Relieving total pain in an adolescent:a case report

Background: Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it.Case presentation: A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan.Conclusions: This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.</p

A small group learning for evidence-based medicine in pre-clinical medical students:EBM in pre-clinical medical students

Background Evidence-based medicine (EBM) is the application of current, best-available clinical evidence to health care decisions for individual patients. Many medical schools put EBM courses in their curriculum as they considering it is important. However, to teach the EBM course in pre-clinical year medical students is challenging owning to their clinical inexperience. Methods A prospective study of the third-year medical students of Walailak University located in the southern part of Thailand. They participated in a two-week course of evidence-based medicine. The effectiveness of the course organization was assessed by percentage of students whose scores reached the minimal passing level and using pre-study and post-study self-reported evaluation. Results The percentage of students whose scores reached the minimum pass level (70%) was 100%. The scores are normally distributed with a mean of 88.59 (SD 3.33). Self-reported evaluation of knowledge and skills increased 4.28 scores (SD 2.06, p-value &lt;0.001) and 4.24 scores (SD 2.08, p-value&lt;0.001), respectively. Conclusion Using small group learning for evidence-based medicine in pre-clinical medical students achieved remarkable learning outcome regardless of clinical experiences. However, the role of the facilitator was of crucial importance as student learning depended on the facilitator's proper guidance and evaluation in the small group sessions

A narrative review of facilitating and inhibiting factors in advance care planning initiation in people with dementia

Purpose of the review: To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD).Methods: A narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussion. Results: Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP. Conclusion: This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics.</p

Retained mind mapping skills and learning outcomes in medical students:a mixed methods study

Background: Mind maps (MM), is a learning method assisting learners in the visualisation of relationships betweentheoretical concepts. Studies also showed enhancement of data retention, overall comprehension, and creativity inMM users. Thus, MM has been implemented in many medical schools to facilitate medical students’ learningexperiences. Nevertheless, retained mind mapping skills and its effect on the learning outcomes in long-term followupremain unknown. Methods: A concurrent mixed-methods design with convenient sampling method. All (48) second-year medicalstudents joined a three-day MM workshop. One year later, we surveyed the students who still use MM and thosewho did not. Mind Map Assessment Rubric (MMAR) and Grade Point Average (GPA) were compared between twogroups. Content analysis with data triangulation method was used to explore their preferences and MM skills.Results: We achieved a 100% response rate. 39 (81.2%) of participants were female. The mean age of participantswas 20.6 years (SD = 0.5). 37 students still use MM (77.1%). With MMAR, participants in MM group scored 28.9higher than participants in MM-free group significantly (p = 0.01). There were no differences in the median GPAs toboth groups. However, there was a significant correlation between using MM in learning and the second trimester(year1) (r=0.29, p&lt;0.05). Majority of participants in MM groups stated the advantages of using MM as a toolhelping those organising data and their thought process. On the contrary, students in MM-free group declared thedisadvantages of MM as a time-consuming and missing data from lectures. Conclusions: Without revision in MM, participants’ skills deteriorated immensely. There was a non-statisticallysignificant trend toward increased learning outcomes with MM group. Further studies to examine whether morefrequent MM use or workshop revision can boost their learning outcomes or not is recommended

Reflective and feedback performances on Thai medical students’ patient history-taking skills

Abstract Background Reflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated. Methods In this retrospective study, we assessed RP and feedback performances on Thai medical students’ patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students’ reflective performance and categorised them into one of the six stages of Gibbs’ reflective cycle; their feedback performances were analysed using Pendleton’s model. We investigated the correlations between students’ overall grade point average (GPAX) and patient history-taking scores on the Objective Structured Clinical Examination (OSCE). Students’ opinions of the RP teaching method were also collected. Results All (n = 48) students participated in our study. The students’ mean age was 21.2 ± 0.5 years. The majority of the students were female (64.6%). The data indicated that 33 and 4% of the participants were categorised into the evaluation stage and action plan stage of Gibbs’ reflective cycle, respectively. In addition, 22 and 15% of the participants were able to state what their peers did well and suggest how peers could improve their skills, respectively. All students passed the minimum passing level of four history-taking OSCE stations. Participants agreed that RP was a useful tool (mean 9.0, SD 0.1), which enhanced their thought processes (mean 8.4, SD 0.2) and future performances (mean 8.2, SD 0.2). However, there was no correlation between the students’ highest Gibbs’ reflection levels and their history-taking OSCE scores. Conclusions RP, together with feedback, proved to be a useful technique to help fourth-year Thai medical students improve their reflection skills, enhance their medical knowledge, and improve patient history-taking skills. Further study with longer monitoring is required to further explore negative and positive influential factors affecting students’ achievement of better reflection performances

