Title:

Beyond the e-portfolio: connectivity and communities of learning in a virtual environment

Status:

Ongoing

Period:

2017-2020

PI:

Chen JY

Source of funding:

UGC Funding Scheme for Teaching and Learning Related Proposals

Abstract:

To fulfill the educational needs of MBBS and BEd students who are dispersed in experiential learning activities, both HKU and EdUHK are committed to exploiting the paedagogical benefits of an e-portfolio system, focusing on an interactive, mobile-accessible virtual learning space-cum-working e-portfolio that engages both students and faculty facilitators in a learning community. The social constructivist and community of learning conceptual frameworks provide a solid grounding to support a focus on the inquiry-based ‘working’ e-portfolio. Local and international research have also suggested that this is an area worth pursuing as the potential benefit to students is substantial but best practice, including the extent of mentor engagement given practical considerations, remains elusive and requires further exploration to sustainability. Curricular and technical aspects of developing of a virtual ‘working’ e-portfolio will be informed by the experience reported in the literature, current practice, and the paedagogical and practical expertise among colleagues from both universities.

Title:

Resilience: a nationwide study of medical educators.

Chan L, Dennis A.

Background:

Medical educators have the potential to play an important role in addressing resilience issues across the medical education continuum. Yet, limited research has explored this cohort, particularly in the UK context. This study aims to address this gap by exploring resilience and the factors that relate to resilience in UK medical educators.

Methods:

A cross-sectional online questionnaire was employed. It contained the validated Connor-Davidson Resilience Scale 25 (CD-RISC-25) and Patient Health Questionnaire-8 (PHQ-8), for determining medical educator resilience and depression levels respectively. Sociodemographic characteristics were also collected to identify potential factors associated with resilience. Finally, participants identified factors that facilitated or undermined their resilience through open-ended questions. Data was analysed using quantitative (e.g. multiple regression analysis), and qualitative (i.e. thematic framework analysis) approaches.

Results:

Among 244 UK participants, the mean CD-RISC-25 score was 72.9 and standard deviation 10.3. The PHQ-8 score was the only significant negative predictor identified (B = -1.22, p < 0.001). Other sociodemographic variables examined were not found to be predictors of CD-RISC-25 scores. Educators identified multidimensional factors influencing their resilience, but predominately viewed internal factors as being supportive, and external factors as undermining.

Conclusion:

Medical educators in this study had resilience levels that were comparable to other population samples. The study also highlights the importance of considering external factors, such as contextual and sociocultural influences, in addition to individual factors when addressing resilience.

Keywords:

Resilience; medical educators; learners; depression; contextual; sociocultural.

DOI: https://doi.org/10.15694/mep.2019.000020.1

Title:

Resilience: a nationwide study of medical educators [Version 2]

Chan L, Dennis A.

Background:

Medical educators have the potential to play an important role in addressing resilience issues across the medical education continuum. Yet, limited research has explored this cohort, particularly in the UK context. This study aims to address this gap by exploring resilience and the factors that relate to resilience in UK medical educators.

Methods:

A cross-sectional online questionnaire was employed. It contained the validated Connor-Davidson Resilience Scale 25 (CD-RISC-25) and the eight-item Patient Health Questionnaire Depression Scale (PHQ-8), for determining medical educator resilience and depression levels respectively. Sociodemographic characteristics were also collected to identify potential factors associated with resilience. Finally, participants identified factors that facilitated or undermined their resilience through open-ended questions. Data were analysed using quantitative (e.g. multiple regression analysis), and qualitative (i.e. thematic framework analysis) approaches.

Results:

Among 244 UK participants, the mean CD-RISC-25 score was 72.9 and standard deviation 10.3. The PHQ-8 score was the only significant negative predictor identified (B = -1.22, p < 0.001). Other sociodemographic variables examined were not found to be predictors of CD-RISC-25 scores. Educators identified multidimensional factors influencing their resilience, but predominately viewed internal factors as being supportive, and external factors as undermining.

Conclusion:

Medical educators in this study had resilience levels that were comparable to other population samples. The study also highlights the importance of considering external factors, such as contextual and sociocultural influences, in addition to individual factors when addressing resilience.

