Medical simulations provide hands-on training at various levels of medical expertise. Yet these simulators fail to accurately mimic the look, feel and behavior of human tissue. Applying measured mechanical properties from human cadaver tissues promises to improve the fidelity of simulated tissue behaviors when subjected to medical procedures. Samples of human parietal pleura were tested under uniaxial tension to failure and measured characteristics were replicated in synthetic pleura. Context specific parameters were then collected and compared between human pleura and the new synthetics. These comparisons tested the hypothesis; H1 Gaps exist between synthetic and human pleura performance, H2: Human tissue fracture mechanics define desired performance of synthetic tissues, H3: Synthetic and human tissues with similar stress/strain parameters will behave similarly when blunt punctured. The results promote the future development of high fidelity tissue simulants for medical training. The studied tissue is parietal pleura which contributes the critical haptic "pop" indicating access to the proper anatomic space during the tube thoracostomy procedure. Once accessed through blunt puncture, tube is then inserted to drain air and fluid from around the lungs. Stress/strain based hyper-elastic and fracture properties calibrated from fresh human cadaver pleura were used to define performance requirements. Synthetic pleura were then prototyped and their mechanical properties were characterized. Commercial pleura simulants were puncture tested and compared to compliant custom and off-the-shelf formulations. A non-compliant but commonly used pleura substitute was also tested. Blunt puncture force and displacement were compared for each of the materials to test the stated hypotheses.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The dissertation explores relationships between social mobility and tribal identification, based on observations made among a sample of medical trainees at the University of Ibadan (formerly, the University College, Ibadan) in Western Nigeria. The thirteen-month study was carried out during 1962-63. Data were collected on 270 Southern Nigerians entering medical training in the years 1952-1960. Material was taken from university records, personal observations, unstructured interviews, and formal interviews with a sub-sample of 103 trainees drawn from among graduates or potential graduates in the years 1960-1965. Social background characteristics were compared with performance in training. Based on the ability to sit for and to pass all parts of the standard Second M. B. and Final M.B.-B.S. examinations and to graduate in the minimum five-year training period, representatives of large triues (Ibos, Yorubas) had a significantly higher pass rate than representatives of small tribes (Binis, Ijaws, Efiks, Ibibios, and several smaller groups). Corrections for caliber and location of secondary schools attended showed no variations in this pattern. Nor was it possible to account for these differential performances in terms of examination procedures, faculty bias, degree of exposure of various groups historically to foreign impact, or feelings of social isolation during training. [TRUNCATED] / 2031-01-01

In regions of the world that experience a deficit of surgical care, educational initiatives can foster the development of a skilled surgical workforce. Implicit in training these health workers is the mandate to retain them in the country in order build capacity. Eyal’s framework presents ways in which locally relevant training can improve retention and outlines the ethical and pragmatic concerns of such initiatives. In 2006, Guyana established it’s first surgical training program, an example of locally relevant training. The University of Guyana Diploma of Surgery (UGDS) program was selected for this case study research. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of the UGDS program. The purposes of this dissertation research were two-fold. Firstly, it sought to understand how the UGDS program influences retention and the ways in which the UGDS members contribute to capacity building and the program’s sustainability. Secondly, this program evaluation provides a useful context to inform Eyal’s framework. 8 graduates, 2 trainees, 4 faculty members and 2 persons identified as policy makers were interviewed. Interviews were conducted face to face, and then transcribed. Surveys were administered to graduates and trainees and reflective reports and presentations were coded and analyzed. Overall, the data mapped fairly well onto Eyal’s framework. The results of the study suggest that the benefits and concerns Eyal outlines would be better represented along a continuum rather than being classified as either advantageous or disadvantageous with respect to retention. While Eyal’s claims generalize across settings, he should acknowledge this limitation and consider the important role that context plays. Overall, the results suggest that the UGDS program has positively influenced retention and capacity building. Key recommendations were made to the UGDS program that aim to improve retention and capacity building. As regions continue to face challenges associated with providing adequate surgical care, fostering retention and capacity building is recommended so that a sustainable surgical workforce can meet surgical needs. / Thesis / Candidate in Philosophy

