Papers by Dujeepa D Samarasekera
Annals Academy of Medicine Singapore , 2024
Medical professionalism refers to the set of values, behaviours, and ethical principles that guid... more Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system.
The Asia Pacific Scholar , 2024
Introduction: The mini-Clinical Evaluation Exercise (CEX) is meant to provide on the spot feedbac... more Introduction: The mini-Clinical Evaluation Exercise (CEX) is meant to provide on the spot feedback to trainees. We hypothesised that an ultra-short assessment tool with just one global entrustment scale (micro-CEX) would encourage faculty to provide better feedback compared to the traditional multiple domain mini-CEX. Methods: 59 pairs of faculty and trainees from internal medicine completed both the 7-item mini-CEX and a micro-CEX and were surveyed regarding their perceptions of the 2 forms. Wordcount and specificity of the feedback was assessed. Participants were subsequently interviewed to elicit their views on factors affecting the utility of the CEX. Results: Quantity and quality of feedback increased with the micro-CEX compared to the mini-CEX. Wordcount increased from 9.5 to 17.5 words, and specificity increased from 1.6 to 2.3 on a 4-point scale, p < 0.05 in both cases. Faculty and residents both felt the micro-CEX provided better assessment and feedback. The micro-CEX, but not the mini-CEX, was able to discriminate between residents in different years of training. The mini-CEX showed a strong halo effect between different domains of scoring. In interviews, ease of administration, immediacy of assessment, clarity of purpose, structuring of desired feedback, assessortrainee pairing and alignment with trainee learning goals were identified as important features to optimize utility of the (mini or micro or both) CEX. Conclusions: Simplifying the assessment component of the CEX frees faculty to concentrate on feedback and this improves both quantity and quality of feedback. How the form is administered on the ground impacts its practical utility.
Medical Teacher , 2024
Purpose: Generative AI will become an integral part of education in future. The potential of this... more Purpose: Generative AI will become an integral part of education in future. The potential of this technology in different disciplines should be identified to promote effective adoption. This study evaluated the performance of ChatGPT in tutorial and case-based learning questions in physiology and biochemistry for medical undergraduates. Our study mainly focused on the performance of GPT-3.5 version while a subgroup was comparatively assessed on GPT-3.5 and GPT-4 performances. Materials and methods: Answers were generated in GPT-3.5 for 44 modified essay questions (MEQs) in physiology and 43 MEQs in biochemistry. Each answer was graded by two independent examiners. Subsequently, a subset of 15 questions from each subject were selected to represent different score categories of the GPT-3.5 answers; responses were generated in GPT-4, and graded. Results: The mean score for physiology answers was 74.7 (SD 25.96). GPT-3.5 demonstrated a statistically significant (p = .009) superior performance in lower-order questions of Bloom’s taxonomy in comparison to higher-order questions. Deficiencies in the application of physiological principles in clinical context were noted as a drawback. Scores in biochemistry were relatively lower with a mean score of 59.3 (SD 26.9) for GPT-3.5. There was no statistically significant difference in the scores for higher and lower-order questions of Bloom’s taxonomy. The deficiencies highlighted were lack of in-depth explanations and precision. The subset of questions where the GPT-4 and GPT-3.5 were compared demonstrated a better overall performance in GPT-4 responses in both subjects. This difference between the GPT-3.5 and GPT-4 performance was statistically significant in biochemistry but not in physiology. Conclusions: The differences in performance across the two versions, GPT-3.5 and GPT-4 across the disciplines are noteworthy. Educators and students should understand the strengths and limitations of this technology in different fields to effectively integrate this technology into teaching and learning.
Medical Teacher, 2024
Curriculum change is relatively frequent in health professional education. Formal, planned curric... more Curriculum change is relatively frequent in health professional education. Formal, planned curriculum review must be conducted periodically to incorporate new knowledge and skills, changing teaching and learning methods or changing roles and expectations of graduates. Unplanned curriculum evolution arguably happens continually, usually taking the form of “minor” changes that in combination over time may produce a substantially different programme. However, reviewing assessment practices is less likely to be a major consideration during curriculum change, overlooking the potential for unintended consequences for learning. This includes potentially undermining or negating the impact of even well-designed and important curriculum changes. Changes to any component of the curriculum “ecosystem “- graduate outcomes, content, delivery or assessment of learning – should trigger an automatic review of the whole ecosystem to maintain constructive alignment. Consideration of potential impact on assessment is essential to support curriculum change. Powerful contextual drivers of a curriculum include national examinations and programme accreditation, so each assessment programme sits within its own external context. Internal drivers are also important, such as adoption of new learning technologies and learning preferences of students and faculty. Achieving optimal and sustainable outcomes from a curriculum review requires strong governance and support, stakeholder engagement, curriculum and assessment expertise and internal quality assurance processes. This consensus paper provides guidance on managing assessment during curriculum change, building on evidence and the contributions of previous consensus papers.
