Medical Education Online

Manuscripts organized by Volume

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Volume I 1996

Because It's Time

David J. Solomon, Ph.D

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.

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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.

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Medical Informatics for Medical Students: Not Just Because It's There

Eta S. Berner, Ed.D. and Dennis W. Boulware, M.D. with the assistance of the Medical Education Committee's Medical Informatics Subcommittee

University of Alabama School of Medicine

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.

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Community Partnerships: Going Beyond Curriculum to Change Health Professions Education

Rebecca C. Henry, Ph.D.

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.

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A Critical Elements Approach to Developing Checklists for a Clinical Performance Examination

Barbara G. Ferrell, Ph.D

The University of Texas Medical Branch

Abstract: A two-stage process was used to develop checklists for cases on a clinical performance examination for a clerkship in family medicine. Items generated for each checklist were reviewed by faculty members to determine which of them might be deemed "critical" to the case; those which were so important that less than mastery would result in failure of the exam. For each case, a score was determined based on completion of the items which judges rated as "critical," and weights for each of the items on the checklists were generated. This method yielded a scoring protocol for each case. The protocol is outlined and applied to a hypothetical student. The perceived advantages of the approach are discussed and suggestions made for further work. The protocol is being used to develop similar checklists for additional cases as they are written for the clinical performance examination.

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Computer Education in Emergency Medicine Residency Programs

Joilo C. Barbosa, MD, MS* , Paula Willoughby, DO** , Robert G. Mrtek, PhD ***, Craig A. Rosenberg, MD, FACEP*

*Departments of Emergency Medicine and Internal Medicine
**Department of Emergency Medicine SAEM/Physio-Control EMS Fellow
***Professor, Departments of Medical Education and Pharmacy Administration, University of Illinois at Chicago

Abstract Objective - To determine if and how recent innovations in computer technology have affected the access and usage of computers by emergency medicine residents. To evaluate the status of resident computer training as compared to a previous survey reported and as outlined in the Core Curriculum. Methods - Questionnaires were mailed to the 113 residency program directors listed in the Society for Academic Emergency Medicine (SAEM) home page. Topics queried included current availability of computers, the existence of computer education programs, the status of Internet related activities as well as resident exposure to and actual usage of computers. Results - The response rate was 65% (73/113). The average resident to computer ratio is 6.5:1. While 100% of the programs have computers available for resident use, only 48% offer any kind of formal computer education and only 41% indicate they have an assigned computer educator. Most programs offer some kind of access to the Internet (79%). Software availability is as follows: word- processing (100%), spreadsheets (99%), graphics (96%), literature search programs (96%), databases (88%), statistics (86%), communications (85%) and Internet/commercial network (77%). Resident exposure and usage roughly parallels the availability of software. Conclusion - Computer knowledge in today’s world is a necessity whether one practices medicine as a clinician, researcher, educator, or administrator. Although computers are available for resident use in virtually all programs surveyed, less than half offer formal computer education as recommended by the Core Curriculum. Formal recommendations need to be developed regarding the design and implementation of a computer education program.

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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.

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Volume II 1997

The Philadelphia PRIME Program: A Model For Primary Care Education

Lisa M. Bellini, MD and David A. Asch, MD, MBA

Department of Medicine, University of Pennsylvania School of Medicine and Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Abstract: Expanding primary care and ambulatory experiences in internal medicine training programs is limited by insufficient resources devoted to their development and implementation, heavy inpatient service demands and loyalty to the traditional inpatient based training model. Overcoming these barriers is a challenge likely to create new approaches to ambulatory education. The pilot Education and Ambulatory Care (PACE) program at the Sepulveda VA is one such initiative that represents a multidisciplinary approach to primary care services, improving quality and access to patient care services, as well as the quality of primary care education. We describe the development of a similar model for resident training and primary care service, also funded through the Veterans Affairs (VA), but implemented with fewer resources. The program redirects faculty and administrative resources to a new clinical environment centered around primary care. We believe this educational model has broad implications for the future of medical training because it is achievable and thus exportable to other programs.

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Implementing a Requirement for Computer Ownership: One Medical School’s Experience

Amy V. Blue, PhD^*+, Carol L. Elam, EdD^*, Robert Rubeck, PhD^*, Lois M. Nora, MD, JD^*¯

^*Office of Academic Affairs,
⁺Department of Surgery,
^¯Department of Neurology, University of Kentucky College of Medicine, Lexington, KY

Abstract: The need for training physicians in the use of computers and the increased presence of computing in medical education suggest that medical schools should determine what kind of computer accessibility and support should be offered to students so that they can acquire sufficient computer skills and use computing applications in the curriculum. At the University of Kentucky College of Medicine, a requirement for ownership of computers by students was adopted in 1995. On the basis our experience, this paper discusses the assessment of institutional readiness for such a requirement, the technical and support issues related to such a requirement, the development of computer applications in the curriculum, and a framework used to evaluate the impact of such a requirement. Recommendations for other institutions interested in adopting a requirement for computer ownership by students are included.

