Background: Delivering research skills training to health professionals through short, applied sessions outside a formal higher education program, can help fill gaps in training and build research capacity in clinical settings. This has been the endeavor of some of the Applied Research Collaborations funded by the National Institute for Health and Care Research in England since 2014. How to evaluate this type of training in terms of the wider impact it may have, has not featured heavily in the literature and methods have largely borrowed from more generic approaches to training evaluation which can over-simplify outcomes and ignore longer-term impacts. Methods: We developed the framework in four stages: mapping potential impacts of our research skills training courses to identify key concepts; shaping into three domains in which impact could be expected, informed by established definitions of research capacity building; testing the initial framework and adapting wording of impacts; refining the framework into a practical tool. Results: The final framework specifies types of impact in three domains of influence - individual, group/organization and health system, and maps these against key questions to guide inquiry, as well as suggested methods for capturing the impact and expected timeframe for each type of impact. Discussion: The framework provides a structure for guiding the evaluation of research training as well as a focus on medium-longer term impacts, encouraging a broader and continuous approach to evaluation. It is hoped this will support educators in other contexts and fields, in the planning of a wider range of training evaluation activities, to capture impact more fully.
Background: The academic clinician-educator (CE) often has a career spanning 40 or more years. Retirement represents the last stage of one's professional identity. Planning for retirement can be both exciting and challenging. Although it would seem reasonable that there would be research addressing the transition to retirement that incorporates guidance on important decisions or pathways to retirement with outcomes related to satisfaction, adjustment, or fulfillment in retirement, in fact, there is minimal such research. As CEs, the recently retired authors have drawn on our experiences in pediatrics as the foundation for our inquiry. The authors suggest that retirement decisions and needs differ in academic health center (AHC) faculty from those in health-care private practice. As an example, we suggest that CEs in all specialties, and likely other senior faculty in the health sciences, may have unique opportunities in retirement to enrich their institutions and their specialty organizations. The gaps we have encountered and our experiences in the retirement process have resulted in this paper, in which we encourage research that will inform more substantial, timely, and practical advice going forward. Methods: Our exploration of retirement from AHC careers includes two foci: (1) A review of relevant literature on retirement issues the CE, AHC, and national educator organizations might consider important in this transition process; and (2) the description of a theoretical framework known as Conservation of Resources Theory simply to help organize perspectives on the losses, gains, or conservation of tangible and intangible resources to weigh in the planning and transition process. Results: Several considerations relevant to retirement planning, both specific to academic faculty retirement in the health sciences and to retirement planning more broadly, emerged from our literature exploration. However, there were virtually no studies addressing these considerations, both personal and professional, accompanied by tracking their impact on satisfaction or well-being once in retirement. Discussion: Emerging from our examination of literature and our experiences in transitioning to retirement are a number of questions deserving of further study, likely in longitudinal, comparative or more broadly in global inquiries, in the effort to develop models to guide the retiring academic CE. Over the next decade, there will be so many faculty members considering or negotiating retirement that there is an urgent need to develop and study models that both inform this process and monitor outcomes in terms of satisfaction with the retirement years.
Background: Perceptions of patients of the nature and quality of the interaction with their doctors during consultation are potentially an important factor determining patient satisfaction and doctors' success. Failure by medical doctors to understand how patients perceive them or what patients desire from them may hinder the establishment of strong, trust-based doctor-patient relationships. The purpose of this study was to explore the health service users' views in a region of Botswana on what constitutes optimal doctor-patient interaction during consultation and propose recommendations for integration into medical education curricula. Methods: A purposive sample of 12 individuals was selected in a setting where health and well-being are underpinned by principles of interdependence and interpersonal connections (botho/ubuntu philosophy) for semi-structured interviews using the critical incident technique to elicit desired behaviors and actions of medical doctors during consultation. The participants described their good and bad consultation experiences with medical doctors. The data were analyzed using thematic analysis. Results: Three themes, derived from 11 codes, were identified from the data: conversational skills (welcoming and focused), interpersonal skills (humane, respectful, empathetic, unprejudiced, and personal), and professional traits (humble, trustworthy, thorough, and empowering). Discussion: Many expressed desires or expectations correspond with humanistic attributes described in the literature, suggesting their universal value. More importantly, the desires and expectations align with the principles of the Bantu philosophy of botho/ubuntu. Accordingly, educators should intentionally provide learning opportunities for students to promote the development of the desired attributes that enhance an effective doctor-patient relationship but should employ culturally relevant pedagogy.