The Asia Pacific Scholar , 2024
Introduction: Continuing medical education and continuing professional development activities (CM... more Introduction: Continuing medical education and continuing professional development activities (CME/CPD) improve the practice of medical practitioners and allowing them to deliver quality clinical care. However, the systems that oversee CME/CPD as well as the processes around design, delivery, and accreditation vary widely across countries. This study explores the state of CME/CPD in the East and South East Asian region from the perspective of medical practitioners, and makes recommendations for improvement. Methods: A multi-centre study was conducted across five institutions in Hong Kong, Indonesia, Malaysia, Singapore and Taiwan. The study instrument was a 28-item (27 five-point Likert scale and 1 open-ended items) validated questionnaire that focused on perceptions of the current content, processes and gaps in CME/CPD and further contextualised by educational experts from each participating site. Descriptive analysis was undertaken for quantitative data while the data from open-ended item was categorised into similar categories. Results: A total of 867 medical practitioners participated in the study. For perceptions on current CME/CPD programme, 75.34% to 88.00% of respondents agreed that CME/CPD increased their skills and competence in providing quality clinical care. For the domain on pharmaceutical industry-supported CME/CPD, the issue of commercial influence was apparent with only 30.24%-56.92% of respondents believing that the CME/CPD in their institution was free from commercial bias. Key areas for improvement for future CME/CPD included 1) content and mode of delivery, 2) independence and funding, 3) administration, 4) location and accessibility and 5) policy and collaboration. Conclusion: Accessible, practice-relevant content using diverse learning modalities offered by unbiased content providers and subject to transparent and rigorous accreditation processes with minimal administrative hassle are the main considerations for CME/CPD participants.
Medical Teacher, 2020
Background: The Corona Virus Disease-19 (COVID-19) has been declared a pandemic by the World Heal... more Background: The Corona Virus Disease-19 (COVID-19) has been declared a pandemic by the World Health Organization (WHO). We state the consolidated and systematic approach for academic medical centres in response to the evolving pandemic outbreaks for sustaining medical education. Discussion: Academic medical centres need to establish a 'COVID-19 response team' in order to make time-sensitive decisions while managing pandemic threats. Major themes of medical education management include leveraging on remote or decentralised modes of medical education delivery, maintaining the integrity of formative and summative assessments while restructuring patient-contact components, and developing action plans for maintenance of essential activities based on pandemic risk alert levels. These core principles must be applied seamlessly across the various fraternities of academic centres: undergraduate education, residency training, continuous professional development and research. Key decisions from the pandemic response teams that help to minimise major disruptions in medical education and to control disease transmissions include: minimising inter-cluster cross contaminations and plans for segregation within and among cohorts; reshuffling academic calendars; postponing or restructuring assessments. Conclusions: While minimising the transmission of the pandemic outbreak within the healthcare establishments is paramount, medical education and research activities cannot come to a standstill each time there is a threat of one.
The Asia Pacific Scholar, Jan 4, 2022
Honouring the heritage and building the future of healthcare The practice of medicine has been ro... more Honouring the heritage and building the future of healthcare The practice of medicine has been rooted strongly in traditions. Discipline-based academies, colleges, societies, and associations regularly practice "rituals" based on context-specific traditional norms and cultural practices. Medical education and training are no different. Being part of a larger, higher education institution and preparing graduates for a future profession, they too have deeply embedded rituals such as the whitecoat ceremony, the silent mentor appreciations, oath taking, and the commencement. These practices have a strong influence of the institutions in which the programs are conducted giving each of these practices not only the professional but the context and institution specific angle and colours.
South East Asian Journal of Medical Education, Jun 30, 2015
Entrustable professional activities (EPAs) have emerged as a useful and feasible way to put outco... more Entrustable professional activities (EPAs) have emerged as a useful and feasible way to put outcomebased competency frameworks into practice. It has given curriculum planners a tool to signpost the expected outcomes of a trainee as well as for the trainers to effectively evaluate if the student/resident is attaining the relevant competencies at the right time. Work on EPAs is well underway in graduate medical education and some allied health professions. However, currently, there is a paucity of published work in this area in undergraduate medical education. We describe a transferrable approach to feasibly document EPAs in an undergraduate medical education curriculum in Singapore and discuss limitations and challenges faced when developing EPAs in this setting.
