abstract: Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based procedures include surgical and clinical procedures, some of which are protocol-driven. Cost and time required for individual team-based training sessions, along with other factors, contribute to making the training complex and challenging. A great deal of research has been done on medically-focused collaborative virtual reality (VR)-based training for protocol-driven procedures as a cost-effective as well as time-efficient solution. Most VR-based simulators focus on training of individual personnel. The ones which focus on providing team training provide an interactive simulation for only a few scenarios in a collaborative virtual environment (CVE). These simulators are suited for didactic training for cognitive skills development. The training sessions in the simulators require the physical presence of mentors. The problem with this kind of system is that the mentor must be present at the training location (either physically or virtually) to evaluate the performance of the team (or an individual). Another issue is that there is no efficient methodology that exists to provide feedback to the trainees during the training session itself (formative feedback). Furthermore, they lack the ability to provide training in acquisition or improvement of psychomotor skills for the tasks that require force or touch feedback such as cardiopulmonary resuscitation (CPR). To find a potential solution to overcome some of these concerns, a novel training system was designed and developed that utilizes the integration of sensors into a CVE for time-critical medical procedures. The system allows the participants to simultaneously access the CVE and receive training from geographically diverse locations. The system is also able to provide real-time feedback and is also able to store important data during each training/testing session. Finally, this study also presents a generalizable collaborative team-training system that can be used across various team-based procedures in medical as well as non-medical domains. / Dissertation/Thesis / Ph.D. Biomedical Informatics 2014

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No. of bitstreams: 1 TESE_Obirajara.pdf: 981087 bytes, checksum: 33950bb941008b07b0cfe9bd6609c963 (MD5) Previous issue date: 2014 / Esta tese emerge de pesquisa no campo da educação médica, tendo como objeto de estudo o modelo pedagógico utilizado na Disciplina de Patologia do Curso de Medicina da Universidade Federal do Rio Grande - FURG. O desenho metodológico proposto pela disciplina, busca otimizar o ensino de patologia para que este possa ser efetivo na formação do estudante de medicina, de acordo com os pressupostos das Competências e Habilidades das Diretrizes Curriculares Nacionais (DCN). Entretanto, a implementação de um modelo pedagógico requer avaliações, reflexões e a flexibilidade de reorientação do projeto. Adotando essa percepção, a tese apresentada como objetivo central, além de reflexões e inquietações quanto ao compromisso com a formação médica, avaliar a metodologia de ensino-aprendizagem proposta na Disciplina de Patologia da Faculdade de Medicina da Universidade Federal do Rio Grande - FURG na formação médica, sob a ótica das DCN. A coleta de dados ocorreu via questionário estruturado, respondido por 165 estudantes, que cursaram a disciplina nos anos de 2007 a 2009, após a implementação das mudanças na disciplina. Para a análise dos dados foram utilizados softwares específicos para construção do banco de dados e análise estatística. A análise foi realizada a partir de parâmetros da estatística descritiva, adotando-se medidas usuais de tendência central e de dispersão, e cálculos de frequência simples e relativos. Também se realizou a Análise de Componentes Principais (ACP), técnica multivariada que permite resumir em um conjunto menor de fatores ou componentes, as questões respondidas pelos estudantes a respeito da avaliação da Disciplina de Patologia. A tese é constituída por três artigos científicos que abordam o processo de ensino-aprendizagem na educação médica, a partir da perspectiva de mudança de paradigma no modelo de ensino-aprendizagem na Disciplina de Patologia, do Curso de Medicina da Universidade Federal do Rio Grande – FURG. Para tal, é desenvolvido um percurso teórico que se inicia com o primeiro artigo, que tem como objetivo promover uma reflexão sobre as mudanças no currículo médico a partir da aprovação das Diretrizes Curriculares Nacionais em 2001. O segundo artigo, envolve uma interlocução acerca da relevância do modelo pedagógico desenvolvido na referida disciplina e os pressupostos do processo de aprendizagem revelados pela neurociência. O terceiro artigo tem como objetivo avaliar a metodologia de ensino-aprendizagem proposta na Disciplina de Patologia da Faculdade de Medicina da Universidade Federal do Rio Grande-FURG, e sua contribuição no processo de ensino-aprendizagem, a partir da percepção dos estudantes, sob a ótica das Diretrizes Curriculares Nacionais para o Curso de Medicina. Subsequentemente, considerando a interlocução do referencial teórico e dos resultados obtidos junto aos acadêmicos, retomando o objetivo principal, é possível preconizar que a mesma, embasada no entendimento do organismo como sistema complexo, numa perspectiva de saúde integral, atendendo aos pressupostos das DCN, contribui para o desenvolvimento de competências e habilidades essenciais para a formação médica. / This thesis is result of a medical education research being the object of study the pedagogical model used in the discipline of pathology of the medical course at the Federal University of Rio Grande - RS. The methodology pattern proposed by the mentioned discipline aims to optimize the teaching of pathology in order to be effective on medical students training, according to the assumptions of the National Curriculum Guidelines (NCG) Skills and Abilities. However, the implementation of a pedagogical model requires evaluations, reflections and a flexibility to review the proposed project. Adopting this perception, the thesis presented has as main objective not only reflections and concerns about the commitment to medical education but the evaluation of the teaching-learning methodology proposed in the Department of Pathology, Medical School, Federal University of Rio Grande regarding the medical training and considering the NCG. Using a structured questionnaire was collected the useful data. This set of questions was answered by 165 students taking this discipline during 2007-2009, after the implementation of changes in referred discipline. For the data analysis specific to construction of the database and statistical analysis software were used. The analysis was performed from the descriptive statistical parameters, adopting the usual measures of central tendency and dispersion calculations of simple and relative frequency. Moreover the Principal Component Analysis (PCA) was performed, a multivariate technique that allows summarized in a smaller set of factors or components the questions answered by the students regarding the evaluation of the discipline of pathology. The thesis consists of three scientific papers that discuss the process of teaching-learning in medical education regarding a paradigm change in the teaching and learning model in the Department of Pathology, Medical School of the Federal University of Rio Grande - FURG. A theoretical path is developed beginning with the first article, which aims to promote reflection on the changes in the medical curriculum following the approval of the National Curriculum Guidelines in 2001. The second article involves a dialogue about the relevance of the pedagogical model developed in this discipline and assumptions of the learning process revealed by neuroscience. The third article aims to evaluate the teaching-learning methodology proposed in the Department of Pathology, Medical School, Federal University of Rio Grande-FURG, and a contribution to the teaching-learning process, considering the perception of the medical students, and taking into account the National Curriculum Guidelines for Medical School. Later, considering the dialogue of the theoretical framework and the results obtained from the students and resuming the main objective, it is possible to advocate that the dialogue based on the understanding of the body as a complex system focusing a complete health and following the assumptions of Curriculum Guidelines, contributes to develop essential competencies and skills for medical education.

Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance. Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting. Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV). In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage. In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression. In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results. In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology. Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives. The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest. Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting. Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions. Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties.

L’objectif de la thèse est de parvenir à élaborer un modèle d’acquisition de la compétence du médecin. La question de recherche a été libellée ainsi : quelles implications peuvent avoir les expériences professionnelles, la vie quotidienne, les échanges entre pairs, enfin, tout ce qui peut correspondre à des ressources pédagogiques dites « informelles» dans l’amélioration des compétences professionnelles des étudiants en médecine et des médecins. J’ai fait l’hypothèse suivante : dans tout apprentissage, il y a du formel et de l’informel. Et cet informel pourrait être repéré dans un dispositif pédagogique de type coopératif, expérientiel et réflexif ; le contexte d’apprentissage « informel» et « non formel » a certainement un rôle dans l’acquisition des connaissances et des compétences des professionnels de santé.Trois dispositifs pédagogiques fréquemment utilisés au cours du 3e cycle de la formation initiale des médecins et en formation médicale continue ont été proposés à des étudiants en médecine et des médecins installés en milieu ambulatoire. De tels dispositifs basés sur la mobilisation de l’expérience, la réflexion et la coopération entre les participants seraient susceptibles de contribuer à l’amélioration de la compétence des étudiants en médecine et des médecins.Il existe, dans chacun des dispositifs d’apprentissages éprouvés, et en tenant compte des cadres de références et des connaissances propres à chaque participant, des savoirs formels et informels. Ces savoirs ont contribué dans leur globalité à la transformation des apprenants. Cependant, la distinction entre ces deux modes d’apprentissages formels,informels est surtout théorique. Elle est notamment fonction des lieux et des moments où ces apprentissages ont été dispensés. Il existe en réalité un véritable continuum entre ces différents apprentissages. / This thesis attempts to offer a model for the acquisition of knowledge and skills amongphysicians. The research undertook to explore the role of professional experiences, dailylife, exchanges between peers, and all other forms of so-called « informal » learning inenhancing the professional skills of medical students and physicians. The author laboredunder the following hypothesis: all learning involves both formal and informal aspects,and the informal aspects can be found in cooperative, experiential and reflexive typepedagogical constructs. Finally, « informal » and « non-formal » learning opportunitiescertainly play a role in the acquisition of knowledge and skills among health care professionals.Three teaching mechanisms frequently used during the 3rd cycle of initial medical trainingas well as in medical continuing education programs were made available to medicalstudents and physicians working in ambulatory setting. These tools, which encourageparticipants to marshal their own experiences, to reflect thoughtfully and to cooperatewith each other, can improve the skills of medical students and physicians.Each of the three teaching mechanisms studied herein, factoring in individual backgroundsand proficiencies, contain both formal and informal knowledge and skills which,as a whole, contributed to the transformation of the participants. However, it is importantto note that the distinction between formal and informal learning is primarily theoretical,and may simply depend on context or location. Therefore, rather than opposethem, it may be more appropriate to consider that these types of learning lie on a continuum.

