Exploring the challenges and ethical requirements of medical sciences education during COVID-19: a qualitative study

The controversial role of ethics in clinical education and its ability to draw the attention of a large audience is inevitable. The issues and challenges of the COVID-19 pandemic have transformed the clinical education environment. This study was conducted to explore the challenges and ethical requirements of medical sciences education during the COVID-19 pandemic in 2020. The study was qualitative research and the instrument was a semi-structured interview. The participants included faculty members of the basic and clinical Sciences at Iran University of Medical Sciences. After 16 rounds of interviews, theoretical saturation was achieved. Qualitative data were analysed using conventional content analysis, which resulted in 81 preliminary codes and 28 sub-categories. Finally, two themes of "ethical challenges" and "ethical requirements", and 10 categories were achieved. The sub-categories were consisted of "being patient-centred", "social accountability of curriculums", "ethical challenges of the clinical environment", "the poor performance of the clinical faculty members and students", "being justice-centred", "raising awareness", "observing clinical research ethics", "preservation and promotion of mental health", "patient confidentiality", and "respect for individuals". We hope the ethical challenges in medical education that were created due to the emergence of Covid-19 can be reduced and eliminated by defining a framework for ethical requirements.

Orientation of medical trainees to a new clinical environment (the ready-steady-go model): a constructivist grounded theory study

Background High-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety. However, few consultants receive extensive formal training to support new trainees and must create their own ways of integrating newcomers into their clinical team and work environment. We aim to conceptualise the strategies consultants use in the early stages of working with new trainees that will be useful for future faculty development in this area. Methods We used constructivist grounded theory (CGT) methodology by interviewing fifteen consultants in three medical specialties, to explore how trainees are integrated into a new clinical environment. We used CGT principles and procedures (iteration, constant comparison, and theoretical sampling) to analyse and construct a conceptual interpretation of the empirical data. Results Consultants’ central concern when introduced to a new cohort of trainees was that they had the required knowledge and skills (ready), were adapted and integrated into the new workplace and clinical team (steady), and safely participating in practice (go). Consultants used two broad strategies: formal orientation and informal orientation. Both these approaches had the common goal of intensifying interaction between consultants and trainees to get trainees to a position where they were ready, adapted, integrated, and participating safely and efficiently in practice. Several disruptors were identified by participants that delayed and sometimes completely inhibited the orientation process. Conclusions The model of orientation constructed through this research could be a valuable tool to support faculty development initiatives, the reflective learning practice of clinical supervisors, and curriculum design. The disruptors were identified as valid priorities for improving trainee orientation in postgraduate medical education. Future research should involve a longitudinal approach to explore trainee engagement with orientation upon entering a new clinical workplace.

Characterization of Ag/AgCl Dry Electrodes for Wearable Electrophysiological Sensing

With the rising need for on-body biometric sensing, the development of wearable electrophysiological sensors has been faster than ever. Surface electrodes placed on the skin need to be robust in order to measure biopotentials from the body reliably and comfortable for extended wearability. The electrical stability of nonpolarizable silver/silver chloride (Ag/AgCl) and its low-cost, commercial production have made these electrodes ubiquitous health sensors in the clinical environment, where wet gels and long wires are accommodated by patient immobility. However, smaller, dry electrodes with wireless acquisition are essential for truly wearable, continuous health sensing. Currently, techniques for the robust fabrication of custom Ag/AgCl electrodes are lacking. Here, we present three methods for the fabrication of Ag/AgCl electrodes: oxidizing Ag in a chlorine solution, electroplating Ag, and curing Ag/AgCl ink. Each of these methods is then used to create three different electrode shapes for wearable application. Bench-top and on-body evaluation of the electrode techniques was achieved by electrochemical impedance spectroscopy (EIS), calculation of variance in electrocardiogram (ECG) measurements, and analysis of auditory steady-state response (ASSR) measurement. Microstructures produced on the electrode by each fabrication technique were also investigated with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The custom Ag/AgCl electrodes were found to be efficient in comparison with standard, commercial Ag/AgCl wet electrodes across all three of our presented techniques, with Ag/AgCl ink shown to be the better out of the three in bench-top and biometric recordings.

