Medical Education OnlineFeature ArticlesFeature Articles are manuscripts discussing issues of general interest to the health education community. The articles are provided in HTML (Browser) format and PDF format which can be viewed and printed with Adobe's Acrobat Reader (TM). PDF files provide a higher quality print format. To obtain Acrobat Reader software at no charge, press here. Because It's Time David J. Solomon, PhD The University of Texas Medical Branch. Abstract: Recent advancements in technology and the dramatic increase in access to the Internet have made electronic journals feasible. This paper discusses the rationale for starting Medical Education Online and some thoughts on how electronic networks and other advances in communication are going to impact on scientific journals and scholarly communication in general. HTML (Browser) version of the article. PDF version of the article. Problem-Based Learning: A Paradigm Shift or a Passing Fad? Gwendie Camp, PhD The University of Texas Medical Branch Abstract: The use of problem-based learning in medical education and other educational settings has escalated. What once was considered a "fringe" innovation has become much more mainstream. The author raises issues surrounding whether PBL will become such a successful innovation that it becomes the "norm", or whether its popularity and widespread adoption will fade and be replaced by another, newer innovation. HTML (Browser) version of the article. PDF version of the article. Medical Informatics for Medical Students: Not Just Because It's There Eta S. Berner, EdD. and Dennis W. Boulware, MD with the assistance of the Medical Education Committee's Medical Informatics Subcommittee University of Alabama School of Medicinne Abstract: There has been increasing interest in the use of computers in medical education, but there has been less attention given to the rationale for the use and selection of applications. This article discusses an approach to the selection of medical informatics applications for the undergraduate medical curriculum. HTML (Browser) version of the article. PDF version of the article. Community Partnerships: Going Beyond Curriculum to Change Health Professions Education Rebecca C. Henry, PhD Michigan StateUniversity Abstract: Much of the recent reform in medical education has focused on the specific curriculum and location of the experience. The author describes the W.K. Kellogg Foundation's Community Partnerships in Health Professions Education model which yields significant influence to the community for shaping the educational experience. The role of leadership and institutional policy change are also discussed as important factors in the change process. HTML (Browser) version of the article. PDF version of the article. A Plea for Health Manpower Training Through Distance Education Prof. P.K. Dutta, Dr. T.K. Jena, Dr. S.K. Panda Indira Gandhi National Open University Abstract: To achieve the target of health for all by 2000 AD (HFA/2000), developing countries such as India need a proper perspective to implement health for all through a Primary Health Care approach and must develop a plan to achieve manpower needs. The present health institutional infrastructure is inadequate to meet this requirement. Distance education is a relatively new concept which not only has the ability to train a large number of health care workers in a short time in a cost effective way but can also attend to skills of health care without diluting the quality. The School of Health Sciences, IGNOU is, at present, working on two health programs for nursing and medical personnel through distance education. Alternate models in distance education could also be envisioned to meet the immediate pressing needs. HTML (Browser) version of the article. PDF version of the article. Clinical Diagnosis as a Dynamic Cognitive Process: Application of Bloom's Taxonomy for Educational Objectives in the Cognitive Domain Kanu E.O. Nkanginieme, MD, FmCPaed University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Abstract: - Making a diagnosis is the pivotal cognitive activity of a practicing physician. Correct diagnosis usually leads to appropriate treatment. Clinical diagnosis a very dynamic cognitive process. It has tended to remain a sub-conscious activity and has been studied mostly as a complex categorization task,from fixed points of view. Bloom's taxonomy of the cognitive domain classifies the cognitive process into six dynamic levels of increasing complexity, from knowledge as the baseline, through comprehension, application, analysis, synthesis, to evaluation as the highest level. This classification, if appreciated by medical teachers and students and correctly applied, should make meta-cognition of the diagnostic process routine. The most 'sub-conscious' thoughts can be brought to 'consciousness' and thus become 'teachable'. A sample case summary is used as an example to illustrate the application of the Bloom's taxonomy for meta-cognition of the diagnostic process. HTML (Browser) version of the article. PDF version of the article. Skills to Enhance Problem-based Learning Michael Peterson, EdD University of Delaware, College of Health and Nursing Sciences Abstract: Problem-based Learning (PBL) has become a popular method of instruction among educators in the health professions. Central to the effectiveness of PBL is the ability of students to work together to solve problems. When