Springer eBooks, 2022
The original version of the book was inadvertently published with incorrect affiliation for Profe... more The original version of the book was inadvertently published with incorrect affiliation for Professor "Indri Kurniasih" and an incorrect citation in Chapters 6 and 9, respectively, which have now been corrected. The book and the chapters have been updated with the changes.
European Journal of Dental Education, May 16, 2022
ObjectiveEntrustable professional activities (EPAs) are tasks that a person who is qualified or i... more ObjectiveEntrustable professional activities (EPAs) are tasks that a person who is qualified or is in the process to be credentialed are allowed to engage. There are several levels of entrustment based on degrees of supervision assigned to each EPA. This paper aims to describe the process and outcome of creating EPAs; validate EPAs relevant to undergraduate dental training.MethodsA draft set of EPA statements was developed based on the consensus of an expert panel. These were then mapped to the nationally determined minimum experience thresholds (clinical and procedural experiences/competencies) and aligned to task‐based instructional strategy. The EPAs were validated to improve the relevance by using a criterion‐based rubric.ResultsAn end‐to‐end process workflow led to the development of an EPA‐based educational framework to bridge the gaps in the curriculum. The process identified a total of 41 EPAs and out of which, 10 EPAs were notated as core EPAs and will be subjected to structured workplace‐based assessment complying to the national standards. The validation exercise rated core EPAs with an overall score matching close to the cut‐off of 4.07 (Equal rubric).ConclusionThe end‐to‐end process workflow provided the opportunity to elaborate a structured process for the development of EPAs for undergraduate dental education. As validation is a continuous process, feedback from implementation will inform the next steps.
South-East Asian Journal of Medical Education
Designing effective small group learning can be a challenge for any institution involved in highe... more Designing effective small group learning can be a challenge for any institution involved in higher education. Problem Based Learning (PBL) has been in existence as an innovative and student centred learning method for the past five decades. From its simple origin at McMaster University, Canada, PBL has spread across the globe and its complexity has also evolved as a learning system. Due to limitations in resources, many Medical and Health Professional schools have incorporated PBL with other didactic teacher centred learning modalities. This is known as the hybrid curricula model. However, the hybrid model sometimes creates unwarranted competition between PBL and other modalities of teaching, leading to ineffective learning and tutor dissatisfaction. Using the hybrid PBL model to contextualize and integrate subject matter learnt through didactic and teacher led teaching learning modalities could circumvent these limitations. This is known as the "Hub format" of the hybrid model. The Hub format while allowing integration of content matter, allows the learner to discover relevant new knowledge for future learning and practice. It also facilitates the teachers to align student assessment to their learning, leading to improved student engagement in PBL and their motivation for learning.
In 1910, however, Flexner submitted a highly influential report to the American medical authoriti... more In 1910, however, 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 such as anatomy, biochemistry and physiology. Flexner’s recommendation was readily accepted, not only in the USA, but also globallyincluding Asia.
The Journal of continuing education in the health professions, 2015
Hand surgeons need continuing professional development due to rapid advancement in the field. Tra... more Hand surgeons need continuing professional development due to rapid advancement in the field. Traditional approaches have proven to be challenging due to the nature of surgical practice and other demands. Social media sites have shown the potential to build an online community of practice. One of the authors (VR) started Hand Surgery International on LinkedIn in February 2011. The number of members increased from 38 in the beginning to 4106 members by August 13, 2015, with members from all over the world. Half of them are from plastic surgery, with 16.8% hand and 17.8% orthopedic surgery; 63.8% of them are consultants. There were 151 discussion topics, which generated 1238 comments at an average of 8.2 comments per discussion thread. The topics focused on management of difficult patients, seeking consensus, and searching information. The features participants found most useful included case-based discussion, polls/surveys, and network opportunity. Members perceived the LinkedIn comm...
The Lancet
The Health Policy paper by Julio Frenk and colleagues1 in The Lancet on educating health professi... more The Health Policy paper by Julio Frenk and colleagues1 in The Lancet on educating health professionals after the COVID-19 pandemic highlights the post-pandemic learning environment, use of technology to improve learning, interprofessional education (IPE), and lifelong continuing education and training for the health professions. The perpetual shortage and maldistribution of health professionals within complex health systems and unmet population health needs may require innovative approaches for the education of health professionals for effective practice. IPE is an educational approach that could positively influence health-care practices and patient outcomes. With its origins in the 1960s, predominantly in the UK and the USA, IPE has since spread to various regions of the world.2 The application of IPE in different regions and countries varies, ranging from a uniprofessional approach to a seamless incorporation of IPE to the whole learning environment. WHO defines IPE as occasions where students from two or more professions in health and social care learn from, about, and with each other during their education for effective collaboration in future practice.3 The Interprofessional Education Collaborative proposes four essential competencies for IPE: values and ethics, roles and responsibilities, interprofessional communication, and teamwork and team-based care.4 These are predicated on each profession also being trained to a high level of knowledge and skill in its own right.
