Category: Articles

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Original Research Articles

Onsite and offsite use of computer aided learning in undergraduate radiology education

Aim: Computer-aided learning (CAL) is considered comparable to traditional media for undergraduate radiology teaching. Previous studies have often compared the efficacy of traditional media to onsite CAL use, yet real world usage of CAL is likely to occur in offsite settings. This study aims to compare usage and learning outcomes of a chest radiology CAL in onsite and offsite settings. Methods: Participants were fourth year medical students (n=52) at the National University of Singapore (NUS) undertaking one week radiology rotations. Students were randomly allocated to complete a web-based chest radiology CAL onsite, or offsite at a time and place of choice. Pre- and post-tests were taken to measure knowledge gain, and a questionnaire was used to explore student usage and preferences.

Results: The onsite CAL group demonstrated significant knowledge gain (+15.8%, p<0.05) whilst the offsite group did not (+5.8%, p>0.05). However, the difference between the groups was not statistically significant (p=0.069). Total time spent and completion of the program was similar between the two groups. Yet, questionnaire results showed that the offsite group multitasked more and appeared to have poorer concentration. A majority of students from both groups preferred the convenience of offsite CAL use over onsite CAL use.

Conclusion: A significant difference between the test groups was not observed, although there was a trend toward onsite CAL use being more effective. In planning CAL teaching, particularly for offsite use, educators need to provide sufficient support and integration for an optimal outcome.

Introduction

Chest radiology is important for acute and emergency management, and is therefore an essential learning component of undergraduate radiology teaching. [1] However, studies show that chest radiology competency amongst graduating medical students is poor. [2,3] Poor competency is attributed to lack of formal teaching of radiology in the curriculum. [2,3] Worldwide, radiology teaching is compromised by limited formal teaching in a hectic curriculum, and competing demands on radiologists. [4,5]

Computer aided learning (CAL) has been advocated as a potential tool to alleviate some of the limitations in radiology teaching. [6] CAL is time and cost effective for educators, [7] and especially useful in an image rich specialty such as radiology. To evaluate the effectiveness of CAL for transferring knowledge gain, previous studies have undertaken media comparisons between CAL and traditional learning, such as lectures or tutorials. Individual studies in radiology and non-radiology medical education [8,9] demonstrate that overall, knowledge gain with CAL is comparable to …

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Letters

The justice of melancholia

In a previous issue of this journal, Nguyen [1] succinctly identified a high incidence of mental health conditions in Australian medical students.

The increased rates of depression and suicidal ideations experienced by this population depict a bleak future for the medical profession in this country. Of great concern is the fact that the barriers preventing medical students from accessing support are not only unique, but despairingly fraught with immeasurable difficulty and stigmatisation; stigma that is entrenched and perpetuated through the core of the medical culture. [2] Despite our existence in an apparently enlightened and diverse cultural framework, the disconcerting stigma branded upon mental health exists and it is truly deplorable…

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Letters

Mental illness and medical students

The recent article by Nguyen in AMSJ Vol 2, Issue 1 [1] raises several interesting points for discussion regarding the mental health of medical students.

In recent years, the mental well-being of medical students has received increasing publicity and coverage. This was previously a somewhat taboo topic within the medical community, but it has transitioned to become an issue that is now widely discussed and debated amongst students, faculty and the wider medical community. The outcome has been fruitful with a multitude of new initiatives highlighting the importance of mental health in health professionals. Nevertheless, there continues to be a worrying disparity in the prevalence of mental illness between medical students and the wider Australian population.

Nguyen outlined key factors that could contribute to this problem, including the fact that the medical course inflicts on students immense stressors including an overwhelming workload, rigorous examinations and lofty aspirations. [2,3] There is no doubt that this places an increasing burden on medical students. However, it must also be acknowledged that medical students generally have limited constructive coping strategies to deal with such stressors in the first place. Consequently, this may lead to a downward spiral involving concomitant behavioural problems; for example, excessive alcohol intake and the use of recreational drugs. [4]

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Letters

National standards in medical education: Being accountable and striking a balance

The recent suggestions of a national curriculum and a national examination have created important discussions about Australian medical education and its future. [1-2]

The debate surrounding their merits and disadvantages is likely to remain ongoing without reaching a consensus amongst all involved stakeholders. [3] With the significant increase in the number of medical graduates and heterogeneity of current and future medical curriculum and programmes, [4-5] there is an urgent need for regulatory authorities of medical practitioners (such as the Medical Board of Australia and the Australian Medical Council (AMC)) to ensure all Australian medical graduates have reached agreed standards of delivering adequate and safe patient care. [6]

One of the most practical and effective measures that can be immediately taken by the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the competencies set out in their curriculum or programmes. [7] It will also provide opportunities for the AMC to maintain the national agreed standard for Australia. [8] The current key issues here are social accountability and patient safety, both of which are extremely important topics amongst the Australian medical education community and all state health services. [9]

The annual external review and audit of final examinations can also strike a balance, allowing medical schools to maintain autonomy over curriculum development,the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the provided they can demonstrate that their graduates meet the national agreed standard.