Learning clinical reasoning in the workplace: a student perspective

Introduction Clinical reasoning is a core competency for every physician, as well as one of the most complex skills to learn. This study aims to provide insight into the perspective of learners by asking students about their own experiences with learning clinical reasoning throughout the medical Master’s curriculum. Methods We adopted a constructivist approach to organise three semi-structured focus groups within the Master’s curriculum at the medical school of the Radboud University Medical Center in Nijmegen (Netherlands) between August and December 2019. Analysis was performed through template analysis. Results The study included 18 participants who (1) defined and interpreted clinical reasoning, (2) assessed the teaching methods and (3) discussed how they used their context in order to learn and perform clinical reasoning during their clinical rotations. They referred to a variety of contexts, including the clinical environment and various actors within it (e.g. supervisors, peers and patients). Conclusion With regard to the process by which medical students learn clinical reasoning in practice, this study stresses the importance of integrating context into the clinical reasoning process and the manner in which it is learnt. The full incorporation of the benefits of dialogue with the practice of clinical reasoning will require additional attention to educational interventions that empower students to (1) start conversations with their supervisors; (2) increase their engagement in peer and patient learning; (3) recognise bias and copy patterns in their learning process; and (4) embrace and propagate their role as boundary crossers.

Nursing Education Innovations and Obstacles During COVID-19

The COVID-19 pandemic created a paradigm shift in the way educators employ active learning strategies. In this chapter, the authors discuss how engaging and innovative learning strategies were developed to teach baccalaureate-level nursing students during the COVID-19 pandemic. The initial focus is on the teaching and learning strategies created for first-semester students who are developing foundational nursing skills and concepts. The discussion transitions to complex strategies developed for fourth-semester students, solidifying critical thinking and clinical judgment skills. Highlighted are active learning strategies used in the classroom, skills lab, and simulated clinical environment. These promote clinical judgment and present practical direction for adapting technology to provide an engaging learning environment. Throughout the chapter, the authors use several strategies to showcase how a nursing program responded to COVID-19 restrictions, including active learning and technology strategies, and how they can be applied across a curriculum using varying levels of technology.

Humor, Well-Being, and Health Literacy

Health influences general well-being, and well-being affects future health. Oral health professionals report a decreased well-being and a higher burnout. This chapter measures and evaluates the perception of the health professional and the patient about factors of stress and well-being. It evaluates the strategies used to overcome the anxiety and stress that involve the meeting. Two surveys applied by questionnaire, with face-to-face and online dissemination, the first to patients and second to dentists, were done. Of the 245 patients, 46% consider themselves to be anxious. The instruments used in a clinical environment cause discomfort, and their noise is the predominant cause for this fear. Of the 306 dentists, 80% show the ability to face difficult situations. Finally, 90% have an awareness that contributes to the well-being of others. Oral health professionals should prepare themselves with techniques to develop a therapeutic relationship that is more positive, calm, and less stressful.

Influence of different types of real-time feedback on hand washing quality assessed with neural networks/simulated neural networks

Background: Thousands of people die every day around the world from infections acquired in a hospital. Hands are the main pathways of germ transmission during healthcare. Hand hygiene monitoring can be performed using various methods. One of the latest techniques that can combine all is a neural network-based hand hygiene monitoring system. Methods/Design: Each participant performed 3 hand-washing trials, each time receiving different type of feedback. The order in which each participant of the study used the developed applications was strictly defined, thus each hand-washing study session started with performing hand washing using application A, B and C accordingly. All captured videos of hand-wash episodes were saved and later analysed with neural networks. In the end, both evaluation results were compared and evaluated. Results show that when the participants use Application Type A, they perform hand washing much faster, as well as in comparison of Application Type A versus application type C. However, the longest time spent for the hand washing was detected while using the application type B. Conclusion: Study shows that structured guidance provided during the real time hand washing could be associated with better overall performance. The Application C has confirmed its effectiveness. Proving its advantage among other applications, the Application C can be integrated into the clinical environment