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Mandatory Microcomputers: Potential Effects on  Medical School Recruitment and Admissions

Brian E. Mavis, PhD^* and Jane M. Smith, MA†

^*Office of Medical Education Research and Development
†The Office of Admissions, College of Human Medicine, Michigan State University

Abstract: To inform discussions about a proposal that required incoming medical students own a microcomputer, applicants accepted for admission to the College of Human Medicine at Michigan State University were mailed a survey which focused on microcomputer literacy, ownership and perceptions of a mandatory microcomputer proposal. The response rate was 79%. Two-thirds of respondents had access to a microcomputer at home; more had access at school. Microcomputer ownership ranged from 95% for respondents with graduate education to 28% for underrepresented minorities. Reactions to the proposal were mixed: male and graduate-educated respondents were most in favor whereas underrepresented minority respondents reported that such a policy would negatively influence their decision to attend our medical school. Cost was a concern for respondents independent of their support for the proposal. The results suggest that despite increased computer literacy, this proposal could undermine efforts to recruit a diverse matriculating class. Other computer-based innovations in medical school admissions will favor computer literate students.

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Volume III, 1998

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.

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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.

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An Analysis of Web-Based Instruction in a Neurosciences Course

Chris Candler, MD and Robert Blair, PhD

University of Oklahoma College of Medicine.

Abstract - Among the recent trends in medical education is the increased use of computer-aided instruction (CAI), particularly via the World Wide Web. While there have been many studies comparing CAI to traditional instruction, there are relatively few studies that analyze the benefits of web-assisted instruction. Presently, many medical schools have initiatives to web-enable significant portions of their curriculum. To maximize the potential of the medium, educators must carefully plan and design their educational materials and do more than put their syllabus online. Technical issues such as user interface design, access and availability play an important role in determining how students will receive such materials. Furthermore, the web-based portion of a course must be properly integrated with more traditional educational modalities such as lectures and labs. The following paper describes the planning and implementation of web-based materials in a pilot project involving a medical neurosciences course.

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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.

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Faculty Members’ Expectations of Student Behavior in the Small-Group Setting

Amy V. Blue, PhD*, Carol Elam, EdD†, Sue Fosson, MA† and Giulia Bonaminio. PhD‡,

*Medical University of South Carolina College of Medicine, †University of Kentucky College of Medicine, ‡University of Kansas School of Medicine, USA

Abstract: This study examined faculty members’ expectations of student behavior in three types of small group settings (student-directed, teacher-directed, and skill-based) at a single institution. Twenty-eight faculty members participated in in-depth, semi-structured interviews that addressed how students should prepare for small-group sessions, what learning behaviors informants expect students to exhibit, strategies informants use to stimulate group interaction, and how informants evaluate student performance in the small group settings. Analysis of informant responses indicates small-group instructors have similar expectations of student behavior across all small-group settings. Students are expected to have good interactive skills, be well-prepared and participate in the group, and demonstrate knowledge of the material or facility with the skill taught. Given the results that indicate faculty members’ have largely undifferentiated approaches to their evaluation of student performance, efforts should be taken to help faculty hone their small group teaching skills to enhance students’ knowledge and skill acquisition in small-group teaching formats.

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Medical Students As Standardized Patients In A Second-Year Performance-Based Assessment Experience

Kathryn L. Lovell, PhD*, Brian E. Mavis, PhD^†, Jane L. Turner, MD^‡§, Karen S. Ogle, MD^¶, Marilee Griffith^§,

*Department of Pathology and Neuroscience Program,
^†Office of Medical Education Research and Development,
^‡Department of Pediatrics & Human Development,
^§Office of Academic Programs,
^¶Department of Family Practice, College of Human Medicine, Michigan State University

Abstract: Performance-based assessments of medical students using standardized patients (SPs) have been conducted in a variety of formats during both pre-clinical and clinical years. At Michigan State University College of Human Medicine, a series of performance-based assessment (PBA) experiences have been established in the second year to evaluate students' abilities to integrate basic skills and medical knowledge. The format developed was based on classmates acting as SPs. The PBA experiences were perceived by students as being effective in reinforcing the goals of the curriculum and the format was viewed positively. The small-group learning experience provided by the patient training session was valued by students, and was an important part of their positive attitude toward the time required for acting as an SP. Thus using students as SPs can be an excellent cost-effective approach for performance-based assessments used as formative evaluation.