Background: Antibiotics are precious substances that have saved millions of lives since their discovery, resulting in significant advances in modern medicine. However, antibiotic resistance and a slowdown in the discovery of new antibiotics with novel mechanisms of action are affecting the sustainability of antibiotics. The objective of this study was to describe the content of South African and Nigerian medical students' curricula with respect to prudent antimicrobial prescribing. Methods: A content analysis framework was used to identify, describe, and count the keywords, key phrases, and sentences relevant to the teaching of prudent antimicrobial prescribing in the complete curricula content of two African countries' medical schools. The courses are taught in the Graduate Entry Medical Programme (GEMP) curriculum (years 3-6) of the South African medical school and years 4-6 of the Nigerian medical school. The frequency of keywords/key phrases relevant to prudent antibiotic prescribing such as antimicrobial stewardship, mechanisms of bacterial resistance, and principles of antibiotic therapy was determined. Results: The two curricula reviewed were found to be different. While the South African medical school uses an integrated curriculum in the GEMP (a stream where candidates with undergraduate degrees are enrolled into the 3rd year of medical school and spend 4 years), the Nigerian medical school operates a traditional (discipline based) curriculum from MBBS 1-6. A greater number of keywords and key phrases were found in the South African curriculum compared to the Nigerian curriculum in relation to prudent antibiotic prescribing and antimicrobial stewardship. The key phrase "antimicrobial stewardship" or "antibiotic stewardship" was absent in the Nigerian curriculum but appeared four times in the South African curriculum. Discussion: The findings of this curriculum review suggest a need for revision of the medical curricula of the two countries, to one that will better prepare learners for antimicrobial stewardship.
Background: Despite female genital mutilation/cutting (FGM/C) practices being an illegal form of gender-based violence in Canada, this practice impacts many Canadians. Lack of education and training among Canadian health-care providers has resulted in systematic barriers to care. Awareness and FGM/C-related education among Canadian health-care providers must be urgently assessed. Methods: Canadian medical students were recruited to complete an anonymous survey via E-mails distributed through their schools' student organization between January and March 2021. We evaluated student understanding of FGM/C, attitudes toward medicalization and legislation, and prior clinical experience using multiple choice, Likert scale, and open-response questions. Results: Respondents (n = 135) performed poorly on knowledge assessment questions (mean percent correct <50%). Only 10.4% of respondents indicated knowing how to involve appropriate authorities when necessary, and most never evaluate FGM/C in patient history (86.7%) or clinical examination (57.1%). Subgroup analysis revealed that prior education significantly improved knowledge scores and influenced students' behaviors and attitudes. About 92.2% of respondents supported the integration of FGM/C curricula in undergraduate medical education. Discussion: This study reveals that Canadian medical students have a poor understanding of FGM/C and are not prepared to identify affected patients or intervene when necessary. These results provide rationale for the implementation of FGM/C-learning modules in undergraduate medicine.
Background: This article focuses on a growing, global recognition of the importance of the field of interprofessional education for person-centered collaborative practice (IPECP) expressed through high-level policy and accreditation decisions/actions taking place in 5 countries. Policy decisions are used to motivate strategies related to IPECP that align with national health plans, and workforce issues. Methods: Using a collective of representative stories from around the globe, a grouping of case studies were developed to illustrate different approaches and challenges to IPECP implementation. Results: Institutions from countries of various income levels face many similar challenges in the execution, delivery, and sustainability of IPECP. All programs face issues of financing, of preparing faculty, of developing and organizing curricula, and of bridging between campus and community. Discussion: Policies are being developed that promote a global approach to the inclusion of IPECP in the accreditation and regulation of postsecondary institutions and health service organizations, in keeping with WHO National Health Workforce Accounts. Policies developed promote and demonstrate the benefits of IPECP through remote emergency learning methods. The policies also build national systems for IPECP as an integral part of continuing professional development and lifelong learning. The organization of interprofessional research programs and the increasing publication of their results of such programs will lead to a clearer understanding of the efficacy of the field of IPECP. To ensure sustainability, stakeholders and policymakers should continue to foster policies that facilitate IPECP.