these abilities are lacking, PBL outcomes can be compromised. Since these skills have not been emphasized in public school or higher education, students are often forced to muddle through group processes in the effort to learn. The purpose of this paper is to discuss the interpersonal skills necessary to enhance PBL, and suggest how these skills can be improved and incorporated into the curriculum. HTML (Browser) version of the article. PDF version of the article. Implications of Results From Cognitive Science Research For Medical Education Andy C. Reese, PhD Medical College of Georgia Abstract: Recent results from the cognitive sciences provide insights into the neurobiological basis of memory formation and learning. Learning involves three steps: acquisition of information (physical encoding in the brain), its retention, and the ability to retrieve the information when needed. The results also support the concept of multiple intelligences identified by Gardner and Kolb’s Experiential Learning Cycle theory of learning. Courses developed using these principles are particularly effective in facilitating formation of rich association networks of information that are critical to recall of specific information when needed. Case-based courses satisfy more important learning criteria than other instructional methods, but the effectiveness of all methods can be improved using principles derived from cognitive science research. Computers are a supplement that can enhance the effectiveness of all instructional techniques. However, their use must be integral to the instruction rather than simply being added on to existing courses. HTML (Browser) version of the article. PDF version of the article. Policy Analysis in Medical Education: A Structured Approach David W. Musick, PhD University of Kentucky College of Medicine Abstract: "Educational policy analysis" is a formal discipline that has not been widely used in medical education. A review of literature shows that the lack of policy analysis "tools" results in an approach to educational policy analysis and/or development that may be fragmented and unorganized. This paper describes a twelve step, explicit approach to policy analysis within medical schools. An example of how to use this approach is included. Adoption of this method of policy will result in a more explicit and formal approach to curricular governance and educational decision-making within medical schools. HTML (Browser) version of the article. PDF version of the article. Scaffolding for Success in Problem-Based Learning Tony Greening, School of Information Technology and Mathematical Sciences The University of Ballarat, Australia Abstract: Problem-Based Learning (PBL) is based on an alternative pedagogical model to the conventional, didactic one, and offers benefits to the quality of student learning. The approach has been adopted by many institutions. The focus of this paper is on the influence of the learning support structure in an environment (such as the typical PBL environment) that encourages student independence as one of its basic tenets. The immediate reaction might be to assume that it takes on a reduced importance in such circumstances. That assumption is challenged in this paper. HTML (Browser) version of the article. PDF version of the article. Nutrition Education in Medical Schools: Trends and Implications for Health Educators Jessica A. Schulman, MPH, RD, LD/N Department of Health Science Education University of Florida, Gainesville Abstract: With 20% of deaths in the U.S. attributed to improper diet and lack of exercise, renewed interest has emerged in nutrition education for medical professionals. Sociopolitical factors are exerting a profound influence on changes in medical curricula, moving medicine away from traditional biomedical curricula and toward more comprehensive programs of study. This paper explores how public demand for nutrition information, inadequate nutrition training among physicians, changes in health care, and medical education reform are influencing the evolution of nutrition in medical schools. This paper also discusses barriers, possible solutions, and specific actions for health educators. To achieve nutrition-literacy among prospective physicians, the following elements must be developed and established: 1) adequate organizational and administrative supports, 2) continuity in credentialing nutrition specialists, 3) innovative nutrition curricula, 4) committed faculty nutrition mentors, 5) clear nutrition education goals, 6) methods for evaluation of program activities/outcomes, 7) substantive research agenda, 8) multidisciplinary medical curricula, and 9) collaboration. HTML (Browser) version of the article PDF version of the article. Is it Time to Take the Paper Out of Serial Publication? David J. Solomon, PhD. Michigan State University Abstract: The ramifications of shifting from paper to electronic serial publication are discussed in light of the recent National Institutes of Health (NIH) proposal for a comprehensive electronic archive of peer-reviewed and preprint publications. The paper evaluates six concerns that have been expressed about the conversion to a purely electronic journal system and discusses the economic impact and growing tension among authors, publishers and librarians over scholarly publication. HTML (Browser) version of the article PDF version of the article. Upholding the Missions of Academic