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Student Information Resource Utilization in Problem-Based Learning

Louise F. Deretchin, Lynn C. Yeoman, Charles L. Seidel

Baylor College of Medicine

Abstract – Purpose: To examine the profile of medical students’ resource use in a longitudinal problem-based learning course and to examine patterns of change. Method: Over a six-month period, 116 students indicated on resource checklists which resources they had used for independent research of learning issues identified in their problem-based learning sessions. On the checklist, resources were categorized as printed, electronic, human, or physical evidence (i.e., models, demonstrations). Results: Over the six-month period, the percentage of use  (number of times a resource category was used / number of weekly reports submitted)declined from 64.0% printed, 81.7% electronic, and 4.3% physical to 44.0%, 69.8%, and 3.9%, respectively. Use of human resources increased from 29.1% to 36.6%. Use of a variety of resources (resources from ³ 2 categories of resources) also declined.

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Observational Validation of a Model of Ambulatory Teaching

W. Barry Biddle, PhD, Lee Ann Riesenberg, RN, MS, Stanley Erney, MD, Kathylene Siska, PhD

State University of New York, Health Science Center at Syracuse, Clinical Campus at Binghamton

Purpose: This study examines teaching by preceptors in a longitudinal, primary care clerkship for third year medical students. The authors compared observations from different points in the clerkship to determine the validity of a three-stage model (modeling, supervision, and consultation) based on their previous research.

Methodology: Seven experienced preceptors were observed three times over the course of the year while teaching third-year medical students. A single observer recorded the teaching behaviors using an observation instrument containing 30 behaviors relevant to ambulatory teaching. The behaviors were categorized into five groups (Modeling, Supervision, Consultation, Validation, and General Teaching) for purposes of comparing their relative contribution to the proposed three-stage model.

Results: Frequencies of teaching behaviors within the five categories were compared over the three observations. Modeling behaviors declined over the three time periods (p<.02), while Validation increased from the first to the second observation (p<.02). The examining room was the predominate location for teaching. Location differences in favor of the examining room were statistically significant for Modeling, Supervision, and Validation teaching behaviors.

Conclusions: There was a shift in teaching behavior over time in a longitudinal clerkship. The decrease in Modeling behaviors coupled with the increase in Validation behaviors supports the proposed model of teaching. The failure to identify change in supervision behaviors may be due to the long time interval between observations. Additional observations at more frequent intervals are needed to clarify this part of the hypothesis.

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Volume IV 1999

The Multidimensional Learning Model: A Novel Cognitive Psychology-Based Model for Computer Assisted Instruction in order to Improve Learning in Medical Students

Tarek M. Abdelhamid, M.D.

Medical Education Development Office, The University of Auckland School of Medicine and Health Science

Abstract - In the recent years there has been a huge increase in the amount of information needed to be understood and memorized by medical students. Many authors have advocated the need for utilizing cognitive psychology strategies to allow students learn the expanding medical information in a more effective and efficient manner. The present paper describes a novel and interactive method for teaching and learning (the Multidimensional Learning Model) that allows the students to ‘think’ to generate the information. The model integrates different memory strategies to facilitate the learning process and is heavily dependent on illustrations and graphics. Furthermore, the model is potentially suitable for designing Computer Assisted Instruction. A pilot study was performed on the model and the preliminary results are promising.

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Figure 4 Executable demonstration of the model

The Development of a Collaborative Distance Learning Program to Facilitate Pediatric Problem-based Learning

Carol S. Kamin, EdD^*., Robin D. Deterding, MD^*, Brent Wilson, PhD^†, Michael Armacost, MA^†, Tom Breedon, M.A^†

^*University of Colorado School of Medicine
^†University of Colorado-Denver

Abstract - Introduction. A team of pediatric educators at the University of Colorado School of Medicine teamed with faculty and graduate students from the University of Colorado-Denver to develop a prototype program to support medical students’ learning of national pediatric curricular objectives, regardless of their clinical location and variable patient exposure. Description. This hybrid Web/CD-ROM program allows "virtual" problem-based learning teams composed of four to five students and a faculty member to collaborate asynchronously through a digital video patient case. One prototype case has been developed and funding has been secured to develop a bank of cases to support the national pediatric curriculum. Discussion. Cases delivered by digital video provide a rich medium for visual and auditory cues to patient evaluation, which in turn encourage the development of visual recognition skills needed in clinical practice. Such cases also model appropriate professional behavior and allow students to solve clinical problems in authentic clinical situations.

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The Role of Faculty Development in a College of Medicine’s Promotion and Tenure Process

Mark H. Gelula, Ph.D., Richard P. Foley, Ph.D.

Department of Medical Education (M/C 591)
University of Illinois at Chicago College of Medicine

Abstract - The history and genesis of an institutionalized approach to faculty development are discussed. The paper describes the development of a new program to improve the teaching skills of junior clinical faculty, Scholars for Teaching Excellence (STE) and how it was able to help faculty as they worked toward promotion and tenure under modified promotion and tenure procedures. The paper describes the origin of STE, changes in its original design, the theoretical bases for these changes, and initial program evaluation data. Implications for any program in a higher education setting are drawn. These may provide a practical and adaptable process for institutions confronting the research versus teaching controversy in the advancement of its faculty members.

