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Introduction: The aim of this short communication is to examine the journey of scholarship in health professions education (HPE). Methods: We will focus on tangible small steps to start, sustain, and succeed along this journey. Through a proposed innovation in scholarship – micro-scholarship – we will describe how this is similar to and an extension of bite-size or micro-learning, and workplace micro-practice related to just-in-time (JiT) learning settings. Results: We will demonstrate how the small steps for generating and engaging with micro-content can be similarly applied to micro-scholarship. Then, progressive and iterative refinement of output and practice of micro-scholarship can be combined and result in macro-scholarship after cycles of public engagement for final digital or print publication. This stepwise approach creates an accessible, sustainable strategy to achieve success as a scholar in HPE. We will elaborate on micro, macro, and meta matters and celebrate how these small steps encourage and allow broad participation in the creation, critique, and progressive refinement of scholarship. Conclusion: Small, sustainable, steps leads to success as a scholar in Health Professions Education - Micro (macro and meta) matters.

In this paper, we propose Micro-Scholarship as a new and innovative approach to begin the scholarship journey for Scholarship in Health Professions Education. We introduce Micro-Scholarship as both an outcome and process, with the iterative and progressive development of a variety of micro-assets that can be combined and counted as 'traditional' Scholarship. We highlight the core components and processes that are enabled by a variety of digital technologies and supported by engagement with a community of practice. We also emphasise the importance of reflection throughout the entire journey. Our intention is to offer practical advice that can lower the bar for entry to Scholarship in Health Professions Education, with the potential to increase the sharing of different viewpoints at an early stage of the journey and to build a community of scholars.

Objectives To consolidate the available evidence regarding healthcare students' experiences of coaching interventions' effect on their mental well-being in tertiary educational institutions. Design A mixed studies review. Data sources Seven electronic databases were searched for relevant studies from their inception dates until July 2021: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations and Theses Global. Review methods This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was adopted to analyze all findings and thematic analysis was conducted according to Braun and Clarke's (2006) framework. Results Three themes and seven subthemes are generated from the 12 included studies. The main themes are: 1) Receiving much-needed help, 2) Unlocking the secrets of success, and 3) Way forward for coaching in healthcare education. Conclusions Many students benefited from the coaching interventions in terms of academic, emotional and psychological support and received guidance in professional development. However, careful preparation of both coaches and students is needed to improve the success of coaching interventions. Future coaching interventions could incorporate both group and individual sessions, assign students to coaches based on their clinical interests and consider conducting online coaching sessions using video calls. Improvement of study rigor would be required to achieve more accurate results. Lastly, future studies should be conducted on healthcare students of more diverse disciplines and cultures to increase results' generalizability.

This article was migrated. The article was marked as recommended. Evidence- based decision making about the implementation of online learning in medical education during the COVID-19 pandemic is a challenge for decision-makers since it is a time of rapid change. We present a new framework that offers a potential highly useful response to meet this challenge. Our proposed framework for rapid research of online learning during the COVID-19 pandemic recognises the challenge of understanding the complexity of the socio-technical system in which the online learning is implemented, including the behaviour change of individuals in the system and the system's absorptive capacity. The framework provides a structured approach for rapid research to understand the complexity of the implementation of online learning during the COVID-19 pandemic. We recommend that rapid research to inform decision-making about the implementation of online learning during the COVID-19 pandemic should focus on early identification of the needs of the decision-makers and the use of high quality rapid research approaches to provide relevant and timely information about context, processes and outcomes.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has significantly disrupted society and communities across the world requiring new and innovative approaches for healthcare, work, education and leisure. Similar changes have been precipitated in medical education, producing a rapid and major impact on students, educators and institutions. However, institutions still require educators to engage with scholarship in medical education, including providing evidence for promotion and tenure. We propose that resolving this tension between the demands of delivering a high quality curriculum and maintaining scholarship in medical education during the era of the COVID-19 pandemic requires urgent consideration of a transformational change in the scholarship in medical education. Key aspects of this change are a focus on rapid cycles of research to inform teaching, with local and wider dissemination using newer rapid approaches to publication and social media, and acceptability of these changes by institutions.

This article was migrated. The article was marked as recommended. Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19 pandemic and technology has been rapidly and innovatively used to maintain teaching and learning. The future of medical education is uncertain after the pandemic resolves but several potential future scenarios are discussed to inform current decision-making about the future provision of teaching and learning. The use of emergent technology for education, such as artificial intelligence for adaptive learning and virtual reality, are highly likely to be essential components of the transformative change and the future of medical education. The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world.