Keywords:

Resilience; medical educators; learners; depression; contextual; sociocultural.

DOI: https://doi.org/10.15694/mep.2019.000020.2

Title:

Resilience: Insights from medical educators.

Chan L, Dennis A

Background:

Educators have unique opportunities to cultivate resilience in themselves and in their learners across the medical education continuum through the formal, informal and hidden curricula. Yet, there is a dearth of research exploring how medical educators conceptualise resilience, and how they foster learner resilience in medical education.

Methods:

Thematic framework analysis was conducted on data collected through an online questionnaire, which was part of a larger study exploring resilience in medical educators. Open‐ended questions examined educators’ conceptualisations of resilience and how they reported supporting resilience in their learners. Sociodemographic characteristics were also collected to describe the sample of participants.

Findings:

A total of 244 medical educators participated from across the UK. They predominantly conceptualised resilience as an individual process. Participants mostly reported approaches to fostering learner resilience that aligned with the formal and informal curricula. Approaches addressing the hidden curriculum were seldom mentioned.

Discussion:

Opportunities exist for faculty development around multidimensional conceptualisations of resilience, and for medical educators to critically reflect on how their concepts of resilience may be influencing their approach to fostering learner resilience. Furthermore, the hidden curriculum could be featured as one of the multifaceted strategies to support resilience in learners.

DOI: https://doi.org/10.1111/tct.13058

Title:

A Comparative, Multi-national Analysis of the Quality of Life and Learning Factors of Medical and Non-medical Undergraduate Students

Marcus A. Henning, Julie Chen, Christian U. Krägeloh, Erin M. Hill, Roger Booth & Craig Webster

Objective:

This study compares data from two medical student cohorts early in their training from New Zealand and Hong Kong and then makes further comparisons with a non-medical group.

Method:

Questionnaires obtained information regarding educational site (universities situated in New Zealand, Hong Kong, and USA), gender, age, motivational beliefs, quality of life, and competitiveness. The study was split into two phases. The first phase focused on measuring and comparing the learning and wellbeing variables of two medical student cohorts. The second phase focussed on making further comparisons with non-medical student groups.

Result:

Responses were elicited from 353 students in medically oriented courses and 688 students with a non-medical orientation. For phase 1, the results indicated differences between the two medical student groups on measures of self-efficacy, intrinsic value, enjoyment of competition, and physical quality of life. For phase 2, differences between the medical and non-medical student groups were noted for self-efficacy, intrinsic value, enjoyment of competition, contentiousness, and physical and social quality of life.

Conclusion:

The results provide insights into medical and non-medical students’ learning and wellbeing experiences from multi-national, multi-discipline perspectives. The results suggest that wellbeing issues of students are likely context-specific and moderated by region, curriculum, gender, and culture.

https://link.springer.com/article/10.1007%2Fs40670-019-00716-2

Title:

How clinician examiners compare with simulated patients in assessing medical student empathy in a clinical exam setting

Carolina Ziebold, David P. Goldberg, Geoffrey M. Reed, Fareed Minhas, Bushra Razzaque, Sandra Fortes, Rebeca Robles, Tai Pong Lam, Julio Bobes, Celso Iglesias, Hugo Cogo-Moreira, José Ángel García,Jair J. Mari

Background:

Empathy is an important clinical attribute to be assessed during clinical examinations. While simulated patients (SPs) are well positioned to assess empathy in such settings, clinician-examiners are objective observers who are also experts in assessment. In this study, the assessments of student empathy from both examiners and SPs in clinical examinations were compared

Method:

The 10-item CARE measure were used for the assessment of empathy in 158 medical students in the Family Medicine specialty clerkship clinical competency test. The ratings from examiners and SPs were analyzed together with genders of students, examiners and patients, and the examination results.