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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.

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Using E-mail based Continuing Medical Education for Family Physicians — Can it work? 

J. Neil Marshall MB CCFP*, Pamela J. Brett MA†, Moira A Stewart BSc,PhD‡, Truls Østbye MD,MPH§,

* Thames Valley Family Practice Research Unit and University of Western Ontario Department of Family Medicine
†University of British Columbia Department of Family Medicine,
‡ Centre for Studies in Family Medicine, Family Medicine and Epidemiology and Biostatistics, University of Western Ontario
§Epidemiology and Biostatistics at the University of Western Ontario

Abstract - Objective: In 1994, the Family medicine Education and Research Network (FERN) was developed to support on-line discussion among London and area family physicians. FERN-D (FERN Dissemination) was introduced as a closed sub-group of FERN to support educational case discussions focused on prevention. The present study reports results of a pilot FERN-D intervention. Design: Pre- and Post- intervention mail-out surveys combined with an e-mail feedback questionnaire and a modified focus group. Setting: Rural and urban family physicians in the London Ontario area. Participants: Initial survey mailed to all area family physicians (N=480). 40 volunteer physicians recruited to the intervention group. Response rate was 50.4% to the pre-survey, and 68% to the follow-up survey (only mailed to responders) Main findings: A higher percentage of the FERN-D group indicated accurate knowledge for seven of the items than the comparison group. Both groups improved their preventive practice scores from pre- to post intervention. The majority of the FERN-D group felt that they had become aware of new techniques or relevant research (58.8%) and had made changes in their practice (64.7%). In both the e-mail feedback and the modifed focus group convenience (89.2%) and interaction with family physician colleagues (86.5%) were cited as advantages to this method of CME. Conclusion: On-line case-based discussion is a promising strategy for enhanced research transfer to family physicians: more research is needed to determine if it can be effectively utilized to change physician behaviour.

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Using Standardized Patients to Teach Clinical Ethics

Walter Edinger, Ph.D, JoDee Robertson, Joy Skeel, M.Div, Judith Schoonmaker, M.D.

Medical College of Ohio at Toledo

Abstract: A literature search shows multiple uses for standardized patients for teaching and evaluating clinical skills. However, there is little written about the use of standardized patients for teaching clinical ethics. When the Standardized Patient Program was organized at the Medical College of Ohio at Toledo in 1991, the Ethics Program realized the potential for innovative and interactive learning opportunities for medical students. Topics including ethical issues in psychiatry, domestic violence, physician assisted suicide, taking a sexual history, giving bad news and discussing DNR status have been incorporated into cases in which standardized patients are trained. These cases are then used to help students learn about these difficult issues. Student interaction with standardized patients in the second year teaches them how to communicate with a manic patient refusing psychotropic medication; and how to take a sexual history without embarrassment. In the third year medicine clerkship, students have to discuss "bad news" with a patient and try to obtain a "code status" decision. By using standardized patients, we make our teaching more clinically relevant for students. We build didactic presentations around case studies to demonstrate what physicians are likely to encounter in the clinical setting. In this paper we will describe how the synergistic relationship between the standardized patient and ethics programs has enhanced the educational process for our medical students.

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Is it Time to Take the Paper Out of Serial Publication?

David J. Solomon, Ph.D.

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.

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Volume 5  2000

Long-term Effectiveness of Infection Control Training among Fourth-year Medical Students

Karen Calabro, MS, MPH^*, Karie Bright, RN, MPH^†, Kamiar Kouzekanani, PhD^‡,

Coordinator of Health Promotion and Health Education at The University of Texas-Houston Health Services, Assistant Professor at The University of Texas-Houston School of Nursing,
^†Research Associate, The University of Texas - Houston Health Services
^‡The University of Texas at Austin

.Abstract - The purpose of this study was to determine the long-term knowledge retention of infection control training among fourth-year medical students (n=110) who received training in their second year. Previous infection control training focused on standard precautions and infection control procedures. The evaluation of knowledge retention two years after the planned intervention demonstrated that although there was a significant knowledge increase about infection control immediately after participating in the intervention, there was no significant knowledge retention about infection control two years later. Furthermore, when the knowledge scores of the intervention group two years post training were compared to a control group, there were no differences. When compared to the control group, an improvement in reporting exposure incidents was found among the intervention group. More research is needed to determine effective training methods that can improve retention of infection control and safety precautions. Retraining on a regular basis may be indicated.

