Letter
Open Access

Student-Based Clinical Training

Mojtaba Dayyani[1], Farzaneh Barzkar[2], Mozhgan Afkhamizadeh[1]

Institution: 1. Faculty of Medicine, Mashhad University of Medical Sciences., 2. Faculty of Medicine, Zahedan University of Medical Sciences.
Corresponding Author: Dr Mojtaba Dayyani ([email protected])
Categories: Curriculum Planning, Learning Outcomes/Competency, Students/Trainees, Teachers/Trainers (including Faculty Development), Teaching and Learning
Published Date: 17/08/2018
Keywords: Medical education; Problem-based learning; curriculum; Medical students; Clinical training.

Letter

Some studies have demonstrated the fundamental role of medical education and training systems in the development of physicians’ performance and consequently the quality of health services in various societies. (Davis et al., 1999)

 

Problem-based learning (PBL) has been introduced as an interactive method of clinical training, but its efficacy and adoption in different countries with different levels of facilities, human resources, and economic states is still an administrative concern. (Koh et al., 2008)

 

In Mashhad University of medical sciences, Iran, a couple of volunteer medical students have founded a group called: Students’ Educational Advisory Committee (SEAC). The principal goal of SEAC is to improve the quality of medical training through running appropriate research projects and having consultation meetings among faculty members and students. Additionally, organizing pilot studies for educational projects, holding seminars about medical education and last but not the least acting as a mirror for reflecting gaps of the contemporary system to the faculty for optimization of the curriculum are further examples of SEAC assignments.

 

As a successful educational experience, we introduced a new training plan called: "Student-Based Clinical Training" (SBCT) which is based on PBL, with some differences.

 

A standard case problem is designed or selected by an educator to be presented to the 4th year medical students by a tutor who is also a volunteer student because we all know that todays’ students are tomorrows’ professors.

 

Students are asked to organize small groups for having a consultation, searching online, and making the differential diagnosis. The official language of the sessions is English so that the students are familiarized with the conditions of scientific gatherings. When the diagnosis is made through discussions in groups, a quick review of principal points is presented by the tutor. All of the processes are under the direct supervision of a professor who is a specialist in the field of discussion. Having a totally student-centered atmosphere for dynamic learning is one of the most remarkable points of this method.

 

In this pilot project after a three-month course at the Internal medicine ward of Imam Reza Teaching Hospital, Mashhad, Iran, both students, and educators were asked about the efficacy of the course. Interestingly, 97.5 percent of the students and all of the professors answered that SBCT is much more efficient than traditional methods, and all of them agreed to continue this plan. These results are firmly in the same line with some prior studies that assessed participants’ satisfaction regarding the problem-based learning method. (Berkson, 1993; Vernon and Blake, 1993; Newman, 2003)

 

Following the implementation of this pilot project, we think providing a constructive atmosphere between faculty and students builds the basis for making impossible changes, possible.

 

In this experience, with the assistance of medical students, we could diminish the limitation of time, budget and workforce concerning the implementation of a new method of clinical training. Furthermore, giving the opportunity of being a tutor may improve teaching and communication skills of the students who are thinking about their potential future roles in the field of medical education.   

 

We believe that regardless of economic state, medical students have extraordinary potentials to improve the quality of the training systems; utilizing trusted pieces of evidence, creativity, teamwork, and hope for change.

Take Home Messages

  • Student-Based Clinical Training is introduced as a modified form of PBL.
  • A volunteer student takes the responsibility of being tutor under the supervision of an expert, which reduces the workforce and time for the educational system.
  • Entirely student-centered learning provides a dynamic atmosphere of learning while it’s an opportunity for those who are thinking about their future roles in the training systems.
  • This method might be an effective way of training in the countries with limited resources.
  • The contribution of the faculty and students is vital for making changes in the training system and thrives the potentials within students.

Notes On Contributors

Mojtaba Dayyani is a Neurosurgery Research Assistant at the Department of Neurosurgery, Ghaem Teaching Hospital, Medical faculty, Mashhad University of Medical Sciences, Mashhad, Iran.

Farzaneh Barzkar is a Medical Student at the Student Research Committee, Medical Faculty, Zahedan University of Medical Sciences, Zahedan, Iran.

Mozhgan Afkhamizadeh is an Assistant Professor of Endocrinology at the Department of Internal Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Acknowledgements

None.

Bibliography/References

Berkson, L. (1993) 'Problem-based learning: have the expectations been met?', Acad Med, 68(10 Suppl), pp. S79-88. https://doi.org/10.1097/00001888-199310000-00053

Davis, D., O'Brien, M. A., Freemantle, N., Wolf, F. M., et al. (1999) 'Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?', JAMA, 282(9), pp. 867-74. https://doi.org/10.1001/jama.282.9.867

Koh, G. C., Khoo, H. E., Wong, M. L. and Koh, D. (2008) 'The effects of problem-based learning during medical school on physician competency: a systematic review', CMAJ, 178(1), pp. 34-41. https://doi.org/10.1503/cmaj.070565

Newman, M. (2003) 'for the Campbell Collaboration Systematic Review Group on the Effectiveness of Problem-based Learning', A pilot systematic review and meta-analysis on the effectiveness of problem based learning. Newcastle upon Tyne, UK: University of Newcastle upon Tyne.

Vernon, D. T. and Blake, R. L. (1993) 'Does problem-based learning work? A meta-analysis of evaluative research', Academic medicine, 68(7), pp. 550-63. https://doi.org/10.1097/00001888-199307000-00015

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This pilot project was not reviewed by our institutional review board, but we followed the Declaration of Helsinki (2013) and obtained informed consent from the participants.

External Funding

This paper has not had any External Funding

Reviews

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Mohamed Al-Eraky - (28/08/2018) Panel Member Icon
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That’s a nice initiative to establish, what’s called: Students’ Educational Advisory Committee (SEAC) to promote self-directed learning (SDL) and peer-assisted learning (PAL) among medical students. Perhaps it’s more towards directed-self learning (DSL), because the standard case problem was designed or selected by educators and the discussions on the differential diagnosis was supervised by clinical experts, as the authors indicated. That’s fine.

I agree with Trevor that this may be more into case-base learning, not PBL. Anyway, PBL may take different shapes and flavours. Evidence supported that there is no such thing as standard PBL formula. The authors need to explore which ‘flavour’ of PBL may suit in their culture. I would assume that Iranian students in an oriental context may need more guidance from tutors. Authors may investigate more about this point in my Letter: The Cultural Flavours of PBL … in Medical Education journal.

Al-Eraky M. The cultural flavours of problem-based learning. Med Educ [Internet]. 2013 Oct [cited 2014 Dec 21];47(10):1049. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24016176

Thank you.
Trevor Gibbs - (17/08/2018) Panel Member Icon
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An interesting letter about creating an active learning methodology. As a purist when it comes to PBL, I would not say that this is PBL -based but follows a more case-based learning activity
With a little bit of effort, this letter could be turned into a paper, that describes this active learning method. It needs more theory to be based upon, and a much more descriptive evaluation, that is taken over a longer period of time and looks in depth at the internal values and feelings as well as the clinical learning outcomes. I look forward to reading that paper