Medical Education

Software for modeling and simulation has been used in almost all areas of education, as well as actively used in medical education [19, 20]. This simulation gives students the opportunity to apply different approaches and techniques before they encounter real patients. The objectives of these simulation applications are to enable students to gain basic medical skills without harming the patients [21, 22]. They are aimed at practicing certain medical practices according to standards on models and simulators, and then on patients, which allows to achieve a higher level of qualification of doctors [23, 24].

The present-day cost of educating a medical graduate is based on the traditional model of medical education whereby the early years of the programme are dominated by large group lectures and practicals and the latter years are based in a large teaching hospital attached to a practising clinical team receiving both formal and informal clinical instruction, with a high degree of self-directed activity on the part of the student in learning how to interview and examine patients. The proposed new model involves considerably more intensive small group interaction with at most 20 students per group across the course and is therefore more labour intensive from the teacher perspective. Typically the replacement of a single 1 hour plenary lecture delivered by a senior member of staff will involve at least 5 tutor staff (where class n=100 students) and up to 15 person hours (where class n=300 students) of contact time. The provision of interactive and virtual electronic material and other teaching aids further increases the costs.

medical education by calculating content valid- ity ratio(CVR),  content validity index(CVI) of each item. The reliability of the questionnaire was assessed and confirmed through Chronbach’s Alpha coefficient. The total reliability of the first, second and third domain of questionnaire was 0.94. Data were analyzed by descriptive analysis of findings. Pearson correlation and The Stepwise linear regres- sion test were also used for inferential statistics. The IBM SPSS for Windows versions 19.0 (IBM SPSS Inc., Chicago, IL) was applied for data analysis.

students will also be important because a high satis- faction with overall learning environment, which encom- passes aspects of the “low commitment” factor, was independently associated with resiliency and recovery from burnout [2]. Similarly, in a qualitative investigation with medical students, frustration with the study pro- gram was one of the factors that was found to decreased quality of life [9]. The choice of a major in medicine is often guided by excellent academic grades in high school, or from the consideration of medicine as a pro- fession assuring money and status in society [9], rather than the aptitude or interests of the individual student. This might have partly contributed to the low- commitment in medical education. In relation to this, a previous study with college students indicated that a perceived fit with an academic major was strongly asso- ciated with affective commitment to major and academic self-efficacy [23].

Not only in the general public but also in medical profes- sional life, there is the perception that every physician has to be able to handle critical emergency situations regard- less of the location, severity of the emergency or the indi- vidual's prior experience [6]. Consequently, in 1998, the Society of American Emergency Medicine Physicians (SAEM) described three core subjects to be taught within medical school curricula: BLS skills, including the diagno- sis and treatment of shock; treatment of common acute problems; and assessment of undifferentiated patients [2]. Undoubtedly, there is a need for compulsory imple- mentation of emergency medical care content in under- graduate medical education, and in particular, many studies have revealed a low standard of necessary CPR skills in medical students and recently graduated physi- cians [7-9]. Jagoda et al. cited the Macy Foundation report on emergency medicine when stating "...medical school deans and faculties must ensure that every medical stu- dent has acquired the appropriate knowledge and skills to care for emergency patients" [10,11]. Accordingly, key

The PIME promotes collaborative research and mentor- ing, which has also proven to be effective in improving the quality of MER. PIME is led by a full time, appointed PhD medical education researcher who provides meth- odological skills that enhance the quality of projects. The researchers spend the majority of time leading their own programmes of medical education research and collaborate with educators in the pursuit of their ideas to improve the quality of teaching and learning of trainees in the DFM. The PhD medical education re- searcher mentors interested DFM educators as they transform their scholarly and research ideas into feasible projects, offering support to faculty members with re- search design, data analysis and other research compo- nents, and is uniquely positioned to identify and help address any obstacles. If additional methodological ex- pertise is provided, the medical education researcher is added as a co-investigator on PIME-funded projects.

the country towards the internationalization of medical education. In this regard, the Plan of International Development of Medical Education was drafted in 2015. The Plan of International Development of Medical Education was designed with the aim of identifying available potentials in all the universities of medical sciences, encouraging the development of international standards of medical education, and planning for the utilization of the existing capacity. This plan was rendered as a common mission to 10 spatial regions for implementation, and several measures in collaboration with universities and colleges of medical sciences located in these areas were taken (17). 10 regions of spatial planning shows the geographical breakdown of medical universities in Iran which is approved in form of a resolution by the Council of the Cultural Revolution as a macro-policy maker of Science and Technology in Iran (18).