In light of Accessibility for Ontarians with Disabilities Act, 2005, medical schools witnessed increased number of students with disabilities matriculating in their program. However, the administrators face challenges because ensuring accessibility in dynamic clinical settings may not always be feasible or ideal while considering the resource implication and patient safety. There is little consensus and established guidance on how to provide responsible accommodations for otherwise-qualified medical students with disabilities. To understand the development of resilience in medical students with disabilities as they confront potential institutional barriers and social or self-imposed stigma, we asked: how do medical students with disabilities identify and communicate their learning needs to negotiate necessary accommodations with the Student Accessibility Services and/or the MD program? The Constructivist Grounded Theory approach by Charmaz (2006) served as the methodological guide. In-depth individual interviews were conducted capturing the students’ perspective on accommodations arranged by the program, inclusion challenges in medical education and their recommendations on how to enhance program accessibility. Three major themes emerged: 1) creating a dialogue to devise learner-centered accommodation strategies, 2) recognizing available extrinsic and intrinsic resources, and 3) optimizing available extrinsic and intrinsic resources. Self-reflection was the key underlying ingredient driving students’ resilience development in partnership with inclusive learning environment and supportive faculty. Student diversity present in the medical schools merits further research. Diminishing stigma towards health professionals with disabilities is imperative. Endorsement of cross-departmental and institutional collaboration that enables dissemination of cost-effective and comprehensive accommodation strategies is recommended. / Thesis / Master of Science (MSc)

Background: Current literature promotes a student-centred approach with an active learning design, as such curricula have demonstrated improvements in outcomes such as critical thinking and clinical competence. Current literature demonstrates success in North America and Europe. However, research in low-resource countries have highlighted resource- and satisfaction-related issues due to such shifts. This study implements a case-based learning (CBL) intervention at Kasturba Medical College Mangalore Campus (KMCMG), India. Faculty and undergraduate medical student perceptions are explored in order to understand the contextual factors that will lead to an effective, acceptable and feasible medical curriculum. Methods: This cross-sectional, mixed-methods study employed a Likert scale questionnaire and semi-structured focus groups to 3rd year medical students (n=248), as well as semi-structured interviews with faculty (n=10) in the Department of Community Medicine. Cases were created through a co-development process with KMCMG faculty. Questionnaire data was analyzed by descriptive statistics and qualitative data was analyzed primarily by an inductive-iterative approach. Results: Both faculty and students find CBL to be more valuable than the traditional lecture-based method, and find CBL meaningful for students as future physicians. Comments highlighted the importance of student preparedness and of trained facilitators in order to enhance the learning experience. A significantly larger proportion of Indian schooled students, versus those who studied abroad, felt that CBL helped acquire new information (p=0.016), enhanced their clinical approach (p=0.008), and believed the role of the facilitator was important (p=0.001). Conclusion: Feedback towards CBL was found to be satisfactory in all aspects, and both students and faculty would like to see more CBL sessions in the future. Limitations such as faculty shortage and the inability to use informational technology at this time should be taken into consideration when moving forward. It is recommended that a resource-light version of CBL be considered, to provide robust orientations to faculty and students, and to further engage with faculty and students in order to enhance the CBL experience. / Thesis / Master of Science (MSc)