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Dr Arun Midha^*, Mrs Kathryn Redway^†, Dr. Hilary Fielder^*, Professor Stephen Palmer^*, Dr. Cerilan Rogers^*, Dr. Dorothy Wright^‡,

^* Division of Public Health, University of Wales College of Medicine,
^†Henwick Old Farm, Thatcham Kent,
^‡Morgannwg, Health Authority, 41 High Street, Swansea

Abstract - In the United Kingdom, a qualified medical doctor needs to undertake a five year training programme to reach Consultant status (Medical Specialists in a particular area such as public health, surgery, obstetrics etc.) During this period of training they are known as 'Specialist Registrars'. Consultants in Public Health Medicine have a key training role acting as Trainers assisting these Specialist Registrars to acquire epidemiological public health skills necessary to attain Consultant status. In addition to formal Public Health Medicine training, Trainers have a pastoral role that can mean that they need to be sensitive to the emotional needs of their Specialist Registrars. Praising or reprimanding adults is not an easy task and few people are trained for it. In this training role, Consultants themselves need to be equipped to undertake this effectively. The 'Wales' training model, developed by the Faculty of Public Health Medicine in Wales, has sought to address this need and could be replicated to train Trainers in other medical specialties and in other parts of the world

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Generating Productive Learning Issues in PBL Tutorials: An Exercise to Help Tutors Help Students

 Kathleen M. Quinlan, Ph.D

Office of Educational Development, College of Veterinary Medicine, Cornell University

Abstract: The development of productive, manageable, appropriate learning issues is central to students’ achievement of content objectives in problem-based learning. Students’ reflection on their learning issues is also an important part of the development of their self-directed learning skills. The use of an exercise to support tutors in helping students develop and apply criteria for productive learning issues is described and analyzed. According to feedback from tutors, the forty five minute preparatory workshop for tutors, followed by a 15 to 20 minute "mini-workshop" with students in their tutorials was a successful format for achieving the objectives of the exercise in a first year problem-based learning course. By integrating the activity into the tutorial process, the student participation rate was much higher than previous, stand-alone workshops for students on educational process. Several modifications to the exercise and proposals for related future research are offered.

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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.

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The Effect of a Community Hospice Rotation on Self-Reported Knowledge, Attitudes and Skills of Third-Year Medical Students

Rebecca Ferrini, MD, MPH and Jeffery L. Klein, Ph.D.

University of California, San Diego

Abstract - Introduction: Increasing attention is being paid to educating practicing and future physicians about end-of-life care. Since 1994, the University of California, San Diego has provided a mandatory 16 hour rotation for third-year medical students in hospice and palliative medicine at a community hospice.

Aim of Investigation: To determine the effectiveness of an intensive, community-based rotation in changing palliative medicine attitudes, knowledge and skills among third-year medical students.

METHODS: Pre- and post-test questionnaires incorporating self-assessment of knowledge, attitudes and skills were administered to 195 third-year medical students before and after completion of this rotation from 1997 to 1999. Analyses compared responses, controlling for age, gender and previous clinical experience.

RESULTS: In general, students report a deficit in their ability to perform palliative medicine tasks, irrespective of prior clinical experience. Students reported significant improvements in each of 17 items measuring knowledge and confidence performing palliative medicine tasks after completion of the rotation. Medical students reported positive attitudes about palliative medicine which improved after the rotation. However, as a result of the rotation, medical students were more likely to report self-awareness of personal fear about death.

CONCLUSIONS: This rotation may serve as a model for teaching the art and science of palliative medicine to physicians in training.

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Lifelong Learning with Digital Compendia

Dennis Paul Valenzeno, PhD^*, Thomas Brennan, PhD^†, Francis Gasparro, PhD^‡, Christopher Lambert, Ph.D^§, Kendric Smith, PhD^**

^*University of Kansas Medical Center,
^†Dickinson College,
^‡Thomas Jefferson University, ^§Connecticut College,
^**Stanford University

Abstract - The Digital Compendium is a new concept in education, andis described here for the science of photobiology, a Digital Photobiology Compendium (DPC). Medical school is the start of a lifelong learning endeavor. Increasingly computer- and web-based resources will facilitate this process. Yet there are currently few resources that span the range of knowledge from student through practicing professional. To this end we are developing a technologically advanced, scientifically up-to-date learning tool, with the initial effort in the field of photobiology. Photobiology is a young interdisciplinary field that is growing in importance because of its relevance to laser/light therapies and the biological consequences of increased UV radiation due to ozone depletion. The DPC will be web-based, consisting of a matrix of more than 100 instructional modules in all subdisciplines of photobiology. The modules will be mutually compatible to allow the user (learner or instructor) to connect a set of modules in a user-defined Work. Standard Works will also be predefined. The matrix will include modules suitable for learners at various levels from advanced undergraduate through practicing.

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Lajos Ángyán, M.D., D.Sc.

