Medical Education Online

Manuscripts organized by Volume

Manuscripts 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.

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.

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, 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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

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.


Volume II 1997


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.


Analyzing the Emergence of a Learning Issue in a Problem-Based Learning Meeting

Timothy Koschmann*, Phillip Glenn**, and Melinda Conlee*,

*Department of Medical Education,
**Department of Speech Communication, Southern Illinois University

Abstract: Though much has been published concerning the intended or realized benefits of participating in a Problem-Based curriculum, we know little about what participants (faculty and students) actually do when they say they are doing Problem-Based Learning (PBL). The current paper is part of an ongoing to effort to apply methods borrowed from studies of discourse to understanding PBL as a form of enacted practice. In particular r r r, the paper provides a description of the interaction within a PBL tutorial meeting leading to the generation of a Learning Issue (LI). We introduce the term Knowledge Assessment Segment (KAS) for important stretches of interaction during which participants identify learning issues. We present a detailed analysis of a selected segment. Specific feat t t tures discussed include: how the group's perspective on a topic changes over the course of the discussion, the tutor's role in providing "scaffolding" for student reasoning, and the group's incorporation of "thinking about thinking." The purpose of descriptive studies of this sort is to enhance our understanding of what it means to do Problem-Based Learning.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


Skills to Enhance Problem-based Learning

Michael Peterson, Ed.D.

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.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


Videoconferencing for Instructional and Administrative Purposes: The Audience Reacts

Christopher B. Reznich, Ph.D.

Office of Medical Education Research and Development, College of Human Medicine, Michigan State University

Abstract: Reduced funds for medical student and resident training have prompted the College of Human Medicine at Michigan State University to explore innovative instructional delivery and administrative support systems. The Office of Medical Education Research and Development conducted a demonstration project in the use videoconferencing technology to connect the main campus to three outstate sites. The objectives of the project were to provide instructional experiences for students, residents, and faculty using videoconferencing; to conduct administrative meetings; and to evaluate the use of videoconferencing in these contexts. The results of the demonstration project lend strong support to the use of videoconferencing technology for instruction and administrative support, even in light of technical constraints. Lessons were learned in the areas of working with vendors effectively, preparing presenters to use the system, and the need to test system peripherals and connections before the actual videoconference.

HTML (Browser) version of the article.

PDF version of the article.


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.

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.


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.

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.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article.

PDF version of the article.


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.

HTML (Browser) version of the article

PDF version of the article.

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.

HTML (Browser) version of the article

PDF version of the article.


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.

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.


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.

HTML (Browser) version of the article

PDF version of the article.


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.

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, 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.

HTML (Browser) version of the article

PDF version of the article.


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.

HTML (Browser) version of the article

PDF version of the article.


Public Health Medicine Training: How Should We Train the Trainers?

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

HTML (Browser) version of the article

PDF version of the article.


Teaching Awards and Reduced Departmental Longevity: Kiss of Death or Kiss Goodbye. What happens to Excellent Clinical Teachers in a Research Intensive Medical School?

David C. Aron, MD, MS, John N. Aucott, MD, and Klara K. Papp, PhD

Departments of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (DCA and KKP) and Park Medical Group, Johns Hopkins University School of Medicine, Baltimore, MD (JNA) and the Louis Stokes Cleveland Dept. of Veterans Affairs Medical Center, Cleveland, OH (DCA)

Abstract - Context: Although medical education is the unique mission of academic medical centers and medical schools, there is a perception that research is valued more than teaching.
Objective: To determine in a group of excellent teachers (1) job satisfaction; (2) differences in perceptions among those who remained in the department compared to those who left; and (3) where those who left went.
Design, setting, participants: Survey of all Department of Medicine "Clinical Teacher of the Year" award-winners in an academic medical center.
Outcome measurements: Satisfaction scale: 5=extremely satisfied to 1=extremely dissatisfied; perception scale: 5=valued most highly to 1=not valued at all).
Results: Thirteen winners (48%) left the department. Of the 10 in the clinical track 6 went into private practice. Award-winning faculty who remained in the department had significantly higher satisfaction ratings (mean+1SD) than those who left for all three activities – teaching (3.8+0.6 vs.1.8+0.7 [p < 0.001]), research (3.3+0.7 vs. 2.0+1.1 [p=0.003]), and clinical (3.5+0.5 vs. 1.7+0.7 [p < 0.001]). In general, winners were most satisfied with various aspects of teaching; areas of highest dissatisfaction related to support for education. Research was rated most highly and teaching least valued {Mean (StdErr)= 4.2(0.1) and 2.8(0.1)}. There were no differences in perceptions between award winners who left and those who stayed.
Conclusions: Teaching excellence is a perishable commodity. Greater effort is needed to retain the best clinical teachers within academic medical centers.