During the years preceding 1910, the education and training of physicians (doctors) -to-be was based mainly on a master-apprentice model; the primary focus then was on the teaching and development of clinical skills. In 1910, however, Abraham Flexner submitted a highly influential report to the American medical authorities: in it, he recommended that all medical schools should be university-based and that, importantly, medical practice should have a scientific basis strongly underpinned by the basic medical sciences. The recommendation provided the impetus for the design of medical education that begins with a pre-clinical phase to provide the strong scientific foundation for the clinical phase that follows. During the clinical phase, student learning will focus primarily on the clinical sciences relating to the diagnosis, treatment and management of patient care. Thus, two key 'pillars' (the basic sciences and the clinical sciences) of medical education were established; this two pillar model of medical education persisted for many decades thereafter and remained so till today. However, in order to optimise delivery of health care this must be viewed as an 'eco-system' taking into account the practice setting both present and future. The authors will attempt to provide a background to the changing trends in medical education and the changing practice environment, due primarily to the disruptive forces of change in this article.

Background The use of multiuser virtual worlds (MUVWs) for collaborative learning has generated interest among healthcare educators. Published evidence to support its use is growing, but none has synthesized the evidence to guide future work. Objective This study sought to provide a comprehensive and systematic evaluation of MUVWs in healthcare education. Design A systematic review Methods A systematic search of five databases including CINAHL, Cochrane library, EMBASE, PubMed, and Scopus, was conducted from inception up to January 2017. Two independent researchers selected studies that met the inclusion criteria and assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI). A total of 18 studies were reviewed and their data were synthesized narratively using a 3-P model (presage-process-product). Results Average scores in the MERSQI for methodological quality are 10/18, which is modest. A rally by the government or professional bodies towards more collaborative working among healthcare professionals is a key driver behind implementing MUVWs. Funding is important for its development and evaluation. Team training in acute care and communication training were the most frequent learning objectives, and predominant learning activities include practice on simulation scenario and debriefing. Two-thirds of the studies did not explain their theoretical framework that underpinned their design and implementation of MUVWs. While MUVWs in healthcare education is generally well-received, learning outcomes remain inconclusive. Conclusion Despite a growth of studies on the use of MUVW in healthcare education, there is a need for more understanding of the application of theories to inform the learning activities. Therefore, we suggest educators to incorporate a theoretical model to explain the learning processes behind MUVWs. To improve the quality of evidence, we call for researchers to employ a more rigorous and broader approach to evaluation that explicates longer-term outcomes, including cost benefit analyses.

The ubiquitous use of technology in medical education creates increasing tensions related to the benefits and disadvantages of the ease of access to content and the opportunity to monitor online behavior. We recommend a collaborative understanding by all stakeholders, from learners and educators to higher education institutions and professional regulatory authorities, to inform future practice and policy.

This article was migrated. The article was marked as recommended. Medical education is increasingly becoming a digital world, with a range of new technologies that are transforming and challenging our current activities as a medical educator. The purpose of this article is to highlight how technology not only supports teaching and learning but also offers new opportunities for demonstrating the educational scholarship of medical educators.

Sebaceous gland carcinoma (SGC) of the eyelid is usually considered a rare tumour (1–5% of all cutaneous malignancies in the USA), but higher incidence rates have been seen in Asia (28–60%). It has a tendency for intraepithelial spread, as well as regional and distant metastases. Early diagnosis and timely management can help reduce morbidity and mortality. In the eyelids, it may arise from meibomian glands (most common), glands of Zeis or sebaceous glands associated with the caruncle. It is two to three times more common in the upper lids due to the higher number of meibomian glands. Any unilateral blepharoconjunctivitis with loss of eyelashes and thickening of lid margin that fails to respond to treatment should be biopsied, and so should an atypical or recurrent chalazion.

Orbital cellulitis refers to the infection of the soft tissues of the orbit. It is characterized by acute onset of fever and constitutional symptoms associated with lid swelling, conjunctival chemosis, proptosis and limitation of eye movements. In a severe case, it may be associated with visual loss. In the overwhelming majority (90%) of cases, the source of infection is the paranasal sinuses. Occasionally, an infection in the eyelid or lacrimal sac can extend posteriorly, resulting in orbital cellulitis. An external penetrating wound or a retained orbital foreign body may also be responsible for the cellulitis. In a rare event, an endogenous infective embolus can lodge in the orbital tissues causing orbital cellulitis. Occasionally other pathologies may mimic orbital cellulitis requiring radiological and histopathological confirmation.

Computed tomography (CT) scan was introduced in clinical practice in 1971 with single axial slice at a time scanning capability. This has progressively evolved into current modern CT scanners which perform volumetric imaging, with retrospectively reconstructing images in different planes and thicknesses providing high-resolution soft tissue and bone images in short scan durations.