BACKGROUND: Many patients face chronic pain, which can be debilitating and dramatically impair patient's quality of life. These patients often seek treatment from their primary care physicians, who may utilize a wide range of options to manage their chronic pain, including opioids. Opioids provide analgesia while potentially leading to other adverse effects, including misuse, addiction and overdose. Therefore there is a need for clinicians to develop safe opioid prescribing practices. This has been recognized by the development of national guidelines and recommendations to improve the training and education of physicians in this domain. However, a gap in medical education and training for safe opioid prescribing skill exists, creating physicians who may feel ill prepared to treat this patient population. To remedy this problem, an educational intervention was designed that utilized a didactic session with or without an immediate or delayed observed structured clinical exam (OSCE) to improve safe opioid prescribing skills among internal medicine residents at an academic medical center. The specific aims of this thesis are to understand both quantitative and qualitative impacts of this educational intervention, specifically to describe participant characteristics, quantitatively evaluate within and between group changes at 8-months in safe opioid prescribing knowledge, confidence and self-reported practices and qualitatively describe participants' experience of the OSCE as a learning tool. METHODS: Using a quasi-experimental design, 39 internal medicine residents were assigned to either a control or intervention groups. The intervention groups received a didactic session alone, a didactic session and immediate OSCE or a didactic session and a delayed OSCE. Participants were surveyed at baseline, 4- and 8-month follow-up to assess their safe opioid prescribing knowledge, confidence, and self-reported practices. RESULTS: Participants in the didactic followed by immediate OSCE group significantly improved both within group confidence and practices at 8-month follow-up. Additionally, participants in this group improved their confidence at 8-month follow-up significantly compared to the control group. Participants from the other educational intervention groups (didactic followed by delayed OSCE and didactic only) also saw improvements in confidence and practice, but the effect was not as robust. OSCE participants found the OSCE to be a useful learning tool and both participants in the immediate and delayed OSCE groups highlighted the need to receive the didactic session immediately prior to the OSCE session. DISCUSSION: Despite many barriers in safe opioid prescribing facing internal medicine residents including limited faculty mentorship and difficult inherited patients, this educational intervention still improved their safe opioid prescribing knowledge, confidence and practice. The use of OSCEs as an education tool is an innovative approach to develop clinical skills and can be adapted in a variety of ways to accommodate institutional and learners' needs. / 2017-05-01T00:00:00Z

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Background: Empathy is essential to forming strong patient-physician relationships that enable physicians to provide better healthcare. In the medical education literature, empathy consists of cognitive, affective, behavioural, and moral domains. Studies have measured declines in empathy during medical training. Researchers speculate that factors within formal, informal, and hidden curricula contribute to empathic decline. Several frameworks suggest that empathy in the moral domain (i.e., the inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs) is the most fundamental to the empathic response. Studying the factors that influence moral empathy during training is important to developing insights into the reasons for the demonstrated declines in resident empathy. Methods: Descriptive phenomenology was used to address the research objective. Medical residents from various specialties participated in lightly structured interviews concerning their experiences. Interview transcripts were inductively and collaboratively analyzed to construct a preliminary set of factors that influence moral empathy. These factors informed the creation of a script for a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers, and scholars. Following the play, audience participants completed a survey that served as a member-check of the factors that contributed to the final construction of factors. Results: The results were constructed as three categories under which seven factors are nested. These categories are: Innate Capacity, Previous Personal Encounters, and Specific Patient Encounters. With the exception of a few, most factors do not directly influence residents’ moral empathy but rather challenge their ability to act on their moral empathy. Discussion: These results offer unique insights into the declines in empathy that have been previously reported in the medical education literature, while also highlighting a moral-behavioural tension that has implications for competency-based medical education, the four-factor model of empathy, and the assessment of empathy in medical education. Future work may build on the results of this study to develop an assessment tool for moral empathy and to elucidate the relationships between the domains of empathy in order to arrive at a more refined conceptualization of the construct. / Thesis / Master of Science (MSc) / Empathy—the ability to comprehend the experiences of others—is an important tool that enables physicians to build relationships with patients, which helps them provide better healthcare. Studies have shown that empathy declines during medical training due to a variety of factors. Frameworks describing the empathic response suggest that one’s inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs may be fundamental to providing clinical care with empathy. As such, the goal of this study was to explore the factors that influence these inner motivations of residents in order to gain insights about the evidence that purports residents to demonstrate less empathy as they progress in their training. To address this objective, 10 medical residents from various specialties were interviewed about their experiences, the data were analyzed by way of a descriptive phenomenological methodology, and the initial findings were presented as a verbatim theatre play as a means of member-checking the proposed results. After viewing the play, an audience of medical residents, educators, learners, researchers, and scholars provided feedback through a survey that contributed to the final conclusions of the study. In this regard, the study shows that, apart from a few factors, residents’ inner motivations to be empathic are not significantly influenced during medical training. Rather, certain factors associated with residency affect their ability to deliver on their inner motivations. This study offers insights into the role of motivation in empathic decline, assessment of empathy during medical training, and potential significance of a tension between one’s motivation to be empathic and the opportunities that they are afforded to be empathic during residency.