Result:

SPs empathy ratings were higher than those from examiners across all ten items of CARE. A weak positive correlation was found between both ratings. Female SPs were more likely to give higher ratings, and examiners were more likely to give higher ratings to female students. SPs rating was moderately correlated with student examination score, while the correlation with examiners rating was strong

Conclusion:

Although the inter-rater reliability was weak between the empathy rating from simulated patients and examiners, the evaluation of empathy from the patient's perspective was seen to be more authentic as they are in interaction with the students.

https://pubmed.ncbi.nlm.nih.gov/31558085/

Title:

Conundrum between internationalisation and interdisciplinarity: reflection on the development of medical humanities in Hong Kong, Taiwan and China

Abstract:

This article reviews the development of medical humanities pedagogies in Taiwan, China and Hong Kong. We reflect on the curricula formation and implementation regarding their interdisciplinary nature and point out the challenges educators face under the climate of current university practices. We first indicate that the emergence of medical humanities in the three societies was enabled by various social forces across the Strait. It also depended on opportunities offered by the higher education reform. We then provide a detailed experience of interdisciplinary team building at The University of Hong Kong, followed by a critical reflection on the challenges of medical humanities along the pursuit of internationalisation among universities in three Chinese societies. We find that the clashing objectives under universities’ strategic planning framework could lead to changes in work environments and research practices, hampering the design and the delivery of the curricula. In the end, the idealised promise of the interdisciplinarity of such curricula could become fugacious.

https://www.mededpublish.org/manuscripts/1920

Title:

Impact of training for general practitioners on their mental health services: The Hong Kong experience.

Lam TP, Sun KS, Piterman L, Lam KF, Poon MK, See C, Wu D.

Method:

A questionnaire survey was conducted among GPs. Of the 516 respondents, 76 (14.7%) had attended a one‑year postgraduate mental health training course.

Results:

he GPs with mental health training saw significantly more patients with mental health problems per week (median class 11-15 versus 6-10) and treated a higher percentage of patients with mental health problems (median class 41-60% versus 21-40%). The differences remained significant, with odds ratios of 2.6 for both indicators after controlling for gender, healthcare setting and years of practice.

Discussion:

Policies should promote training of GPs as part of the increasing workforce for mental healthcare. Estimated from the results, GPs with mental health training have nearly triple the number of consultations related to mental health, compared with other GPs (340 versus 120 per year).

https://pubmed.ncbi.nlm.nih.gov/30114895/

Title:

Playing to our human strengths to prepare medical students for the future

Julie Chen

Abstract:

We are living in an age where artificial intelligence and astounding technological advances are bringing truly remarkable change to healthcare. Medical knowledge and skills which form the core responsibility of doctors such as making diagnoses may increasingly be delivered by robots. Machines are gradually acquiring human abilities such as deep learning and empathy. What, then is the role of doctors in future healthcare? And what direction should medical schools be taking to prepare their graduates? This article will give an overview of the evolving technological landscape of healthcare and examine the issues undergraduate medical education may have to address. The experience at The University of Hong Kong will serve as a case study featuring several curricular innovations that aim to empower medical graduates with the capabilities to thrive in the future.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583434/

Title:

Profiling potential medical students and exploring determinants of career choice

Marcus A Henning, Christian U Krägeloh, Roger Booth, Erin M Hill, Julie Chen, Craig S Webster

Abstract:

At this university, a Biomedical Common Year 1 occurs prior to admission to the medical programme. Students achieving a minimum GPA of 6.0 are eligible for consideration for an admissions interview. The aim of this research was to assess the psycho-educational factors that underpin students’ intention to study medicine. The research question driving the research was, ‘If students have an interest in becoming a future doctor in their premedical course, does this relate to their levels of motivation, competitiveness, perceived stress, health-related quality of life (HRQOL), and grade attainment?’ A total of 339 students (response rate = 25%) who completed a biosciences assessment filled in a survey that asked them to disclose their grade and to respond to a series of questionnaires, namely the Motivated Strategies for Learning Questionnaire, World Health Organisation Quality Of Life questionnaire – New Zealand Version, Perceived Stress Scale, and Revised Competitiveness Index. The findings from the binary logistic regression indicated that several variables predicted students’ career intentions: grade achievement, Perceived Stress, Physical HRQOL, and Environmental HRQOL. Perceived Stress and Physical HRQOL were found to be influential variables that interacted with other variables reducing variability in the model and increasing its predictability. Students with an intention to become a doctor tend to attain higher grades and have better environmental HRQOL scores. Nonetheless, variable interactions suggested that those students with high levels of physical HRQOL and low levels of perceived stress have higher levels of enjoyment regarding competition, self-efficacy, and intrinsic value.

