Co-Editors' notes

In this issue, topics covered include social accountability (SA), the impact of COVID-19, and medical and dental student perceptions related to such significant topics as practice in rural areas and issues in transgender health care. The articles represent contributions from three different disciplines: medicine, dentistry, and physician assistants. Geographically, the authors of the articles are from numerous countries, including Australia, Canada, China, India, Iraq, and the United Arab Emirates. There are two articles addressing the topic of SA. In “SA in undergraduate medical education (UGME): A narrative review,” from Canada, Mihan et al. point out that medical schools have been increasingly called upon to augment and prioritize their SA; the researchers examined how SA has been expressed in medical education across several countries and the impacts of SA activities on medical student experience and community-level outcomes. They identified 40 studies for descriptive analysis and categorized UGME activities into five categories: distributed medical education and community-specific placements/services, community engagement and advocacy activities, international elective preparation and experiences, classroom-based learning of SA-related concepts, and student engagement in SA-UGME activities. They categorized impact into four main outcomes: student experience, student competencies, future career choice/practice setting, and community feedback. Student experiences of SA-UGME activities were reported to be largely positive, with benefits also reported for student competencies and influences on future career choice/practice setting. The researchers conclude that the expression of SA through community engagement in the development of curricular activities indicates a positive shift from social responsibility to SA, but a highly socially accountable curriculum would increasingly consider measures of community impact. Abdalla et al. in “Determinants of SA for medical schools in Iraq: A qualitative case study,” begin with the premise that the mandate of medical schools is to enrich the health system through education, research, and service to satisfy the health needs of the societies they serve. Although the context of every school is unique, one of the increasingly significant roles of medical education is to develop indicators that promote SA. The aim of Abdalla et al's work was to define the determinants of SA in Iraq through qualitative research using open-ended questions. Different themes related to the roles of medical schools, stakeholders, medical schools' mission, curriculum content, research characteristics, service characteristics, enhancers of SA, and accreditation roles were identified. These themes characterize a socially accountable medical school within the context of Iraq. The authors conclude that their study needs to be replicated in different medical schools in the country to successfully build the national determinants of SA. In “Psychological distress among 1st-year medical students amidst COVID-19-related uncertainty at a medical college in Western India: A cross-sectional study,” Shyadligeri et al. looked at psychological distress in medical students in an environment of fear, worry, and uncertainty related to the pandemic. A cross-sectional study was conducted collecting demographic information and measuring psychological distress using the 20-point World Health Organization Self-Reporting Questionnaire 20. The researchers found a 25.5% prevalence rate of psychological distress. Items related to distress were worried about contracting COVID-19, concerns about adverse financial effects on self and family, worried that online mode of learning was putting them at a disadvantage compared to traditional teaching–learning methods, and worries about adverse effects on social support. They conclude that there is an urgent need to develop a system to render counseling/professional help to all the students in need. From Australia, Graziell et al. present “Clinicians' perceptions of medical student teaching in a tertiary hospital“. They state that while medical student placements in teaching hospitals are a cornerstone for gaining clinical experience, the ever-evolving nature of health care has also changed the delivery of student education. In this context, the authors explored the attitudes of clinicians involved in teaching medical students at an Australian tertiary hospital. Clinicians were invited by email to complete an anonymous online survey developed using a combination of questions from previously validated surveys. Areas focused on were “personal purpose and enjoyment of teaching” and “barriers and challenges to teaching.” The majority (>92%) of clinicians enjoyed teaching and saw it as part of their work. However, approximately one-half thought that medical student teaching was underrecognized and one-half indicated inadequate time to teach due to workload. About 60% responded that there was insufficient time to get to know students to provide feedback, and approximately 40% indicated that the scope of student knowledge and desired outcomes were not clearly defined by medical schools. These “modifiable factors” should be targeted, and if successfully addressed, could allow the hospital and university medical school to enhance the medical student experience and promote a culture of teaching and learning in hospitals. In a Student Contribution from Canada, “Application of Constructivism Learning Theory to physician assistant students in primary care,” Thampinathan contends that educational theory must be incorporated into clinical teaching. To this end, Thampinathan also contends that the implementation of Constructivism Learning Theory will help preceptors and learners appropriately understand and assess educational content. The author provides a literature review that covers the key components of the application of Constructivism Learning Theory to physician assistant (PA) students in primary care providing a look at the history, fundamental principles, and the clinician/educator role in Constructivism Learning Theory. In summarizing the tenants of Constructivism, the works reviewed are those of Jean Piaget, Lev Vygotsky, and John Dewey. Gleaning from these theorists, Constructivism Learning Theory highlights three roles that the PA educator should incorporate to support students in the clinical environment: coaching, modeling, and scaffolding. In addition, a problem-based, issue-based, question-based, project-based, or case-based experience with multiple support systems must be in place for the successful application of Constructivism theory. Thampinathan argues that with proper implementation, Constructivism Learning Theory will create highly competent students as they enter and complete their rotations in primary care. The investment needed for the successful implementation of this learning theory is high, but the results will be worth it. In another Student Contribution, “Educating for quality transgender health care: A survey study of medical students, from the United Kingdom,” Dale and Thilomin state that the worse health outcomes suffered by transgender patients are compounded by the lack of training that students receive on addressing the needs of this population. Medical students are future doctors and should be learning to provide care to all of their potential patients. The researchers assessed the impact of a teaching session on students' responses to topics in relation to transgender health, addressing the themes of understanding, education, and profession. Most of the students believed in the importance of learning about transgender health care. Despite the teaching session, there was no increase in the comfort level of medical students in seeing a transgender patient for a nongender issue. The authors conclude that education delivered with the help of the transgender community and specialist doctors can equip medical students with the understanding and level of education required to provide care to all of their patients. Finally, in a Letter to the Editor, “Experiencing blended learning during COVID-19,” from China, Paiwei et al. reflect on how the COVID-19 pandemic has forced change on traditional ways of teaching and learning in medicine. ”Blended'learning” has currently been widely adopted as a practical educational strategy. In a study conducted by the authors, they found that although the university and teachers adopted multiple methods to maintain educational activities, students preferred contact learning. Thank you for your attention to the lessons learned in EducationforHealth.

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