Perception of Advance Directive in Thai Women with Cancer:A Qualitative Study

Advance Directive (AD) is a medical agreement to ensure that patients’ autonomy is respected. In Thailand, there has been Health Act Legislation to promote the use of a living will, a form of AD, since 2007. However, there is no assessment of its practicability yet. The objective of this study was to explore perceptions and attitudes to living wills by women who were diagnosed with cancer. We conducted semi- structured interviews using a purposive sampling method. Fifteen patients at the gynaecologic oncology clinic from January 2014 to April 2015 joined the study. Participants were instructed to read the living will document designed by the Thai National Health Security Office (NHSO) and asked about 3 aspects; awareness of and attitude towards living wills, comprehension of the document, and decision-making. Final codes were analysed using investigator and data triangulation methods along with content analysis. All participants were in the early stages of cancer. Five women were diagnosed with breast cancer, 7 with cervical cancer, and 3 with ovarian cancer. None of them had heard of living wills before. Three themes emerged; 1) Participants felt overwhelmingly positive about the idea of making an AD with a living will. 2) The document was too complicated for participants. 3) Past experiences about death and terminal illness played a major role in decision-making regarding AD. In conclusion, larger scale assessment of AD in Thailand is recommended. Living wills may be useful tools for making AD in women with cancer but they need to be simplified

Challenges in Problem-Based Learning and Suggested Solutions at the School of Medicine, Walailak University:A Mixed-Methods Study

Background: Problem-based learning (PBL) was used in basic and clinical sciences learning in an integrated approach. Despite its implementation into medical curricula around the world over four decades ago, group dynamic issues in PBL are still abundant. To date, there is no publication addressing the difficulties in PBL for Thai medical students.Objective: To explore difficulties in PBL and suggest solutions at the School of Medicine, Walailak University.Methods: A sequential explanatory mixed method was employed using the triangulation method to get the information from students, facilitators, and a medical curriculum expert. Anonymous online survey data from students emphasised barriers to PBL and respondents’ suggestions. Content analysis was performed on written feedback from facilitators. Finally, a researcher performed a semi-structured interview with a medical curriculum expert. Data were collected throughout the academic year 2016.Results: A total of 83 (86.5%) medical students responded to the survey, 58 students (69.9%) reported no difficulties in their learning process; 25 students (30.1%) disclosed challenges in learning. Facilitators’ feedback was collected from a total of 23 PBL sessions. Factors affecting the PBL process included facilitators’ characteristics, course organisation, and learning environment. Favourable characteristics for facilitators included thinking process support (28.7%), appropriate and constructive feedback (27.9%), listening skills (24.3%), safe environment (14.0%), and being concise (5.1%).Conclusions: Three major factors contributing to PBL difficulties among Thai medical students were facilitator’s quality, course organisation, and learning environment. Hence these factors should be optimized to allow students to achieve the best learning process and outcome

Correlation of the scores on different comprehensive examinations and the Medical Competency Assessment Test for National License:a mixed methods study

Introduction: In-house comprehensive examinations for preclinical students from various Thai medical schools were provided. However, their quality has never been evaluated with a score correlation with NLE as the gold standard. This study aimed to assess the correlation of the scores as determined by three different comprehensive examinations and national license examination 1 (NLE step I) and to identify the positive learning strategies.Method: A mixed methods sequential explanatory study was done to investigate the performances amongst four tests and to identify the potential factors affecting those scores using semi-structured interviews and focus groups with content analysis.Result: All (n = 48) third-year medical students participated in our study. The majority were females (64.6%). Significantly positive correlations of NLE scores were: test A scores (r = 0.86), test B scores (r = 0.85), and WU test scores (r = 0.78). The highest accuracy index (AI = 0.87) was the WU test, where sensitivity, specificity were 20.0% and 97.1%, respectively. The WU test revealed that it was most helpful in preparing them for the NLE. Students who passed the exam used three study strategies; group study, tutorial sessions, and review by themselves.Discussion and Conclusion: There were strong positive correlations between three different in-house developed comprehensive examinations and NLE. The WU test showed the highest accuracy index to predict the NLE result. Regular review of lessons was emphasized as a cornerstone

Examination preparedness for the Medical Competency Assessment Test for National License step I:Pilot study

A pretest for the medical competency assessment test for national license step I was divided into 3 parts. The scores, categorized by learning subjects, were notified individually at the end of each part.The purposes of this study were (1) to investigate the effectiveness of a self-directed learning model in order to gain higher scores; (2) to explore factors affecting their scores.The study was a mixed methods research. In quantitative part, all third-year medical students were included into the study. Mean, standard deviation, percentage and non-parametric test were used for data analysis. For the qualitative part, 10 students with high GPAX were selected with purposive sampling method. Focus group interviews and semi-structured interviews were performed. We used investigator and methodological triangulation methods with content analysis to analyse final codes.The findings were as follow: (1) there was a 19.3% (95%CI 13.6-25.1) increased in the 2nd test mean percentage scores compared with the 1st test mean percentage scores. And there was a 26.2% (95%CI 18.9-33.5) increased in the 3rd test mean percentage scores compared with the 1st test mean percentage scores. The study suggested that scores notification helped students recognize their weak points in a self-directed learning process. The pretest project let them feel as staying in a virtual examination room and stimulate them for better preparedness. In addition, a regular-type learning style was most mentioned in students with high GPAX