While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each other in practice. Institutions must be truly socially accountable, which is possible if there is spontaneous SR to the needs, and is fueled by compassion. Compassion in this article is defined as a "feeling for other people's sufferings, and the desire to act to relieve the suffering." Compassion has a long history, whereas SA is more recently described concept that follows the historical development of social justice. SR is the moral or ethical duty of an individual to behave in a way that benefits society. Not everyone feels the need to do something for others. Even if the need is felt, there may be a lack of will to act for the needs or to act effectively to fulfill the needs of society. The reasons are many, some visible and others not. SR provides the basis for being compassionate; hence, medical schools need to include SR as a criterion in their admissions process for student recruitment and inculcate compassion in health professions education and health care. By fostering SR and engaging compassion and self-compassion to achieve SA, we can humanize medical education systems and health care.
Background: Despite a growing drive to improve diversity in medical schools, those from state schools and less-advantaged sociodemographic backgrounds remain underrepresented. We explore applicants' approaches to preparing for medical school selection, considering the complexity of sociodemographic disadvantage in this highly competitive process. Methods: Narrative interviews were undertaken with applicants to a United Kingdom medical school, exploring experiences of preparation for selection (n = 23). Participants were purposively sampled based on involvement in widening participation schemes, school background, gender, and ethnicity. Transcribed data were analyzed using Labov and Waletzky's analytic framework. Bourdieu's concepts of cultural capital and habitus provided a lens to constraints faced and variable experiences. This informed a consideration of the ways applicants approached and navigated their preparation, in the face of various constraints. Results: Constraints to resources and support were often apparent for those from state nonselective (SNS) schools. These applicants and those beginning their preparation later (12-18 months before application) appeared particularly vulnerable to myths and misunderstandings about the application process and appeared less confident and less discerning in their navigation of preparation. Some of the applicants, particularly those from independent and state selective schools, appeared confident and competent in navigating the complexities of the application process, while others (often from SNS schools) were more frequently lost or stressed by the process. Discussion: Those who lack particular preparatory tools or resources (materially, culturally, or perceptually) must "make do" as they prepare for medical school selection, In doing so, they may risk a haphazard, ill-informed or ill-equipped approach. Constraints to opportunities, more typically experienced by those from SNS schools, appeared to motivate the process of bricolage for a number of the applicants. Perversely, medical schools have introduced nonacademic requirements to level the playing field of disadvantage, yet applicants in this group appear to experience challenges as they prepare for selection.
Dear Editor, Medical errors are considered a common cause of patient mortality and morbidity despite all the efforts to improve patient safety. Physicians who have made medical errors may also experience harm afterward, which negatively affects their career and personal life. Not only can support be provided to these physicians, but also educating them to disclose their errors and implementing coping strategies can help decrease the negative impacts experienced. Second victims are health-care professionals who become distressed after encountering a patient-safety incident, an unintended event that could have resulted or has resulted in harm to a patient. The negative effects experienced following an error include physical symptoms (mainly fatigue, sleep disturbance, and tachycardia) and psychosocial symptoms (such as depression, frustration, and difficulty concentrating).[1] With the help of the Lebanese Society of Family Medicine, Lebanese family physicians were invited by the E-mail to participate in a self-administered online survey. The survey consisted of two parts: Demographics and the Second Victim Experience and Support Tool (SVEST).