time allocated to this subject has a large influence on how staff and students perceive neuroanatomy and the teaching thereof. A multi-method research study was conducted to explore the attitudes of anatomy lecturers, undergraduate- and postgraduate students towards the teaching and learning of neuroanatomy in the medical curriculum. This study further explored the perception of students on the importance of neuroanatomy as it relates to their future careers. The sample constituted four groups: Nineteen neuroanatomy lecturers from various medical schools in South Africa, five postgraduate neuroscience students and 299 undergraduate medical students from the University of Pretoria, as well as two international key-opinion leaders in the field of neuroanatomy education and neurophobia. Various methods were used for data collection which included online questionnaires, focus-group discussions, round-table discussions and semi-structured interviews. All the neuroanatomy lecturers acknowledged that neuroanatomy is important in their students’ medical training. However, only a few deem it necessary to modernize their teaching approaches to be more suitable for the 21st century student. Information of the medical neuroanatomy curriculum and teaching practices at the institutions were gathered, which was then benchmarked against various international medical schools’ curricula. One-directional didactic lectures and guided dissection are mainly used for undergraduate neuroanatomy teaching. This indicated a need for more innovative, technology-supported teaching methods better suited for the 21st century medical student in South Africa. Undergraduate medical students preferred lecture notes to other literature types while their most favourite topic was cranial nerves. The postgraduate students shared their undergraduate neuroanatomy experiences and provided constructive feedback and suggestions to undergraduate students and lecturing staff. These students perceive neuroanatomy as an interesting and important subject in their medical degree stating, however, that changes are needed to modernize neuroanatomy and make it more accessible and student-friendly. The interviews with the experts yielded three themes namely the teaching practices in neuroanatomy, perceived relevance of neuroanatomy within the medical curriculum and the perception of neurophobia. The participants had opposing views on teaching approaches and the relevance of neuroanatomy in the undergraduate medical curriculum. However, they had similar opinions on neurophobia, its impact on the undergraduate medical students and possible preventative measures. This study highlighted that there is neither a single best teaching method for neuroanatomy, nor does it need to be a modern teaching approach, but rather student- centred. Therefore, by reflecting on our own perceptions, attitudes and teaching approaches for neuroanatomy, and by making the necessary changes, we can help our students overcome this fear for the neurosciences. / Thesis (PhD)--University of Pretoria, 2020. / Anatomy / PhD / Unrestricted

In 2019, individuals that identified as Black represented 13.4% of the U.S. population, 12.5% of the undergraduate student enrollment population and 7.1% of the medical school population. Subsequently, this has yielded a 5% Black physician population and workforce consisting of just 2.3% Black male physicians (AAMC, 2018). The disproportionately low Black physician representation contributes to greater healthcare disparity outcomes within the U.S. Black population. This study is centered on the post-positive characteristics of Black male medical students that have successfully overcome barriers to entry and matriculated into medical school. The phenomenological post-positive study was conducted through the lens of Self-Efficacy Theory and Critical Race Theory. This qualitative study utilizes a phenomenological approach and semi-structured interviews to collect the steep, rich-lived experiences of the participants (Siedman, 1991). A purposive sampling and snowballing sampling methodology was used to acquire a six-participant sample population of Black male medical students. An in-depth review of the data revealed seven emerging themes associated with Black male students overcoming barriers to matriculate into medical school: 1) Educational Cost, 2) Honors College, 3) Motivation, 4) Support, 5) Academic Excellence, 6) Diversity and Inclusion, and 7) AMCAS Application Process. Higher education institutions, higher education practitioners and Black male premedical students would benefit from the findings outlined in the study. Future research should center on comparative studies focused on the role of the honors college, PWI and HBCU medical institutions and cultural variances among Black subcultures.

Medical education is a complex, intense, and demanding process. Research showed that medical school students experienced significant changes and navigated intense and fluctuating stressors during their four years of medical school (Compton et al. ,2008; Hojat et al., 2004; McKerrow et al., 2020; Pagnin & De Querioz, 2015). Research has shown medical school students were impacted by substantially reduced physical, mental, and emotional health (Rajapuram, Langness, Marshall, & Sammann, 2020). Both internationally and nationally there was a growing interest in researching the health and wellness of medical school students, particularly focusing on quality of life (QOL) (Heidari et al., 2014; Sharma, Gupta, Khare & Agarwal, 2015; Tempski et al., 2012; Zang et al., 2012). This study was quantitative in nature and structured in a casual comparative design. The World Health Organization Quality of Life (WHOQOL-BREF) survey assessment was utilized to assess the QOL domains of Physical Health, Psychological Health, Social Relationships, and Environment. All study participants were fully enrolled medical school students during the 2021-2022 academic year and were at least 18 years old. This study looked to identify if there were statistically significant differences in QOL between year of medical education study (Year 1 through Year 4), phase of medical education (Preclinical: Year 1 and Year 2 / Clinical: Year 3 and Year 4), and gender (male/female) of medical education students. The study included students (n=86) in all years of medical school education (Y1, Y2, Y3, Y4). The results of the study showed no statistically significant differences in QOL between year of medical school education, phase of medical school education, or gender of medical school student.