We are at a crossroad in determining where we are going with medical education in this country. We have a choice to seek the high ground and approach the ACGME competencies with an invigorating, in- novative approach. We can curse at the darkness and look at the glass half-empty (i.e., these competencies were thrust upon us and to some faculty represent yet another hoop to jump through). On the other hand, for those of us immersed in medical education during difficult financial times, we see the compe- tencies representing a glass half-full (i.e., they are an opportunity to reexamine our educational system and create change). The competencies will provide avenues for scholarship for clinician-educators. The ultimate benefactors will be everyone who is a stake- holder, from our medical schools and training pro- grams all the way to our parents and patients. I’m taking the high road and hope to see you with me.

A licensure granted by CAA signifies that robust plans are in place for resources, policies, administration, documentation and financial stability. Program accreditation is the next step where CAA invites a team of visiting international experts (the External Review Team or ERT) to evaluate curricular areas specific for medical education. This step bridges the gap in the standards, for practical purposes, even though the standards may be more generic.

• Tripp Umbach recommends a minimum investment by the State of Georgia of $10 million in 2008 to develop an initial medical education facility and to recruit a regional dean and key f[r]

Although opportunities clearly exist with 1-way texting of information to trainees, it is important to consider the possibility of 2-way texting pro- grams. Instead of messages containing only factual information, they could be question-based and seek trainee input. In this format, trainees could have the ability for a 1-way reply (eg, answering the question only to the sender) or potentially reply to all recipients of the original message. Training programs would have the ability to hybridize texting curricula, balancing texts of medical knowledge with open-ended questions posed to trigger residency- wide discussions on themed topics. Texting curricula could be developed by individual training programs or via a collaborative effort across several residency programs. The minimal geo- graphic boundaries and ef fi cient na- ture of cellular service would enable enrollment of a large number of train- ees and further increase the possibility of interaction. Learners could be di- vided into “ texting teams ” to help facili- tate group participation and knowledge sharing. Programs that enact broad, 2-way texting platforms should con- sider appointing a representative to monitor the discussion. As with all forms of communication, perception and etiquette are paramount. In medi- cal education, trainees interact with other trainees, faculty, staff, patients, and families throughout the day. A texting curriculum provides opportu- nities for modeling and feedback fo- cused on how to interact with one ’ s mobile device in front of others. Dem- onstrating to learners the appropriate usage, timing, and contextual implica- tions of mobile devices during patient interactions is an important compo- nent of medical education with mil- lennial trainees. Being mindful of both

After four very fulfilling years, I took advantage of the University’s generous sabbatical programs and traveled to California for a teaching position. Five months after this move, in the middle of a cardiology conference I had arranged, I got an urgent international phone call (a rarity in those days) from the Dean in Shiraz asking me to drop every thing, go to Chicago, get a Master’s degree in Medical Education, return to Shiraz, start a Medical Education Department and direct the WHO Regional Medical Teacher Training Center for the Easter Mediterranean. This is one of the five WHO regions which consist of 22 countries from Pakistan to Tunisia.

Both resident and attending physician should be expert in using electronic resources, not only because they are fast becoming ubiquitous, but because they improve care quality and resident education. It is for such reasons that, as a component of the Accreditation Council for Graduate Medical Education’s “practice-based learning and improvement” competency, residents must use information technology to optimize learning. The American College of Physician’s Teaching Medicine Series devotes a chapter in The Theory and Practice of Teaching Medicine [5] to medical informatics.

As can be seen from the above presented results of the first five items, it is clear that all participants reacted positively about the role and importance of English language for medical students. Indeed, the students pointed out that English is used broadly in their field of study and their knowledge of English is a determining factor for their academic achievement and for successful communication in their future career as professional doctors. Similar findings were found in (Hassan et al. 1995; Chia et al. 1999; Tasçi 2007; Hwang and Lin 2010). Regarding the use of English as the only language of instruction, there are two different perceptions: participants who are against the idea argued that Arabic should be used for clarifications besides the use of English. Another group who supported the use of English only claimed that English is the easiest and clearest language for medical sciences and the use of other language such as Arabic will lead them to misunderstanding and confusion. In fact, the later opinion is in agreement with a previous study conducted in Saudi Arabia where all participants were against the use of Arabic in medical education (Kassimi 1983). The dean of the faculty argued that a modest use of Arabic could be fine to help those who have lower level of English to understand lectures.

The ultimate goal of medical education is to enable the graduate to transfer sets of what has been learnt to wider contexts and to the contexts of challenges of medical practice (9). In traditional medical schools, the first two years of study are dedicated to basic sciences such as anatomy, biochemistry, physiology and microbiology with relatively little patient teaching. The basic sciences of anatomy, physiology and biochemistry have underpinned the teaching of medicine for decades.