Vascular lesions are classified into tumours and malformations, and malformations are further classified into high-flow and low-flow lesions depending on the haemodynamic characteristics, and there can be combinations of various lesions. The classification of vascular lesions are detailed in the ISSVA (International Society for the Study of Vascular Anomalies). Distensible venous malformation (Common venous malformation [Common VM]), previously known as varices, is the most common type of vascular malformation in the orbit and periorbital region. It is mostly sporadic, but in about 1–2% of cases, it can be familial. It occurs at the venous end of the vascular system and communicates with the venous circulation, thereby causing an increase in size with Valsalva manoeuvre. Common VM is usually present at birth and enlarges with hormonal changes during adolescence and adulthood. Occasionally, there is sudden expansion due to bleeding.

The term orbital pseudotumour was first coined in 1905 to describe an idiopathic condition that produced a mass effect and inflammatory features in the orbit, after exclusion of infection and malignancy. It is now increasingly replaced by the terms “orbital inflammatory disease” (OID) or “idiopathic orbital inflammation”, as its wide spectrum of clinical presentation is increasingly recognized. Orbital inflammatory disease can be divided into specific and non-specific orbital inflammations. Specific orbital inflammatory disorders include idiopathic sclerosing inflammation, granulomatous disorders, transitional lesions (e.g. Sjogren’s syndrome, Kimura disease), vasculitic disorders (e.g. granulomatosis with polyangiitis [Wegener’s granulomatosis]), and others. Non-specific inflammatory cases are a diagnosis of exclusion, and can be classified according to their location in the orbit: anterior, diffuse, apical, myositic, and lacrimal.

Pleomorphic adenomas (also known as benign mixed tumours) of the lacrimal gland arise from epithelial and mesenchymal elements such as ducts, myoepithelial components and stroma. Up to 50% of lacrimal gland tumours are epithelial, and a good number of them are pleomorphic adenomas. They typically occur in the 2nd to 5th decades of life, with no gender predilection. Clinically, they present as mass lesions, manifesting as slowly progressive, painless proptosis. Complete surgical removal along with pseudocapsule and a rim of normal tissue is the treatment of choice.

A mucocoele is a chronic, cystic lesion of the paranasal sinuses, lined by pseudostratified or low columnar epithelium. There is background inflammation, with the cyst filled with mucus, exerting pressure on the boundaries of the sinus due to obstruction of the sinus ostium. The obstruction is caused by congenital anomalies, allergy, infection, trauma, neoplasms and sinus surgery. Surgery is necessary for a complete cure. The ultimate goal of surgical intervention involves in re-establishing the sinus drainage and obliteration of the cavity with complete resection of the sinus mucosal lining.

Thyroid eye disease (TED), also known as thyroid-associated orbitopathy (TAO), is a chronic inflammation of the orbital tissues. It is an autoimmune process that mostly affects patients with Graves’ disease, but it can also affect patients with other autoimmune disorders of the thyroid. Middle-aged women are more prone; the gender ratio between women and men is 4:1. When males develop TED, it tends to be more severe. The disease is also severe in smokers. The diagnosis is often made with clinical signs along with the biochemical changes of thyroid hormone in the blood. Occasionally, imaging is necessary to differentiate it from other causes of muscle enlargement and space-occupying lesions of the orbit. Very rarely, a biopsy of the muscle is necessary to rule out other serious causes of muscle enlargement.

T-cell lymphomas of the ocular adnexa are extremely rare and when present may be a manifestation of known preexisting systemic disease. They arise primarily from the paranasal sinuses, more commonly in East Asians. While B-cell lymphomas are usually well recognized and more easily treated, T-cell lymphomas often carry a guarded prognosis.

Fibro-osseous lesions are a poorly defined group of lesions that affect the jaw and the craniofacial bones. The World Health Organization (WHO) classified these lesions in 2005, which include ossifying fibroma, fibrous dysplasia, and osseous dysplasia (Paget’s disease), in addition to reactive bone lesions. The diagnosis and management is challenging, often requiring multidisciplinary approach.

Design thinking is a process that applies both creativity and innovation to iteratively develop and implement a new product. The design thinking process also enhances design thinking skills that are essential for personal and professional life in a complex world. Health care is increasingly being faced with complex problems, and the education of current and future doctors in design thinking is an important curricular challenge for all medical educators. Medical educators will need to enhance their own design thinking skills to enable them to effectively respond to this challenge.