Background: Postpartum mothers are often initially screened for postpartum depression (PPD) but lack adequate follow up visits after discharge from the hospital post-delivery, despite the variety of complications that can arise from it. Additionally, healthcare disparities (HCD) have been shown to limit access to and the quality of healthcare for minority patients. Simulation-based education offers learners an opportunity to practice screening for PPD with the goal of improving the quality of care for these patient subgroups in future practice. Purpose: The purpose of this study was to explore the lived experience of SBE with prelicensure student nurses in an effort to understand their perception on PPD in relation to healthcare disparities. Methods: Colaizzi phenomenological method was used to gain an understanding of the lived experience of participants in a PPD and healthcare disparities-based simulation scenario. The guiding question was: In nursing students, what is the lived experience of caring for a patient that is at a higher risk for HCD related to PPD? Results: Interviews were conducted via Qualtrics. Initial themes were extrapolated from transcripts and collapsed into three themes that demonstrated relevant meanings. Overall, nursing students who participated in a PPD and HCD simulation were unfamiliar with how to care for patients with higher risk factors associated with various backgrounds and there is need for an expansion of diversity, equity, and inclusion within SBE. Conclusion: This study demonstrates the need for further education for nursing students on how to care for patients suffering from PPD or who are at risk for a healthcare disparity. It also emphasizes the potential benefit of simulation education, which is expanding students comfort level taking care of a more diverse patient population.

No description available.

published_or_final_version / Chinese Historical Studies / Master / Master of Arts

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

<p><strong>Introduction: </strong>McMaster University’s orthopaedic surgery residency program implemented the OSCE as an assessment tool in 2010; this study evaluates the first four OSCEs administered to residents. The OSCEs were composed of knowledge-testing stations, which are normally not included in this testing format, and performance-testing stations. Recruiting enough faculty evaluators challenged the ability to feasibly implement this examination format. Knowledge-testing stations were incorporated since they do not require evaluators to be present. Reliability was assessed, and the correlation between knowledge-testing station scores and performance-testing station scores was determined. The ability of the OSCE to discriminate between residents in different post-graduate years (PGYs) was assessed. Residents’ acceptability of the OSCE was also assessed. <strong>Methods: </strong>Reliability was assessed using generalizability theory. The correlation of knowledge-testing and performance-testing station scores was measured with Pearson’s r. A two-way ANOVA was used to analyze whether the OSCE can discriminate between residents in different PGYs. An exit survey was administrated after each OSCE to assess acceptability. <strong>Results: </strong>The generalizability estimates of each OSCE ranged from 0.71 to 0.87. The disattenuated correlation between knowledge- and performance-testing stations for senior residents was 1.00, and 0.89 for junior residents. A significant effect of year of residency was found for the October 2010 OSCE in the ANOVA (F(1,30) = 11.027, p = 0.005), but the remaining OSCEs did not replicate this finding. In general, residents felt that they were able to present an accurate portrayal of themselves in the OSCEs and that the examination covered appropriate topics. <strong>Discussion: </strong>The OSCEs were reliable and acceptable to residents. The high correlations between knowledge- and performance-testing station scores suggest that the examination can be made more feasible by including knowledge-testing stations. The small sample sizes made significant differences difficult to detect between levels of training, resulting in inconclusive evidence for this construct validation measure.</p> / Master of Science (MSc)

In 1900 the United States had more medical schools than the rest of the world combined. Many of them were commercial institutions devoted to making profits rather than to educating men to perform competently within the medical profession. The profit incentive precipitated low educational standards and made American medical practice decidedly inferior to medical practice almost anywhere else in the civilized world. By 1900 medical education had become pernicious, threatening the health of the nation and the future of the American medical profession. This thesis discusses the efforts to reform medical education practices.