https://medicine.nus.edu.sg/taps/profiling-potential-medical-students-and-exploring-determinants-of-career-choice/

Title:

Primary care workforce and continuous medical education in China: lessons to learn from a nationwide cross-sectional survey

William C W Wong , ShanZhu Zhu , Jason J Ong , MingHui Peng , Cindy L K Lam , Michael R Kidd , Martin Roland , SunFang Jiang

Objective:

This study aimed to examine the education and training background of Chinese community health centres (CHCs) staff, continuous medical education (CME) and factors affecting participation in CME.

Design:

Cross-sectional survey.

Setting:

Community health centres (CHCs).

Participants:

All doctors and nurses working in selected CHCs (excluding those solely practising traditional Chinese Medicine).

Main outcome measures:

CME recorded by CHCs and self-reported CME participation.

Method:

A stratified random sample of CHCs based on geographical distribution and 2:1 urban-suburban ratio was selected covering three major regions of China. Two questionnaires, one for lead clinicians and another for frontline health professionals, were administered between September-December 2015, covering the demographics of clinic staff, staff training and CME activities.

Result:

149 lead clinicians (response rate 79%) and 1734 doctors and 1846 nurses completed the survey (response rate 86%). Of the doctors, 54.5% had a bachelor degree and only 47% were registered as general practitioners (GPs). Among the doctors, 10.5% carried senior titles. Few nurses (4.6%) had training in primary care. Those who have reported participating in CME were 91.6% doctors and 89.2% nurses. CME participation in doctors was more commonly reported by older doctors, females, those who were registered as a GP and those with intermediate or senior job titles. CME participation in nurses was more common among those with a bachelor degree or intermediate/senior job titles or those with longer working experience in the CHC.

Conclusion:

Only half of doctors have bachelor degrees or are registered as GPs as their prime registration in the primary care workforce in China. The vast majority of CHC staff participated in CME but there is room for improvement in how CME is organised.

https://pubmed.ncbi.nlm.nih.gov/28710208/

Title:

At a Crossroads: Family Medicine Education in China.

Wu, Dan, Lam Tai Pong

China is engaged in efforts to train 300,000 family doctors by 2020 to meet its population’s health care needs. This Article discusses the family doctor shortage, compares family medicine training programs, examines the distributional challenges faced by these programs, and proposes directions for further experimentation. Despite an increasing number of family doctors, they represented only 5.6% of all doctors in 2013. Currently, three training programs run concurrently—the post-transfer training, residency training, and designated family medicine undergraduate education programs. These programs face several challenges. First, the educational qualifications of primary care practitioners (PCPs) vary greatly between rural and urban regions. From 2005 to 2013, the percentage of PCPs with three or more years of medical training in urban areas was at least 20.0% higher than in rural areas. Second, regional disparities in the number of family doctors for every 10,000 people exist. The richer eastern part of China has a ratio of 1.51 family doctors for every 10,000 people, nearly double that of central (0.70) and western China (0.86). Third, better-educated doctors are most likely going to prefer to work in hospitals, which offer a lucrative career path with higher pay and social status. Intervention packages that combine student selection policies that look at place of origin and career intent with other incentive strategies are worth implementing. Adequate clinical exposure and regular, rigorous evaluations are crucial for enhancing training quality. China should strike a balance in the distribution of family doctors between the richer and poorer areas to ensure equity.

https://insights.ovid.com/academic-medicine/acmed/2017/02/000/crossroads-family-medicine-education-china/20/00001888

Title:

Five-year outcomes of western mental health training for Traditional Chinese Medicine Practitioners. BMC Psychiatry.

Tai Pong Lam, Ki Yan Mak, Kwok Fai Lam, Hoi Yan Chan, and Kai Sing Sun

Background:

There are increasing expectations for primary care practitioners to deal with mental health problems. In Hong Kong, 15 % of the general public consult Traditional Chinese Medicine (TCM) practitioners regularly for their primary health care needs. This study investigated the 5-year outcomes of a western mental health training course for TCM practitioners in Hong Kong.