University of Pécs, Faculty of Medicine, Institute of Kinesiology, Pécs, Hungary

Abstract - The purpose of this article is to describe a program to incorporate kinesiology into medical education. An institute of kinesiology was established in our Faculty of Medicine, its mission being to develop, teach and apply knowledge about the nature and consequences of regular physical activity. Kinesiology, the science of human motion, was initially offered in the medical curriculum as an optional credit course. Three main points were considered when preparing the subject matter: 1. the fundamentals of kinesiology, 2. its connection with the other subjects in the curriculum, and 3. suggestions from family physicians. At the end of the course the students take a written exam and are asked to evaluate the course.

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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,
^†Office of Medical Education Research and Development and the Department of Medicine, Michigan State University, ^‡Department of Internal Medicine, University of Texas Medical Branch,
^§Department of Psychiatry and Behavioral Sciences, 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.

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Volume 6  2001

College of Human Medicine, Michigan State University

Abstract: Although many medical schools have adopted a variety of methods to assess student competency, the extent to which these innovations have changed how decisions about student progress are made is not clear. This paper describes a survey of 126 accredited allopathic U.S. medical schools to determine which information sources are used for decisions related to medical student progress and graduation. Respondents were asked to indicate up to three information sources used for seven specific decisions about student progress. The results indicate that multiple choice questions (MCQs) and faculty ratings remain the most frequently used information sources. Clinical skills education in the pre-clinical curriculum is the area with the broadest use of assessments for progress decisions. Several explanations are suggested for the primacy of MCQs and faculty ratings in student decisions, including familiarity for faculty and students, ease of implementation and the resources required for the adoption of other assessment strategies.

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Abstract: Purpose: To describe the attitudes related to communication skills, confidence in using commnication skills, and use of communication skills during the physician-patient encounter among a population-based sample of family physicians.
Procedures: A mailed survey, distributed to all family physicians and general practitioners currently practicing in Newfoundland. The questionnaire was designed to collect data in five general areas participant demographics, physician confidence in using specific communication strategies, perceived adequacy of time spent by physicians with their patients, physician use of specific communication strategies with the adult patients they saw in the prior week, and physician use of specific communication strategies during the closing minutes of the encounters they had with adult patients in the prior week.
Main Findings: A total of 160 completed surveys was received from practicing family physicians/general practitioners in Newfoundland, yielding an adjusted response rate of 43.1%. Most of the respondents (83.8%) indicated their communication skills are as important as technical skills in terms of achieving positive patient outcomes. Between one-third and one-half of the respondents, depending on the educational level queried, rated their communications skills training as being inadequate. Fewer than 20% of the respondents rated the communications skills training they received as being excellent. Physicians indicated a need to improve their use of 8 of 13 specific communication strategies during patient encounters, and reported using few communication strategies during the closing minutes of the encounter. Interactions that occurred during a typical encounter tended to focus on biomedical versus psychosocial issues.
Conclusions: Family physicians/general practitioners recognize a need to improve their commnications skills. Well-designed communications skills training programs should be implemented at multi-levels of physician training in order to improve patient satisfaction with their encounters with family/general practitioners, and to increase the likelihood of positive patient outcomes.

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^* Department of Developmental Biology and Anatomy, University of South Carolina School of Medicine,
^† The National Board of Medical Examiners,
^‡ School of Dentistry, New York University

Abstract - We have examined whether cadaver dissection by first year medical students (MIs) affected their performance in two test measures: the NBME Gross Anatomy and Embryology Subject Exam (dissection-relevant questions only), and practical exams given at the end of each major section within the course. The dissections for the entire course were divided into 18 regional dissection units and each student was assigned to dissect one third of the regional units; the other two-thirds of the material was learned from the partner-prosected cadavers. Performance for each student on the exams was then assessed as a function of the regions those students actually dissected. While the results indicated a small performance advantage for MIs answering questions on material they had dissected on the NBME Subject Exam questions relevant to dissection (78-88% of total exam), the results were not statistically significant. However, a similar, small performance advantage on the course practical exams was highly significant.

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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.

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Letter in response to this article

Authors' reply to the Letter

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Impact of Generalist Physician Initiatives on Residency Selection

Michael H. Malloy, M.D., M.S.^*, Christine A. Stroup-Benham, Ph.D.^†

*Department of Pediatric
†Office of Institutional Analysis
University of Texas Medical Branch
Galveston, Texas

Objective:To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies.
Background:In the fall of 1994 a first year Community ContinuityExperience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education.
Design/Methods:We examined the residency selections of cohorts of graduating medical students before (1992-1996) and after (1997-1999) the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not.
Results:Prior to the implementation of the programs, 45%(425/950) of students graduating selected primary care residencies compared to 45% (210/465) of students participating in the programs (p=0.88). At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53%) were more likely to select a primary care residency than non-minority students (40%); students in the two lowest grade point average quartiles (55% and 50%) selected primary care residencies compared to 37% and 38% of students in the top 2 quartiles; and students who stated that income potential had little or no impact on their choice were more likely to select a primary care residency (48%) than those who said income potential was important (37%).
Conclusions:We observed no significant trend towards higher proportions of graduating students selecting primary care discipline residencies as a result of implementing courses that emphasized primary care. Those students expressing an interest in a primary care discipline at their entrance into medical school were more likely to select a primary care residency. A more significant impact on graduating students interested in primary care may be made through the medical student selection process than by altering the curriculum.