[2] The validated SVEST assesses the responses of second victim-related psychological and physical symptoms, the quality of support resources, as well as professional self-efficacy, turnover intentions, and absenteeism. We received a total of 35 responses, of which 17 disclosed committing a medical error. We found that participants scored the highest in the “psychological distress” subscale (3.17 ± 0.82), indicating that embarrassment, fear, misery, and remorse were common emotions experienced after an incident. Married physicians were more affected than single physicians, which may be explained by the responsibilities that marriage imposes and the added workload. Moreover, nonwork-related support provided the greatest amount of relief and satisfaction for participants. Conversely, institutional support was least preferred, possibly indicating that institutions do not offer proper support resources. An educational strategy which provides the opportunity for learning that is both empirical and collective is simulation. It is a technique used to substitute or intensify real-patient experiences with artificially guided experiences that replicate the essential aspects of the real world. This enhances patient safety and increases the level of education of health-care professionals, through using simulation in many forms such as virtual and simulated patients, interactive manikins, and screen-based simulations.[3] It is important to raise awareness of implementing more of these simulations to decrease the incidence of medical errors and to cope with a medical error that occurred. Another important point is that trainees need support and empathy to prevent harm to themselves from the errors. This is achieved by confidential counseling and faculty development programs, which highlight error disclosure and breaking bad news.[4] By implementing a handoff program, reductions in medical errors and preventable negative consequences were noted.[5] Medical institutions should implement a handoff program for their trainees to enlighten them on what to expect and how to cope and deal with a medical error. In conclusion, medical errors are sometimes inevitable and have a negative effect on physicians. We urge medical schools to provide students with appropriate simulations and programs to prevent, disclose, and cope with the medical errors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Background: Underrepresented minorities in medicine (URMM) may face financial and social limitations when applying to medical schools. The computer-based assessment for sampling personal characteristics (CASPER) test is used by many medical schools to assess the nonacademic competencies of applicants. Performance on CASPER can be enhanced by coaching and mentorship, which URMMs often lack, for affordability reasons, when applying to medical schools. Methods: The CASPER Preparation Program (CPP) is a free, online, 4-week program to help URMM prepare for the CASPER test. CPP features free medical ethics resources, homework and practice tests, and feedback from tutors. Two of CPPs major objectives include relieving URMM of financial burdens and increasing their accessibility to mentorship during the COVID-19 pandemic. A program evaluation was conducted using anonymous, voluntary postprogram questionnaires to assess CPPs efficacy in achieving the aforementioned objectives. Results: Sixty URMMs completed the survey. The majority of the respondents strongly agreed or agreed that CPP relieves students of financial burden (97%), is beneficial for applicants with low-socioeconomic statuses (98%), provides students with resources they could not afford (n = 55; 92%), and enables access to mentors during the pandemic (90%). Discussion: Pathway coaching programs, such as the CASPER Preparation Program, have the potential to offer URMMs mentorship and financial relief, and increase their confidence and familiarity with standardized admission tests to help them matriculate into medical schools.
Background: Due to the potential for improved team working and patient care, interprofessional education (IPE) is increasingly recognized as a core competency within the education of health-care professionals. Methods: In response to cancellation of the physician associate (PA) acute medicine clinical placement at our institution following COVID-19, a technology-focused, case-based IPE course between medical and PA students was implemented. The course consisted of 6 weekly seminars involving an average of 16 PA students, two medical students, and two supervising general practitioners. Course evaluation was mixed methods, comprising pre/postcourse questionnaires, weekly feedback forms, and postcourse e-mail interviews. Results: The course improved the confidence and perceived knowledge base of all participating students across every clinical topic covered, while promoting interprofessional collaboration and understanding. Discussion: To our knowledge, this represents one of the first IPE courses implemented between medical and PA students alone and has highlighted the need for further IPE courses between both professions. We show that successful IPE is feasible during a global pandemic, and that initiatives relying on technology alone are successful. Weekly written feedback was overwhelmingly positive, and based on the success of this course, faculty have planned further IPE opportunities between both professions.