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Editorials

In and out in four hours: The effects of the four-hour emergency department target on patients, hospitals and junior doctors

Introduction

In the eyes of the general public, a hospital’s Emergency Department (ED) is synonymous with overcrowding and tedious waiting. Keen to change this, last year, at the meeting of the Council of Australian Governments, the states ratified a National Partnership Agreement on health reform. One controversial outcome of this agreement was the four-hour National Access Target (NAT), which requires that all patients that present to EDs will need to be admitted, discharged or referred within four hours, if clinically appropriate. [1-3]

The new targets are currently being phased in, beginning with life-threatening triage 1 cases, but the true impact of the plan is unlikely to be felt until 2015, when non-urgent triage 5 cases will also be required to meet the target. Under the terms of the agreement, if 95% of patients within a particular Australian state are seen within the four hour target, that state will be awarded extra funding out of a national pool of $250 million over the next four years. [2]

The introduction of the NAT has been met with several questions. Does putting a time limit on patients in the ED jeopardise their safety due to rushed management decisions? Is it realistic that this target can be met when there are so many factors impeding efficient patient assessment? How will you be affected when you work against the clock in the coming years?

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Editorials

Crossing boundaries – the expansion of the AMSJ

Some staff of the AMSJ. Clockwise from left: Patrick Teo, Timothy Yang, Matthew Schiller, Chris Mulligan, Praveen Indraratna, Aaron Tan, Alexander Murphy, Grace Leo, Veronica Lim and Helena Jang.
Some staff of the AMSJ. Clockwise from left: Patrick Teo, Timothy Yang, Matthew Schiller, Chris Mulligan, Praveen Indraratna, Aaron Tan, Alexander Murphy, Grace Leo, Veronica Lim and Helena Jang.

From treating acute blood loss in children to palliative care barriers for the elderly, this issue truly showcases the enormous potential and diverse interests of Australian medical students. Our authors have not been afraid to address controversial issues such as emergency department waiting times, healthcare financing and comparisons between barrier exams across Australian medical universities. We are also privileged to be sharing the insights of four remarkable professorial guest authors. Former Australian of the Year recipients Fiona Stanley and Ian Frazer shed light on future directions of research; the IVF and stem cell research pioneer Alan Trounson reflects on progress in his field and Alden Harken, Professor of Surgery at the University of California San Francisco reminds us how fortunate we are to be in medicine.

 

A core focus of the AMSJ is to become a national journal, that is, one which represents fairly and equally the academic and research achievements of students Australia-wide, without ties to a particular university. The journal has expanded widely in recent months, our current editorial team now spans four states, and we are moving towards full nationalisation of our staff for future issues. Meeting our readers is also a key priority in shaping a national journal, and we were very pleased to hear many positive comments and suggestions from those who attended the AMSA National Convention and Global Health Conference in July.

One of our exciting new initiatives is the AMSJ Blog, updated regularly at our website: www.amsj.org/blog. Authored by staff members, it provides personal perspectives on medical student life, with articles ranging from practical educational posts to lessons learnt outside the hospital, and tackling the bigger questions we all ask ourselves from time to time (‘So you don’t want to be a doctor anymore?’). We hope you take a look at this terrific new forum for student participation.

As always, support for the AMSJ across Australia’s medical schools has been extraordinary, with the free print copies being in huge demand. Remember that you can download the entire journal for free from our website. Articles from the AMSJ will soon be available on the EBSCOhost database and have gained interest from other major academic research databases and indexing systems. We have also had the pleasant ‘problem’ of reaching our friend limit on Facebook and are switching to a new AMSJ Facebook page: www.facebook.com/amsj.org so please make sure you visit and click ‘Like’ to stay up-to-date!

The journal is a massive undertaking, and we are grateful to have a wonderful and dedicated volunteer staff of medical students and peer-reviewers who work very hard to make this journal a success. Of course we also thank you, our readers, for welcoming and supporting us as the AMSJ continues to display the research abilities of Australia’s medical students.