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The Brachial Plexus: Development and Assessment of a Computer Based Learning Tool

Douglas J. Gould, Ph.D.^*

*Department of Anatomy & Neurobiology
University of Kentucky

Abstract - The objective of the present study is to evaluate the use of multimedia technology to simplify study of the brachial plexus. A combination of newly-rendered illustrations, animations, explanatory text, and a set of printable sample questions were combined into a program to provide a tutorial for the brachial plexus. One aspect of the program is an animation showing the development of the brachial plexus from its developmental origins that illustrates limb rotation and the resulting adult anatomy and dermatomal arrangement. The cross-platform program requires Quicktime 3.0 and is packaged on CD-ROM. Student evaluation of the program highlights its ease of use and intuitive navigation. User evaluation provides validation that the use of illustrations and animations is beneficial to user’s understanding and retention of the material. Future plans involve incorporation of pathologic images in order to enhance the clinical relevance of the product.

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Survey of Nutrition Education in U.S. Medical Schools – An Instructor-Based Analysis

Frank M. Torti, Jr.^*, Kelly M. Adams, MPH, RD^*, Lloyd J. Edwards, PhD^†, Karen C. Lindell, MS, RD^*, Steven H. Zeisel, MD, PhD^*

^*Department of Nutrition
^†Department of Biostatistics
School of Public Health
School of Medicine
University of North Carolina at Chapel Hill

Abstract - Background: Recent reports on the state of nutrition in U.S. medical schools suggest that these schools are challenged to incorporate nutrition into an already full curriculum.
Objective: The aim of this study was to determine the current state of nutrition education in US medical schools based on information reported by individuals responsible for teaching nutrition to medical students.
Design: Between July 1999 and May 2000, we surveyed 122 U.S. medical and osteopathic schools. The survey was mailed to the nutrition educator at each institution; recipients could return the survey via mail, fax, or the web.
Results: The majority of the 98 medical schools responding to the survey provided nutrition education. In 90% of responding U.S. medical and osteopathic schools (representing 88 of 98 schools and over 65% of all institutions), all students were guaranteed exposure to nutrition. An average of 18 ± 12 hours of nutrition was required, including material integrated into other types of courses.
Conclusions: Our findings indicate that nutrition education is an integral part of the curriculum for the majority of US medical schools surveyed. A number of medical schools have chosen to incorporate nutrition education into already established basic science and clinical courses.

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^*Department of Family Medicine
^†Department of Obstetrics and Gynecology
Wayne State University
Detroit, MI

Abstract - During the clinical phase of undergraduate medical education (UME) students are often geographically disbursed and assigned to preceptors throughout the community. Monitoring, documenting, and evaluating their clinical experiences and achievement of clinical objectives in this venue becomes a challenge, especially for large UME programs. The purpose of this manuscript is to discuss a method for developing and implementing a school-wide evaluation system for the clinical phase of UME. This type of evaluation system links students' clinical experiential data with the objectives of a clerkship, using technological advances, such as the Personal Digital Assistant (PDA), Internet, and intranet. Clerkship directors are provided real-time reports on student's progress toward achieving clerkship objectives and are able to monitor the clinical activities of the clerkship. Students on the other hand, will be empowered to take more control of their educational experiences by monitoring their own progress.

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Sabri Kemahli, MD

Professor of Pediatrics
Departments of Pediatrics and Medical Education
Faculty of Medicine, Ankara University, Ankara, Turkey

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.

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Volume 7  2002

Abstract - Background: Distance education methods have taken on greater importance as medical student education has moved off campus into the community. What the best methods are for conveying information to students at distant sites has not been determined.
Objective: To determine if students at distant community sites who received an otitis media study case by e-mail that was enhanced with a referral to a web-based otitis study case, performed better on otitis OSCE stations than students who received the same case not enhanced with visuals or referrals to a web-based otitis case.
Design/Methods: Students were randomized by community site to receive either the enhanced (E) or simple otitis study case (S). Students were e-mailed an otitis media study case during the 5th week of the rotation. Those randomized to the E-case received a case that started with a case scenario followed by a "Task" that instructed them to go to this web address: http://www.aap.org/otitismedia/www/vc/ear/index.cfm (American Academy of Pediatrics Otitis Web Site). They were then to select "Case 1" which was a continuation of the case scenario present on their e-mail. A list of learning objectives was also printed on the e-mail. Students receiving the S-case viewed the same case scenario and objectives, but were not instructed to go to the web page. All students rotated through two OSCE otitis stations. In the first station they interviewed a simulated patient(OSCE-SP) and counseled her on the management of her 12 month old with otitis. Within that station they viewed a video of a pneumoscopic exam of two ears, one ear with otitis and the other ear normal. At the 2nd otitis station the student presented the case to a faculty and was asked a series of questions about otitis media(OSCE-PR). Scores on the two stations were compared by group.
Results: There were 198 students who took the OSCE. 178 (90%) responded to a survey that indicated they had opened and read the e-mailed case. There were 87 students in the E-group and 91 in the S-group. The mean ±s.d. OSCE-SP station score for the E-group was 72.6 ±12.0 vs 75.4 ±9.8 for the S-group, p=0.09. For the otitis presentation station the scores for the E-group and S-group were respectively, 82.9 ±9.6 and 83.7 ±9.4, p=0.55.
Conclusions: These data suggest that enhanced visual distance education cases may offer no distinct advantage over simple paper-type case study guides.