Medical Centers: New Work Roles for CEOs Kristina Lu Guo, PhD, MPH School of Policy and Management, Florida International University Abstract - This study uses Henry Mintzberg's classification of ten work roles of managers, and narrows it down to four work roles which are most frequently performed by CEOs as they uphold academic medical centers’ missions of providing quality medical education, research and patient care. Through principal component analysis, the four roles were used to form a typology of CEOs. This typology can be used to identify work roles of CEOs in AMCs. Furthermore, AMCs can use this typology in the hiring process to identify CEO candidates that would best fit the requirements of the organization. In addition, it can be used to train and develop CEOs to improve their performance, especially to conduct appropriate tasks which will strengthen AMC missions. HTML (Browser) version of the article PDF version of the article. Fitting the Means to the Ends: One School’s Experience with Quantitative and Qualitative Methods in Curriculum Evaluation During Curriculum Change Ann W. Frye, MEd*, David J Solomon†, PhD, Steven A. Lieberman‡, MD, Ruth E. Levine, MD§, *Office of Educational Development,
University of Texas Medical Branch Abstract - Curriculum evaluation plays an important role in substantive curriculum change. The experience of the University of Texas Medical Branch (UTMB) with evaluation processes developed for the new Integrated Medical Curriculum (IMC) illustrates how evaluation methods may be chosen to match the goals of the curriculum evaluation process. Quantitative data such as ratings of courses or scores on external exams are useful for comparing courses or assessing whether standards have been met. Qualitative data such as students’ comments about aspects of courses are useful for eliciting explanations of observed phenomena and describing relationships between curriculum features and outcomes. The curriculum evaluation process designed for the IMC used both types of evaluation methods in a complementary fashion. Quantitative and qualitative methods have been used for formative evaluation of the new IMC courses. They are now being incorporated into processes to judge the IMC against its goals and objectives. HTML (Browser) version of the article PDF version of the article. Evaluation of Teaching and Learning Strategies Sybille K Lechner BDS, MDS FRACDS, FPFA, FICD Head, Discipline of Removable Prosthodontics, School of Dental Studies, University of Sydney Abstract - With the growing awareness of the importance of teaching and learning in universities and the need to move towards evidence-based teaching, it behooves the professions to re-examine their educational research methodology. While the what, how and why of student learning have become more explicit, the professions still struggle to find valid methods of evaluating the explosion of new innovation in teaching/learning strategies. This paper discusses the problems inherent in applying traditional experimental design techniques to advances in educational practice. HTML (Browser) version of the article PDF version of the article. The
Importance of Physicians' Nutrition Literacy in the Management of Diabetes
Mellitus
Jessica A. Schulman, PhD, MPH,
RD, LD/N* and Barbara A. Rienzo, PhD†
*Department of
Health Services Administration Abstract - Despite pharmacological advances in diabetes treatment, medical nutrition therapy (MNT) continues to be an essential component of diabetes management. Nonetheless, physicians have missed opportunities to provide nutrition counseling to their patients. This presents a problem because Type 2 diabetes is an epidemic with severe consequences that result from non-adherence to nutrition protocols. The goals of this article are: 1) to explore reasons for the continued paucity of nutrition education in medical training programs, 2) to describe how a power educative approach can be used to improve patient outcomes, and 3) to identify considerations for improving nutrition literacy among physicians. These analyses lead to several recommendations for improving nutrition education for physicians. HTML (Browser) version of the article Letter in response to this article Authors' reply to the Letter PDF version of the article Sabri Kemahli, MD Professor of Pediatrics Abstract - Emphasis is being given to early contact by medical students with patients, and curricula are being designed to address this trend. Although teaching of clinical skills mostly depends on the traditional "apprenticeship" model, there is insufficient supervision of students while they examine the patients. This leads to the lack of acquisition of good clinical skills and some patient-student frustrations during examination by inexperienced students. The problem is greater in pediatric departments. One way to overcome this is to observe the students while they take a history and do a physical examination and to give them feedback. On the other hand, objective structured clinical examinations (OSCEs) should be used more in pediatric examinations to make use of the steering effect such examinations have on student achievement. However, OSCEs should not be the only student assessment tool, but should be complemented by other examination methods. HTML (Browser) version of the article PDF version of the article Infusing the Interdisciplinary into Medical/ Health Sciences Education: Vitamins or Vaccines?
