Background: The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the current study methods and future plans of medical students compared to those in the pre-pandemic period.
Methods: Second-grade medical students reported their academic experiences, study methods, and future career plans before (between 2016 and 2019) and during the pandemic (2020) using a questionnaire-based survey at Hokkaido University, Japan (n = 534).
Results: From 2016 to 2019, we found an increasing trend for participation in short-term international exchange programs, taking the United States Medical Licensing Examination (USMLE), clinical training, and undertaking research abroad among the students. However, these percentages significantly declined (to 35.5%) during the COVID-19 pandemic in 2020 for all the assessed future plans, including short-term exchange programs (-27.9%), taking USMLE (-19.8%), clinical training (-24.5%), and undertaking research abroad (-13.2%) compared to 2019, wherein 67.9% of the students wished to have at least one of these four above-mentioned academic activities.
Conclusions: The COVID-19 pandemic adversely and significantly influenced our medical students’ plans to go abroad for clinical and research training. Future studies are warranted to assess the long-term influence of this pandemic on the career planning of medical students.
This article was migrated. The article was marked as recommended. BackgroundMisdiagnoses are associated with various cognitive biases, which are difficult to reduce even if physicians think about clinical cases deliberately. We propose a new "2-Dimensional Approach" that combines two perspectives in diagnostic reasoning: organs (brain, heart, lung, intestine/liver, kidney) and systems (metabolic, endocrine, blood/tumor, infection, immune, circulatory, nervous systems). Systems involve throughout the whole body and can be pathogenesis of diseases. As a result of diseases, organs show abnormal vital signs and symptoms. We investigated: (1) whether each individual resident has a bias for either organs or systems when they diagnose clinical cases, and (2) whether the 2D Approach can reduce such a bias.MethodsWe randomly assigned PGY1 residents (n=105) to either the 2D Approach group (n=45) or a control group (n=60). After attending either a lecture on the 2D Approach or a non-related lecture, residents were asked to diagnose two clinical cases. We divided each diagnosis into one of the two categories, either "organs" or "systems". We investigated whether each resident would diagnose the two cases into the same category, either organs or systems (i.e., a bias for either organs or systems).ResultsThe participants in the control group tended to diagnose the two cases into the same category, either organs or systems (OR: 5.63, 95% CI: 1.62-21.7, p=0.0030, Fisher's exact test). In the 2D Approach group, the category of diagnoses for the two cases were not related to each other (OR: 2.14, 95% CI: 0.50-9.81, p=0.33).ConclusionThere is a bias for either organs or systems when residents diagnose clinical cases, suggesting that organs and systems are different perspectives in diagnostic reasoning. By combining these 2 different perspectives in a 2-dimensional matrix, the 2D Approach reduces this bias.
This article was migrated. The article was marked as recommended. Background: Clinical reasoning is an essential competence of a physician. Particularly, pathophysiological understanding is the key for novices to organize their knowledge and improve clinical reasoning. To this end, we propose a "2-Dimensional (2D) Approach" that visualizes pathophysiology by using a matrix of organs and systems. Methods: This study was a prospective observational study of 100 residents (PGY-1), who attended a lecture on the 2D Approach. They underwent a pre- and post-test that assessed their ability to list differentials for various symptoms and to choose the most likely diagnosis for a case vignette. We stratified the participants according to their baseline knowledge level on the pretest into 2 groups (high-knowledge and low-knowledge). In each of the 2 groups, we compared the change in the pre- and post-test scores between participants who used the 2D Approach during the posttest and those who did not. Results: In the high-knowledge group (n=59), the change in the pre- and post-test scores was significantly larger in the 2D Approach users than non-users (p=0.046), while in the low-knowledge group (n=41), there was no significant difference in the change of the scores between the 2D Approach users and non-users. Conclusions: On condition that residents have sufficient knowledge, the 2D Approach helps them organize their knowledge and improve their clinical reasoning skills, through visualization of pathophysiology on a matrix of organs and systems.