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Infusing the Interdisciplinary into Medical/ Health Sciences Education: Vitamins or Vaccines?

Nilesh Chatterjee, MBBS MA PhD

Texas A&M University
Health & Safety Division
College Station, Texas

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.

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Adolfo Peña, MD, Ofelia Paco, MD, Carlos Peralta, MD

San Marcos National University, Lima-Perú.

Abstract: Background: All sciences share a common underlying epistemological domain, which gives grounds to and characterizes their nature and actions. Insofar as physicians depend on scientific knowledge, it would be helpful to assess their knowledge regarding some theoretical foundations of science.
Objectives: 1.To assess resident physicians' knowledge of concepts and principles underlying all sciences. 2. To determine, to what extent physicians' epistemological beliefs and attitudes are compatible with the scientific paradigm.
Design: A questionnaire was administered to 161 resident physicians at three hospitals in Lima, Peru.
Results: 237 resident physicians were selected, 161 (68%) of whom agreed to answer the survey. 67% of respondents indicated they did not know what epistemology is, 21% were able to correctly define epistemology; 24% of the residents knew the appropriate definition of scientific theory. No respondents knew the philosophical presumptions of science; and 48% took a relativistic stand towards knowledge.
Conclusions: There appear to be deficiencies in the knowledge of scientific theoretical foundations among physicians

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Does Presenting Patients’ BMI Increase Documentation of Obesity?

Norm Clothier, MD^*, M. Kim Marvel, PhD^†, Courtney S. Cruickshank, MS^†

^*Family Healthcare Associates, Garland, TX
^†Fort Collins Family Medicine Residency Program, Fort Collins, CO

Abstract - Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart) will increase physician documentation of obesity in the medical record.
Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note.
Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully.

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Needs Assessment in Postgraduate Medical Education:A Review

Savithiri Ratnapalan MBBS., and Robert I. Hilliard MD, EdD.

Department of Paediatric Medicine
The Hospital for Sick Children
University of Toronto
Ontario, Canada.

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

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^*Department of Internal Medicine, Section on General Internal Medicine
^†Department of Public Health Sciences, Section on Behavioral Medicine and Health Services Research
^‡Department of Public Health Sciences, Section on Biostatistics
^§Department of Physiology and Pharmacology
Wake Forest University, School of Medicine

Abstract: Objective: To determine resident comfort and skill in performing ambulatory care skills.
Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each). Self-rated ability or comfort was compared by gender, status (year of residency, faculty), and future predicted frequency of use of the skill.
Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use.
Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

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R. Gregg Dwyer, M.D., Ed.D., Linda A. Deloney, Ed.D(c), Mary J. Cantrell, M.A.,
C. James Graham, M.D.

University of Arkansas for Medical Sciences
College of Medicine
Little Rock, Arkansas

Abstract: Transition from the role of passive student to medical practitioner begins with learning the first clinical skill. This transition can be stressful for those experiencing it and to some extent by those coordinating it. Logistically, it requires demonstration of the techniques to the entire class by a single practitioner or to smaller groups of students by multiple practitioners. The former reduces the opportunity for close observation of technique and is less conducive to questions, while the latter requires multiple practitioners, which can be prohibitive given their already dense schedules. To reduce the stress for all involved and to maximize learning opportunities, an innovative approach to teaching the first skill, vital signs measurement, was developed. Small group instruction and practice were facilitated by senior medical student volunteers in a simulated outpatient clinic using actual equipment. Instruction was provided in a relaxed, but guided format. Students were provided with a lesson plan that detailed both, technique and brief physiology points, as well as check sheets to use during the lab and later as a refresher guide. The lesson plan, instructions for facilitators, and student check sheets were developed by a senior medical student and reviewed by the course faculty. Recruitment and briefing of student facilitators and conduct of the lab were also performed by the senior student. The purpose of this trend article is to describe the development of a new course format and to report our experience with implementation of the new format. It is intended to spark interest in applying similar approaches to other curricular issues.

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