Nilesh Chatterjee, MBBS MA PhD
Texas A&M University Abstract - Academic medical institutions have responded to recent changes and challenges confronting the health care system with various recommendations for curricular reform; many grouped under the rubric of interdisciplinary training. The ultimate goal is to create physicians, with mastery over specialized knowledge, who can practice cost-effective, humanized medicine. This article elaborates a conceptual classification system that categorizes curricular reform recommendations into one of two approaches – Vitamins or Vaccines – that highlights differences in the processes of curricular reform programs. Programs seeking the same goal may create different types of practitioners depending on the approach dominating the professional training and socialization process. The Vitamins approach is reactive, supplemental, and incremental, often imparting instruction instead of education. The Vaccines approach is proactive, addresses fundamental factors, and seeks long-term solutions from a preventive perspective. As educators, our choice of approach, Vitamins or Vaccines, for curricular reform will determine how academia prepares physicians for the future. HTML (Browser) version of the article PDF version of the article Needs Assessment in Postgraduate Medical Education:A Review Savithiri Ratnapalan MBBS., and Robert I. Hilliard MD, EdD. Department of Paediatric Medicine Abstract: Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education HTML (Browser) version of the article PDF version of the article Simulation in Medical Education: Focus on Anesthesiology D. John Doyle, MD PhD FRCPC Department of
General Anesthesiology Abstract: Simulation refers to the artificial representation of a complex real-world process with sufficient fidelity to achieve a particular objective, usually for the purposes of training or performance testing. While simulation has been important from early times (as in the rehearsal of animal hunting activities or preparing for warfare), the needs of World War II greatly accelerated simulation technology for use in flight training. With the available of inexpensive computer technology in recent years, simulation technology has blossomed again, especially in the field of medicine, where applications range from scientific modeling to clinical performance appraisal in the setting of crisis management. HTML (Browser) version of the article PDF version of the article Mentoring for the New Millennium William O. Walker, M.D.*, Patrick C. Kelly, COL MC USA†, Roderick F. Hume, Jr., M.D‡ *Assoc. Prof. of
Pediatrics †Director
of Medical Education ‡Co-Director,
Northern Illinois Perinatal Center Abstract: The challenges and benefits of a formal mentoring program are considered within the context of learning organizations: specifically, graduate medical education and professional development. While no single definition addresses every aspect of mentoring, this process is a distinct one with established traditions and expectations. The core requirements of attraction, action and affect remain and are essential for this adult developmental process to be successful. This paper’s review of the literature supports the belief that mentoring has value, even into the next millennium, with some conceptual evolution. We are encouraging a paradigm shift from the traditional dyad model of mentoring to a triad model: organization, mentor, and protégé. The future development of outcome measures will be a necessary goal to demonstrate that both personal and organizational goals can coexist. HTML (Browser) version of the article PDF version of the article An Evaluation on Medical Students' Satisfaction with Clinical Education and its Effective Factors Vahid Ziaee*, Zahra Ahmadinejad†, Ali Reza Morravedji‡ *Department of
Pediatrics Diseases Abstract:
Purpose: To evaluate medical students' satisfaction with clinical
education during medical internship and the effects of variables in the
organizational domain on satisfaction. HTML (Browser) version of the article PDF version of the article Pathways to “Involved Professionalism”: Making Processes of Professional Acculturation Intentional and Transparent Debra Boyask*, Ruth Boyask†, Tim Wilkinson‡ *University of
the West of England †Cardiff
University, ‡Christchurch
School of Medicine & Health Sciences Abstract-
Context - An increase in managerialism and a decrease in trust
of the professions have challenged traditional concepts of professionalism.
The market model of professionalism espoused by some critics also poses
problems for professions, professionals and recipients of professional
services. Professional development is now an important component of medical
curricula. We believe professionalism is evolving and suggest a concept
of involved professionalism as a framework for understanding the complex
relationships between professional practice, community and responsibility. HTML (Browser) version of the article PDF version of the article Medical Education and Curriculum Reform: Putting Reform Proposals in Context Rick Iedema,
PhD*, Pieter Degeling, PhD†, Jeffrey Braithwaite,
PhD‡, Daniel Chan, MD, MB.BS, MHA** †Centre for
Clinical Management Improvement, ‡Centre for
Clinical Governance Research in Health **Bankstown-Lidcombe
Hospital Abstract: The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders. HTML (Browser) version of the article PDF version of the article *Hawthorn Lodge,
Moorgreen Hospital, West End, †McColl Clinic, Prudho Hospital, Prudho, UK Abstract - High rates of mental illness, particularly depression have been reported in Pakistan. The health system is both under developed and poorly resourced. It is therefore not surprising that psychiatric training is at its very early stages, at both undergraduate and the postgraduate level. In order to look after the mentally ill patients radical changes need to be implemented in training of doctors. Medical curriculum needs to place more focus on psychiatry. This should not only help junior doctors in understanding the need for psychiatry, but will also prepare them for the challenges they will face as a General Practitioner or a Family Physician. Similarly, postgraduate training can be made more useful by placing more emphasis on community based and primary care psychiatry and psychotherapy; especially family interventions. The training needs to aim towards preparing psychiatrists who are not only clinicians, but can be agents of change in the society, through health education. HTML (Browser) version of the article PDF version of the article |