Method:

Structured questionnaire surveys were conducted to compare the TCM practitioners’ confidence and engagement in mental health care before and after the Course. The data collected during 2011–2015 were analyzed.

Results:

A total of 151 TCM practitioners returned both pre- and post-Course questionnaires, with a response rate of 95.6 %. After the course, there were significant increases in the proportions of participants being confident of recognizing patients with psychological problems (62.9 % before the course vs 89.4 % after), diagnosing common mental health problems (47.7 % vs 77.5 %), and managing them (31.2 % vs 64.3 %). Overall, 66.9 % of the participants reported some increase in their confidence in recognizing patients with psychological problems, diagnosing or/and managing patients with common mental health problems. Qualitative responses illustrated the major improvements were increased awareness of mental symptoms, better understanding of classification of mental disorders and management approaches. On the other hand, barriers included difficulties in understanding medical terms in English, consultation time constraints, and a lack of formal referral system to psychiatrists.

Conclusion:

The Course has positive impact on TCM practitioners in handling mental health patients. The findings are useful for designing similar trainings on complementary and alternative medicine practitioners in other countries.

Electronic supplementary material:

The online version of this article (doi:10.1186/s12888-016-1080-6) contains supplementary material, which is available to authorized users.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5081669/

Title:

Evaluation of the learning outcomes of a year-long postgraduate training course in community geriatrics for primary care doctors.

T.P. Lam, Rudolph W.M. Chow, K.F. Lam, I.M. Lennoxc, Felix H.W. Chan, Sammy L.T. Tsoia

Abstract:

There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common geriatric problems in the community. This study aims to examine the outcomes of a postgraduate training course in geriatrics for primary care doctors. A questionnaire developed by the research team was sent to the course graduates (years 2001–2007). Ninety-eight replies were received with a response rate of 52.4% (98/187). Difference in the ratings by the respondents before and after taking the course was analyzed using the nonparametric Wilcoxon signed rank test. Most respondents felt more rewarding and had participated more in geriatric care, and the majority had improvement in their communication skills with elderly patients after taking the course. Moreover, the graduates are more confident in diagnosing and managing common geriatric problems, and deciding to which specialty to refer the elderly patients. Of the referrals, there was a significant increase to private geriatricians and a significant reduction to other specialists. The average number of elderly patients seen per day had also increased. However, little change was observed about making nursing home visits, the frequency of which remained low. Many graduates expressed difficulties in conducting nursing home visits.

https://www.sciencedirect.com/science/article/abs/pii/S0167494310001639

Title:

Psychological wellbeing of interns in Hong Kong: what causes them stress and what helps them

Lam TP, Wong JG, Ip MS, Lam KF, Pang SL.

Background:

Many doctors experience psychological ill health. Interns are known to be particularly vulnerable.

AIM:

To examine the level of depression, anxiety and stress in interns in Hong Kong, as well as the causes and how they cope.

Methods:

A questionnaire was designed based on the themes identified in three focus groups of medical graduates of Year 2004 of the University of Hong Kong. The 21-item Depression, Anxiety and Stress Scale (DASS 21) was also administered. All 155 graduates of the same year were invited to participate with a response rate of 63%.

Results:

Percentages of respondents with abnormal levels of depression, anxiety and stress were 35.8%, 35.4% and 29.2%, respectively. Frequent calls during night shift, long working hours and heavy workload constituted the most significant stressors. Factor analysis of the stressors showed that seven factors could explain 68% of the total variance: multidisciplinary team working issues, clinical difficulties, job seeking and employment, workload issues, ethical and interpersonal issues, adjustment to job rotation and performance appraisal. Holidays, peers and sleep offered the most significant relief.

Conclusion:

Interns experience considerable depression, anxiety and stress. The source of stress is multi-faceted, but workload is the most significant stressor. Peer support groups may relief stress.

https://www.sciencedirect.com/science/article/abs/pii/S0167494310001639?via%3Dihub