Welcome to this issue of Education for Health (EfH). Contents include Original Research, Brief Communications, and Letters to the Editors from around the world. We continue to publish authors from a number of different regions. In this issue, there are contributions from Colombia, Ghana, India, Indonesia, Israel, and the United States. The topics covered in this issue include student empathy, faculty development, increasing research productivity in family medicine, student perceptions of the importance of nutrition education for patients, and the implementation of a system of student remediation. In this issue's first article, Chan et al. conducted a literature review to identify methods of anatomy instruction based on “conceptual, operational, technical, and economic feasibility.” The original research article titled “Approaches of Anatomy Teaching for Seriously Resource-Deprived Countries: A Literature Review” included more than 400 articles published between 2000 and 2014. Their findings provide directions that could be considered by any institution facing challenges in providing anatomy education, especially those with resource constraints. In the original research titled “The Human Kindness Curriculum: An Innovative Pre-Clinical Initiative to Highlight Kindness and Empathy in Medicine,” Shapiro et al. reported on their study of the effectiveness of a course in empathy. The authors studied whether a course in empathy would prevent the decline typically seen over the course of the medical curriculum. The researchers found that it was possible to prevent decline in empathy in the 3rd-year students, following implementation of a 12-h “human kindness” course with a clinical emphasis. In their brief communication article, Deshpande et al. studied implementation of an educators' portfolio with a number of faculty members from different disciplines (medicine, dentistry, and physiotherapy). The template was adapted from one used by a US university to an Indian context. Not surprisingly, study participants identified issues understanding how their work should be categorized. This study also showed that little was being done regarding activity effectiveness. While additional work needs to be conducted, the activity promoted self-reflection by faculty members. This reflection can facilitate additional faculty development activities, such as program evaluation and educational activity categorization. From Israel, Levkovich et al. have presented a method for incorporating research in a Family Medicine Program in Israel. The article details the methods used to instruct postgraduate students in research skills that are focused on family medicine practice. Short lectures are provided on line preceding classwork, allowing for more targeted discussions during face-to-face classroom work. Residents who showed interest and motivation went on to complete research projects. While additional research is needed regarding whether outcomes persist into practice, this work shows that incorporation of research training in the postgraduate curriculum increased research production throughout this Family Medicine program. In “Charting a Successful Course: The Academic and Clinical Success Committee's Impact on Student Success,” Diem and Hairell studied factors associated with successful implementation of a remediation program at a US medical school. The authors documented the challenges faced and the benefits of the program. They conclude that sufficient time is always a challenge and that finding faculty with time and the appropriate skill set was critical. In developing an infrastructure to support early identification of students at risk, the program has been able to match students with needed resources. An important part of this report was that the remediation program was implemented with available resources at a number of campuses. This can be of particular interest to those institutions where students are in a number of locations. The challenges of providing instruction in needed skills in an ambulatory-care setting were provided as study outcomes in the brief communication, “Checking In on Check-Out: Survey of Resident and Preceptor Continuity Clinic Patient Management Discussion Learning Priorities.” Covin et al. studied the degree to which postgraduate students and preceptors agreed on learning priorities during checkout with the attending physician. Their study found that preceptors emphasized physical examination more than other activities included in their 20-item survey, while residents' learning goals included all elements in the survey. The authors suggest that additional faculty development for clinical preceptors may help to improve alignment between preceptors' teaching and residents' learning goals. From Ghana, Mogre et al. studied the views of future doctors regarding the provision of nutrition education and support to patients. In this qualitative study titled “Future Doctors' Perspectives on Health Professionals' Responsibility Regarding Nutrition Care and Why Doctors Should Learn about Nutrition,” the authors found encouraging news regarding medical students' intentions to be the first point of contact, providing education, and monitoring. They recognized the role of physicians in patient care and the connection between nutrition and chronic disease. While this is encouraging news, it will be important to follow-up this study with one that measures the extent to which physicians provide nutrition education and support to their patients in practice. Changes to curricula are often accompanied by changes in assessment of trainee ability. Prof. Michael Vassallo et al. have reported on their efforts to measure entrustable professional capabilities (EPCs) in their brief communication titled “An Objective Structured Clinical Examination in Comprehensive Geriatric Assessment.” They found that the station was related to the overall score, but the correlation was low enough to suggest that the scenario measured something different. The article reports psychometric characteristics of the station, and the outcomes suggest a successful implementation of the use of EPCs in station design. Four Letters to the Editor are included in this issue. First, a report on an educational symposium “Report from the 2017 Sino-US Medical Education Symposium in Wuhan, China,” is provided by Lukas et al. Next, Susanto et al. reported work in Indonesia in “Breast Self-Examination Education for Skill and Behavior.” From Colombia, we have “Trauma Care Teaching in Colombian Medical and Nursing Schools: A Training Curriculum Analysis” from Rubiano, Montenegro, and Lozano. Moreover, in the fourth letter, Nikose has reacted to a previously published EfH article “Inclusion of Basic Vitreoretina Training in Indian Ophthalmology Residency Programs.” In this issue, we acknowledge the loss and celebrate the contributions of Daniel Blumenthal and David Sanders. Both played important roles in community health. Please let us know which articles are most meaningful to you as you continue your work in health professions education.