A dedicated commission was established from among the members of INGHE. The members of the commis- sion were young residents in Hygiene and Preventive Medicine (Public Health) supervised by two professors from universities in Rome (Sapienza University of Rome) and Bologna (Alma Mater University). The first phase consisted of a broad-based literature review concerning “global health education” and “medical education”. A deep analysis of two official documents of the Italian Medical Association and The Permanent Conference of the Presidents of Degree Courses in Medicine was conducted, as they provided a mainstream, external per- spective. The second phase was characterized by brain- storming and discussion among the members of the commission, to identify the principal points that should be included in the document. The third phase resulted in the elaboration of the first draft of the paper. Finally, the draft was discussed and reviewed by all members of INGHE. No standardized methodologies have been used to reach the consensus. The draft was shared among the members of INGHE, all of whom were able to read and analyse it independently prior to the group meeting. Consensus was reached after discussions in the plenary session. In March 2015 the final paper was disseminated in Italy [28].

The resident is at the frontline of clinical teaching for medical students, serving as both near-peer and role model. One third of a medical student’s fund of knowledge is acquired from resident teaching. 4 The magnitude and importance of education is often at odds with the limited formal educational training provided to the neurology resident. The formal development of medical teaching skills is not an explicit requirement of programs in the Accreditation Council for Graduate Medical Education (ACGME) requirements. Although residents may spend up to one-fourth of their time supervising or teaching students and coresidents, 4 the ACGME neurology milestone project places education vaguely and more broadly under “scholarly activity.” 5 The onus for structure therefore lies on the program and resident. Many programs center the role of education on the senior resident, assuming that seniority is equal to apt teaching ability, which may be

programs, which accounts for at least eight months of the two-year program, will occur in community settings, albeit some of these may affiliated with university hospitals and facilities. The CFPC reviewed the mandate for Rural Family Practice in 1999 and added a further requirement that “All family medical residents must spend a minimum of 8 weeks in a rural family practice as part of their core family medicine experience” (6).  The shortage of physicians and the corresponding undergraduate and postgraduate expansion: The number of medical students entering MD programs in Canada (and, therefore, eventually postgraduate training) increased by 73% between 1995 and 2009, from 1576 to 2734 (7). PGME in Canada showed similar increases: At the University of Toronto (UofT), postgraduate resident first-year intake increased by 62% (141 positions) between 2000 and 2009. At UBC, first-year positions nearly doubled between 2003/04 and 2010/11, from 159 to 277. It is important to recognize that because of the impact of multiple training years, the increase in postgraduate year 1 (PGY1) positions results in an exponential increase in the total number of trainees in the system over time. At UBC, the total number of postgraduate trainees in the system increased from 556 in 2003/04 to 958 in 2010/11. Further increases are clearly on the horizon, given the continuing expansion of undergraduate medical education and pressure for international medical graduate (IMG) training. Expansion in the number of trainees in clinical settings has expanded the use of affiliated clinical sites.

Medical educators are tasked with teaching competen- cies established by the Accreditation Council of Graduate Medical Education (ACGME). These competencies have been described elsewhere [40]. We would recommend authors align their research with the ACGME core com- petencies and identify which core competencies are being addressed by the study. Competency can be defined as the specific knowledge, skill and attitude needed to com- plete a task correctly. Authors should identify which aspect of competency their study deals with (knowledge, skill or attitude) and precisely how the competency is measured. A more organized approach to technology- assisted education research may allow educators across specialties to learn from each other. This could facilitate a more comprehensive cross-specialty understanding of how to best use technology-assisted education. If, for example, researchers in the surgical specialties identified key training elements of technology-assisted education need to master the skills of laparoscopic procedures, these training elements might be important in learning other skills such as endotracheal intubation or lumbar puncture. Similarly, if one specialty identified the key training elements of professionalism that could be taught or measured using technology-assisted education, all spe- cialties would benefit from this knowledge. More struc- tured, programmatic research maybe the best way to foster transfer of training knowledge from one specialty to another and may be the only way to identify a “ Best Method or Best Use ” for technology-assisted education, something that has eluded medical educators for decades.

This review is subject to several limitations that derive from the lack of reliable research data and that warrant attention as the field of SBML advances in medical education and becomes more refined. The current review shows that SBML holds promise for fulfilling the goal of achieving TS outcomes, but does not yet provide definitive, airtight answers. Few medical mastery learning studies have achieved downstream results at the T2 (better patient care practices) and T3 (better patient outcomes) levels. Table S1 reveals that several research groups have reported T2 and T3 results for paediatric LP, 42 cardiac auscultation, 43 advanced cardiovascular life support, 45,46 temporary haemodialysis catheter insertion, 48 paracentesis, 50 laparoscopic surgery 53,54 and central venous catheter cannulation, 55–57 but much more research is needed. Translational T2 and T3 results are more likely to be achieved through educational and health services research programmes that are thematic, sustained and cumu- lative rather than in single, one-shot studies. Trans- lational T4 outcomes (e.g. cost-effectiveness,