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Review Articles

Prevention of rheumatic heart disease: Potential for change

Rheumatic heart disease (RHD), an autoimmune reaction to an infection of rheumatogenic group A streptococcus bacteria, is characterised primarily by progressive and permanent heart valvular lesions, although other parts of the heart may be affected. Despite an overall decrease in the incidence of RHD in developed countries, it remains a pertinent health issue with high rates in developing countries and amongst certain Indigenous populations in industrialised countries. Primary, secondary and tertiary strategies for the prevention of rheumatic heart disease exist, as do numerous barriers to such strategies. A review of the literature, incorporating its epidemiology and pathophysiology, demonstrates that interventions at various stages of the disease may reduce the collective burden of disease.

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Feature Articles

Should artificial resuscitation be offered to extremely premature neonates?

Introduction

“‘Change’ is scientific, ‘progress’ is ethical; change is indubitable, whereas progress is a matter of controversy.” – Bertrand Russell

Forty years ago it was generally accepted that a baby born more than two months premature could not survive. Now neonates as young as 22 weeks can be kept alive with medical intervention. This essay will explore the medical, social and legal aspects of artificial resuscitation of extremely premature neonates and argue for a change to a palliative approach towards infants born at the threshold of viability.

Background

Extremely premature newborns face a number of medical problems, affecting almost all systems of the body. These problems include extreme skin immaturity and fluid balance instability, lung immaturity and breathing problems, malnutrition and gut damage, retinopathy of prematurity, early and late onset infections and brain damage which can lead to a spectrum of long-term neurological sequelae. [1,2]…

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Feature Articles

Photograph: Tumaini


This photograph was taken during a four week elective placement at Ilula Lutheran Hospital, located in the southern highlands of rural Tanzania, East Africa. It emphasises the innocence and resilience of this country’s generous, kind people.
Ilula Lutheran Hospital is a 70-bed facility with a geographically broad service area. Patients often travel long distances to seek attention at the facility, and present most commonly with conditions such as malaria, complications of HIV, malnutrition, trauma, burns, respiratory and diarrhoeal illnesses, often in their advanced stages.
This photo was taken while visiting a village on an HIV outreach clinic. Nurses and doctors attend villages monthly to diagnose new patients, dispense anti-retroviral therapy and perform general check-ups. The rate of HIV infection in the Ilula area has not been accurately measured; however, the infection rate has been estimated at approximately 20% in the general community and 50% amongst hospital inpatients. The day this photo was taken, the nurses and doctors were helping villagers form a support group to facilitate communication between them and the hospital, to encourage new patients to seek help and to give existing patients a support network to aid with compliance. This little boy was shy as he hid behind the skirt of his HIV-positive mother. The support group was named Tumaini – hope.

This photo was the winner of the 2011 Medical Students’ Aid Project photo competition. MSAP is a not-for-profit organisation run by medical students from the University of New South Wales. MSAP’s goal is to send targeted aid to developing world hospitals visited by UNSW medical students on their elective terms. This is done through collecting donations of equipment from hospitals and doctors around the state, as well as fundraising to purchase additional equipment and arrange for delivery of these supplies. To ensure that the equipment sent is appropriate and useful, the hospitals are asked to compile a “wishlist” of required supplies. In addition, MSAP also educates medical students on issues associated with global health throughout the year. To find out more, and how you can help, visit www.msap.unsw.edu.au today!

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Feature Articles

Markets and medicine: Financing the Australian healthcare system

Introduction

In early 2010 the Commission on the Education of Health Professionals for the 21st Century (the Commission) convened to outline a strategy for advancing healthcare towards a system that provides “universal coverage of the high quality comprehensive services that are essential to advance opportunity for health equity within and between countries.” [1] The strategy focuses on the education of health professionals to empower their capacity as agents of social transformation. [1] This paper endeavours to encourage medical students to think critically and ethically about the consequences of different modes of health finance on the equity of the Australian healthcare system. In doing so, it contributes to this project of health professionalism in the 21st century.

Health finance may seem of little relevance to aspiring or practicing health professionals. However, it is an important determinant of how and to whom medical services are delivered and a critical aspect of Australia’s response to the increasing resource demands of the healthcare system. Rising costs are attributable to a variety of trends including innovative but expensive technology, an ageing population, and increasing prevalence of lifestyle associated disease. Policy makers continue to debate the most effective funding methods to achieve effective use of resources, quality services and equity within the healthcare system…