Background: The mandate of medical schools is to enrich the health system through education, research, and service to satisfy the health needs of the societies they serve. The social accountability (SA) movement aims to intensify the medical school's mission. Although the context of every school is unique, one of the increasingly significant roles of medical education is to develop the indicators that promote SA. The aim of this study is to define the determinants of SA in Iraq using AlKindy College of Medicine/University of Baghdad, Baghdad, Iraq as a case study. Methods: This is a qualitative research using open-ended questions through an online mode; data were analyzed using the content analysis technique. Results: Different themes related to the roles of medical schools, stakeholders, medical schools' mission, curriculum content, research characteristics, service characteristics, enhancers of SA, and accreditation role were identified. The themes are meant to characterize a socially accountable medical school within the context of Iraq. Discussion: The study needs to be replicated in different medical schools to successfully build the national determinants of SA.
The impact of communication and anxiety on Doctor of Pharmacy students across three measures was examined. Data were collected (N = 120) from 4th-year Doctor of Pharmacy students at a historically black college/university using the Interprofessional Socialization and Valuing Scale, the Personal Report of Communication Apprehension, and the Social Phobia Inventory. Results of Rasch Differential Item Functioning Analysis indicated statistically significant differences between each ethnic group on subcomponents of anxiety in each measure (20% Caucasian, 43% African American, 31.7% Asian, and 4.2% others). Evidence from this study shows that racial demographics affect different subscales of anxiety across doctoral pharmacy students. While some pedagogical implications exist, issues within the measures and their items must also be addressed.
Background: Medical student placements in teaching hospitals are a cornerstone for gaining clinical experience. However, the ever-evolving nature of health care has also changed the delivery of student education. Few studies have examined clinicians' perspectives toward teaching students in this setting. We sought to explore the attitudes of clinicians involved in teaching medical students at an Australian tertiary hospital. Methods: Clinicians were invited by email to complete an anonymous online survey developed using a combination of questions from previously validated surveys. The questions utilized 5-point Likert scale statements and were based around the themes of "personal purpose and enjoyment of teaching " and "barriers and challenges to teaching. " Results for each question are presented as frequency and percentage. Results: Of 490 invited, 67 (13.7%) consultant clinicians from various specialties responded. The majority (> 92%) enjoy teaching and see it as part of their work. However, approximately half thought that medical student teaching was under-recognized and half did not have adequate time to teach due to workload. Approximately 60% responded that there was insufficient time to get to know students to provide feedback and approximately 40% indicated that the scope of student knowledge and desired outcomes are not clearly defined by medical schools. Discussion: Our contemporary survey identifies modifiable factors which should be targeted. If these factors are addressed successfully, it may allow the hospital and university medical school to harness the valuable resource of clinical teachers. This could enhance the medical student experience and promote a culture of teaching and learning in hospitals.