This article was migrated. The article was marked as recommended. The important task of nurturing core human values in healthcare can be assisted and facilitated by the use of a variety of technology, to create, store, and disseminate a range of narratives in health and illness, from text and video to immersive experiences using virtual reality. This paper will discuss the importance of narratives to nurture core human values, the use of technology for narrative to nurture core human values, as well as the challenge of using technology for narrative to nurture core human values.

Dear EditorThe letter by Lana Huang and Joshua Breedon (2019) from the University of Cambridge highlights additional factors intrinsic to the medical education system that reinforces superficial ap...

A variety of benign conditions can affect the oesophagus, both primarily and secondarily. Traditionally fluoroscopic oesophagography and endoscopy have formed the mainstay for investigating oesophageal diseases. Increasing use of cross-sectional imaging means that many such diseases and their thoracic complications are now detected at computed tomography (CT), which is very often the first imaging tool. This review describes the CT manifestations of a range of benign oesophageal conditions and discusses the role of CT in their evaluation.

Dear SirOne of the major challenges of implementing the flipped classroom for teaching is facilitating active engagement of students in the learning process (O'Flaherty & Phillips 2015). We respond...

We propose the need for a specific educational scholarship when using e-learning in medical education. Effective e-learning has additional factors that require specific critical attention, including the design and delivery of e-learning. An important aspect is the recognition that e-learning is a complex intervention, with several interconnecting components that have to be aligned. This alignment requires an essential iterative development process with usability testing. Effectiveness of e-learning in one context may not be fully realized in another context unless there is further consideration of applicability and scalability. We recommend a participatory approach for an educational scholarship for using e-learning in medical education, such as by action research or design-based research.

Diffuse proliferative cerebral angiopathy is a distinct entity from cerebral arterio-venous malformations; characterized by multiple small arterial feeders and draining veins with normal brain parenchyma seen in-between the abnormal vessels. It is usually seen in younger age group. Here we report a case of diffuse cerebral proliferative angiopathy in a 78-year-old female patient along with discussion of the neuro-imaging findings and review of the literature. It is important to recognize this entity to avoid aggressive surgery or intervention and thus preventing permanent damage to the normal intermingled brain tissue.

Introduction: This study compares the attitudes between preclinical and clinical medical students towards radiology, following the introduction of a new radiology curriculum for 1st year students. Materials and Methods: Revision of the 1st year medical school curriculum for the academic year of 2008/9 with the inclusion of 13 one-hour formal radiology lectures integrated with each body system was done in an undergraduate Southeast Asian medical school. In the old curriculum, 1st and 2nd year medical students are not exposed to radiology. They received limited radiology teaching in their 3rd and 5th years with 2 one-hour lectures as part of their medicine and surgery rotations. In the 4th year, they have a one week non-examinable posting in radiology. A survey was administered to preclinical (new curriculum) and clinical (old curriculum) students. Survey responses were tabulated and attitudes between preclinical and clinical students were compared. Results: More than half of the preclinical students (155 out of 270 students, 59%) and 90 out of 720 clinical students (12.5%) responded. Students exposed to the new curriculum had attended one or two dedicated radiology lectures and were considering radiology as a clinical elective. Both groups of students did not feel familiar with radiology as with other specialties, were not considering radiology as a career, but felt that radiology was interesting and important to the overall practice of medicine. Conclusions: Exposure of 1st year students to radiology increases their interest in the subject. Further intervention, fi ne-tuning of the curriculum and follow-up surveys will be carried out to see if this interest persists throughout their clinical years. Keywords: Curriculum, Medical Schoo1, Undergraduate

The objective of this study was to quantitatively evaluate the correlation between left and right masticatory muscle volumes in normal subjects.Contiguous 1 mm MR scans were obtained of 12 normal adult subjects aged 20-25 years using a Siemens 1.5 T MR scanner. The volumes of the human masticatory muscles (masseter, lateral and medial pterygoid) were measured from the scans using our previously proposed method. To test for inter- and intraobserver reproducibility, measurements were performed by two users on two separate occasions, with a span of 2 weeks between them and with the previous results blinded. Good inter- and intraobserver reproducibility was achieved in our study.The mean volumes for left and right masseters, and lateral and medial pterygoids were 29.54 cm3, 29.65 cm3, 9.47 cm3, 10.23 cm3, 8.69 cm3 and 8.92 cm3, respectively. The Pearson correlation coefficients between the volumes of the left and right masseters, lateral and medial pterygoids are 0.969, 0.906 and 0.924, respectively.The computed volumes of the masticatory muscles show a strong correlation between the volumes of the left and right masseters, and lateral and medial pterygoids for normal adult subjects. The total masticatory muscle volume on the left and right sides of normal subjects is similar.