The Asia Pacific Scholar, 2021
We believe that curiosity is vital to learning. Many studies have shown that if a student is curi... more We believe that curiosity is vital to learning. Many studies have shown that if a student is curious or the subject matter generates learners’ curiosity, then the student learning is deeper and that they remember better (Dyche &amp; Epstein, 2011; Yuhas, 2014). The quotation cited above is the editorial by Ignatius (2018) in a current issue of the Harvard Business Review. Ignatius, as the Editor-in-Chief, was drawing attention to the recent research “The Business Case for Curiosity” published in the same issue of HBR, by his colleague Francesca Gino (2018). According to Ignatius (2018), the “Recent research … points to several surprisingly practical benefits for business: … . In short, curiosity boosts business performance.”
The Asia Pacific Scholar, 2021
In our January 2020 Editorial, we drew the attention of our readers to “Grit in Healthcare Educat... more In our January 2020 Editorial, we drew the attention of our readers to “Grit in Healthcare Education and Practice”. In particular, we focused on developing the “Grit” of students and trainees; medical students who are well-equipped with the ‘Power of Grit’ will display a “passion for patient well-being and perseverance in the pursuit of that goal [which] become social norms at the individual, team and institutional levels” (Lee &amp; Duckworth, 2018). However, never could we imagine then that such an attribute (i.e. ‘Grit’) would become contextual so soon, as exemplified by the passion and perseverance of healthcare practitioners in patient care in their response to the serious disruptions in individual health (including fatalities) caused by the Covid-19 pandemic!
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Papers by Dujeepa D Samarasekera
Each section is developed by internationally renowned experts in their respective fields. All chapters are succinct and concise, providing answers to everyday issues and challenges using practical solutions. Through its unique structure, this handbook facilitates learning by raising and providing solutions to the questions "What", "Why" and "How". It emphasises lifelong learning and future directions in medical and health professions education — highlighting trends, issues, priorities and strategies (TIPS).
medical schools in these colonies even before Flexner had submitted his seminal report in 1910 on the state of medical education in North American universities. Thus, medical
educators from the West of the globe had already crossed several borders into Asian countries more than a century ago to assume leadership positions and to educate local medical students to become doctors. As would be expected, the design and delivery of the
medical curriculum in the ‘colonial’ medical schools were based mainly on those from the ‘homeland’. For example, a British medical curriculum was adopted in many of the medical schools established in the British colonies then. Moreover, even the postgraduate education of doctors and the accreditation of medical degrees conferred by medical
schools in many of the colonies continued to be linked to medical bodies in the ‘homeland’ (e.g. the Royal Medical Colleges and General Medical Council of UK). In this context then, many of the colonial medical schools in Asia were already practicing a kind of ‘imposed’ global medical education in terms of, both, the movement of medical
teachers and practitioners from across the globe, as well as in the design and delivery of the medical curriculum. However, over the years, most of the colonies became independent nations and charted new directions in medical education to serve the critical
needs of their own local populations. Today many medical schools around the globe, including those in Asia, are reappraising the quality of their respective medical education programmes, especially in the context of healthcare delivery for the 21st century. How will this trend now impact on medical schools in Asia? What effective model can be
applied if it is deemed necessary to globalize medical education? What issues, what opportunities and what challenges will medical educators have to grapple with in the effort to globalise medical education? Will a truly effective global curriculum for medical education emerge? These are some of the more vexing questions which medical educators, especially those in Asia, need to critically reappraise and find answers to. The authors of this chapter will review these issues and challenges in a reflective way and from an Asian perspective.
In order to improve the situation and encourage in-depth learning, good assessment methods are needed. These methods should also assess application of knowledge, cognitive skills, communication skills and professionalism. To achieve this, the assessment process has to be defined in relation to the subject.
The best practices of anatomy assessment are described based on the five stages in the development of this process. Also the utility index of assessment systems and the components are described in detail, such as validity, reliability, educational impact, acceptability, cost, etc.
The chapter also examines the various modes of assessing anatomical knowledge and thereby the tools that could be used to determine whether the students have gained a deep understanding of anatomical knowledge which has been outlined in the learning outcomes and are able to utilize it in later years for clinical reasoning.