Traditionally, medical residency positions have been primarily funded by the federal government. However, due to declining governmental funding support over time, medical schools have resorted to fund these programs through other means such as clinical fees and payments for services. This change has affected the number and types of residencies available to medical school graduates. The purpose of this study was to measure how the availability of fiscal resources shape mission-related outputs, particularly medical residency positions at medical schools. Using academic capitalism as the theoretical framework provided a lens through which to examine how federal policies have shaped the availability and funding of medical residencies today at the institutional level. This concept has been studied in traditional colleges and universities and how they balance mission and money, but less so in the context of medical schools. This study used a fixed effect panel analysis to study the impact of selected variables over a 10-year period on financing of medical residencies. Findings included that tuition revenues, paid for by undergraduate medical students, are increasingly funding medical residency positions. There was little to no effect from hospital revenues and federal research monies on increasing the number of medical residency positions. The funding of university based medical education is particularly timely and of national importance to understand the consequences of federal policies for medical schools and how medical residency funding caps and limits have affected one of the missions of medical schools which is to train physicians.

Indiana University-Purdue University Indianapolis (IUPUI) / The anatomical sciences are experiencing a notable decrease in the time and resources devoted to embryology in North American medical education. With more changes assured, it is necessary to investigate the current trends in curriculum, pedagogy, and related experiences of embryology teachers and learners. To address these concerns, the researcher developed two online mixed methods surveys: one for current anatomy and embryology faculty and another for first year medical students. The faculty survey was followed by interviews with volunteers from that cohort. The researcher used a grounded theory methodology to analyze the qualitative components of the surveys, and descriptive statistics to analyze the quantitative components of the surveys. Both the faculty and student surveys illuminated the vast differences between the explicit, implicit, and null curricular components found in the numerous medical education programs represented. A combined grounded theory methodology and phenomenological approach was used to analyze the interviews with faculty. This generated a lived experience narrative of the phenomenon of teaching embryological content to medical students in the modern world, which led to a better understanding of the needs and challenges that face this subject matter and those who teach it. In this fluid era of medical education reform and integration, the perceptions and experiences of anatomy and embryology faculty and first year medical students are invaluable to assessing the curriculum and pedagogy of this foundational anatomical science and formulating evidence-based recommendations for the future.

No description available.

This paper describes an empirical approach to assessing pediatric residents' attitudes, knowledge and skills in primary care behavioral health. Outcomes from that assessment approach are presented from two pediatric residency training programs in the northeastern United States. Thirty-six pediatric residents completed attitudes, knowledge and skills surveys. The survey was developed to align with the American Academy of Pediatrics’ Policy Statement in 2009 citing aspirational competencies for pediatricians in primary care behavioral health. This alignment addressed both learner variables (attitudes, knowledge, and skills) as well as clinical presentations (ADHD, anxiety, depression, and suicide) highlighted in the policy statement. The survey specifically inquired about self-reported confidence and comfort in managing behavioral health concerns using evidence-based practice parameters (attitudes and knowledge) and their measured ability to deliver evidence-based care in response to clinical vignettes (skills). Findings largely revealed no statistically significant differences in attitudes, knowledge or skills between interns and upper-level residents. Training programs can use the approach described in this paper and the assessment instrument with some possible modifications to monitor annual progress and evaluate any changes in didactic and clinical training.

<p>Focus of Thesis This thesis focuses on the initial stages of developing the Ontario Decision Aid in Rectal Cancer for Stage II and III patients (ODARC). The ODARC is a DA meant to facilitate relevant information exchange among physicians and patients. Such a tool should enhance patient knowledge and accuracy of treatment expectations by effectively conveying to patients relevant information on treatment options and associated benefits and risks. The ODARC is designed for use during a physician-patient consultation. The ODARC prototype development was guided by a workbook on developing & evaluating patient DAs published by O’Connor & Jacobsen (for efficiency we will call this the Workbook).24 This latter document provides detailed instructions for a 7-step DA development process including: 1) assess patient and provider need 2) assess DA feasibility 3) define objectives of the DA 4) identify the framework to guide DA development 5) select tailored methods of decision support to be used in the DA 6) select the designs and measures to evaluate the aid and, 7) plan dissemination.24 In this thesis we have created a prototype ODARC as informed by Steps 1 to 5 of the Workbook. The last two steps covering evaluation and dissemination are beyond the scope and available resources of this current research effort, and can be considered as future research endeavours. This will be reviewed in the final chapter.</p> / Master of Science (MSc)

Yes / Team-based learning is an active learning strategy that focuses on student’s engagement, development of critical thinking, and transferable skills needed in the workplace. While many pharmacy faculties around the world have applied team-based learning into their curriculums, the implementation of team-based learning into the Middle East is still in the experimental phase and poses its own challenges. This reflective statement elaborates on our experience and feedback of implementing team-based learning for the first time at the pharmacy faculty of Zarqa University in Jordan through the delivery of over-the-counter module.