Dear Editor, The COVID-19 pandemic has forced us to change traditional ways of teaching and learning in medicine. In a fluctuating time and situation, teachers and students have adopted various combinations of face-to-face (F2F) and online learning modes for maintaining educational activities.[1] In other words, blended learning has currently been widely adopted as a practical educational strategy. As medical educators, we reflect on our first trial of blended teaching in an English-medium instruction (EMI) regional anatomy course during spring term 2020 and investigate the Chinese medical students' learning outcomes and their attitudes toward this blended learning. A recent meta-analysis study[2] statistically reviewed over 50 articles about blended learning in health professions and concluded that blended learning appeared to be more effective or, at least, as effective as nonblended instruction. This echoes the many recent studies in medical education that distributed learning systems (i.e., distant learning approaches) could not solely work, and suggests a combination of distributed and F2F learning systems to ensure learning efficiency[3,4,5]. Within this context, in our case, the first 12 weeks of teaching were remote teaching through online platforms; the following 6 weeks and the final assessment went back to an on-site mode where the students had practiced anatomical skills in the gross anatomy laboratory under the teacher supervision. We compared the average scores in the final assessment (the anatomical specimen test and the multiple-choice questionnaire (MCQ) part in the written examination) between the target EMI (N= 24), parallel Chinese-medical instruction (CMI), (N= 48), and previous EMI of 2010 (N= 25). Multiple sessions of group interviewing with the students provided an in-depth reflection of their attitudes toward blended learning. The main findings demonstrated that although the university and teachers adopted multiple methods to maintain educational activities, the students preferred the contact learning mode because it was easy to concentrate on and obtain hands-on experience in the laboratory classroom, which is fundamental to anatomy education. Regarding EMI teaching, the students felt that the bilingual teaching and assessment contained fewer English elements than usual. In other words, due to the uncertainties caused by the pandemic, the teachers had to compromise teaching in English and focus on content teaching. In addition, analysis using the SPSS software (version 16.0) indicated that the COVID-19 outbreak negatively affected the target EMI students' academic performance. Specifically, the average scores of the target EMI class in both the anatomical specimen test and the MCQ part were lower than that of both parallel CMI and previous EMI counterparts. A possible explanation might be that the students lack adequate self-discipline and time management skills to accommodate blended learning. As the university had adapted its instructions according to the changing pandemic circumstance, there was not sufficient time for teachers and students for learning preparation and adaptation. Finally, fluctuating emotional status could negatively affect students' learning efficiency. Overall, it is imperative that universities and schools provide mental health support to meet the students' needs. Further research could usefully explore the methods that facilitate students to cultivate self-discipline and improve their time management skills to accommodate blended learning under such circumstances. Financial support and sponsorship This study was financially supported by the Natural Science Foundation of Guangxi Province (2018GXNSFAA281299), the National Natural Science Foundation of China (81460479), and Guangxi Medical University (2019XJGQYB01). Conflicts of interest There are no conflicts of interest.
Background:High maternal-neonatal mortality rate in the East Nusa Tenggara Timur Province, Indonesia, has raised a concern about improving quality health care and prevention. A task force team consisting of the district health office and the corresponding hospital implemented an interprofessional peer mentoring for improving maternal-neonatal health initiative involving various health professionals and community members. This study assesses the effectiveness of the interprofessional peer-mentoring program in improving health-care workers' capacity and community members' awareness of maternal-neonatal health in the primary care setting.Methods:A mixed-methods action research was conducted to measure the effectiveness of the peer-mentoring program. The task force appointed 15 personnel to be trained as peer mentors for 60 mentees from various professions. Peer mentors' perceptions of knowledge and skills improvement were measured before and after the training program. A reflective logbook was then developed to document mentoring activities. Surveys and logbook observations were performed to measure the effectiveness of the 8-month peer-mentoring program. Mentees' capacity and perception were measured before and after the mentoring program. Quantitative data were analyzed using the descriptive statistics and Wilcoxon's paired-rank test, whereas open-ended responses and log-book reflection were analyzed using the content analysis.Results:The peer-mentor training program improved peer mentors' knowledge and readiness from 3.64/5.00 to 4.23/5.00 (P < 0.001). Moreover, mentees viewed the program as effective in improving self-confidence and working capacity in maternal-neonatal health services from 3.47/5.00 to 3.98/5.00 (P < 0.001). Open-ended responses and a reflective logbook revealed that both mentees and peer mentors gained positive learning experiences. Seniority might become an obstacle to the mentoring process since peer mentors reported barriers in engaging elderly mentees due to seniority issues.Discussion:The interprofessional peer-mentoring program was effective in improving both mentors' and mentees' knowledge, self-confidence, and working capacity in maternal-neonatal primary health services and experiential learning. Further observation of the long-term outcomes of the program should be undertaken.