HTML (Browser) version of the article

PDF version of the article.


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.

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.


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.

HTML (Browser) version of the article

PDF version of the article.


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.

HTML (Browser) version of the article

PDF version of the article


Launching Kinesiology in Medical Education

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.

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,
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.

HTML (Browser) version of the article

PDF version of the article.


Volume 6  2001


A Survey of Information Sources Used for Progress Decisions about Medical Students

Brian E. Mavis, PhD, Bridget L. Cole, BA, Ruth B. Hoppe, MD

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.

HTML (Browser) version of the article

PDF version of the article.


Physician Communication Skills: Results of a Survey of General/Family Practitioners in Newfoundland

Fredrick D. Ashbury, PhD*, Donald C. Iverson, PhD† Boris Kralj, PhD‡, *Department of Oncology, McGill University

*Faculty of Nursing, University of Manitoba; Centre for Health Promotion, University of Toronto; PICEPS Consultants, Inc.; optx Corporation
† Family Medicine, University of Colorado Health Sciences Center; optx Corporation; PICEPS Consultants, Inc.
‡ Ontario Medical Association; PICEPS Consultants, Inc.

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.

HTML (Browser) version of the article

PDF version of the article.


Medical Student Dissection of Cadavers Improves Performance on Practical Exams but not on the NBME Anatomy Subject Exam

Leslie Sargent Jones, PhD*, Lance E. Paulman, PhD* Raj Thadani, MS, Louis Terracio, PhD‡,

* 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.

HTML (Browser) version of the article

PDF version of the article.


Negotiating the Maze: Case based, Collaborative Distance Learning in Dentistry

Sybille K Lechner BDS, MDS FRACDS, FPFA, FICD*, Peter Kandlbinder BEd (SCAE), MEd (UTS)†, Shalinie Gonsalkorale BDS (Hons), FRACDS*, Michael Bradshaw‡, Katherine M Harris (Lechner) B Soc Sci, MBA**, Tracey Winning BDSc (Hons) GradDipHEd PhD††

*School of Dental Studies, University of Sydney Australia
†Institute for Teaching and Learning University of Sydney, Australia
‡Multimedia programmer, Click Here Design Sydney, Australia
**The Leading Edge Sydney, Australia
††Dental School, Faculty of Health Sciences, Adelaide University, Australia


Abstract: The module was developed as an elective to give motivated senior dental students an opportunity to expand their horizons in planning oral rehabilitation. It comprised one tutor and 12 students, from five universities world-wide, communicating on the World Wide Web (WWW), to develop oral rehabilitation plans for simulated patients. Trigger material came from one of two Case Profiles and consisted of diagnostic casts and details of the clinical and radiographic examination in WWW/CD-ROM form. No background material was supplied as to the "patient's" age, sex, history or main concern(s). Students worked in groups of three, each student from a different location. Individual students were given a role within the group: "Patient", who developed a "personal background" belonging to the trigger examination material, "Academic" who identified state-of-the-art treatment options available for the dental treatment needs identified by the group and "General Practitioner" who tailored these options to the "patient's" needs and wants. Student feedback focused on their perception of their experience with the program in response to a questionnaire comprising 11 structured and four "open" questions. All students felt that the program increased their confidence in planning oral rehabilitation. Ten students felt that the "best thing about the program" was the interaction with students from other universities and the exposure to different philosophies from the different schools. Eight students mentioned their increased awareness of the importance of patient input into holistic planning. Under the heading "What was the worst thing", students cited some technical hitches and the snowball effect of two sluggish students who were not identified early enough and thus impacted negatively on the working of their groups. Student feedback showed that the module succeeded in its aims but needed modification to improve the logistics of working with an extended campus

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.


An Electronic Mail List for a Network of Family Practice Residency Programs: A Good Idea?

Jodi Summers Holtrop, PhD, CHES

Assistant Professor and Residency Network Director
Department of Family Practice
Michigan State University

Abstract - The use of an electronic mailing list as a means of communication among faculty in a network of university-affiliated family practice residency programs was evaluated. Faculty were automatically subscribed to the list by the list owner. Messages were tracked for one year and a written evaluation survey was sent. Ninety two messages were sent, with 52% of the messages being posted information. While most (65%) survey respondents reported reading 61% or more of the messages, with only 33% ever actually posted at least one message to the list. Given that faculty were automatically subscribed and that there were only 84 total members, the list may have failed to reach a critical mass of active participants. It is concluded that an email list for network faculty did not function as an online discussion group, although it was extremely beneficial as a way of posting information to affiliated residency faculty.

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
Department of Health Science Education
University of Florida

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.


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.

HTML (Browser) version of the article

PDF version of the article.


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.

HTML (Browser) version of the article

PDF version of the article.


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.

HTML (Browser) version of the article

PDF version of the article


An Integrated Approach for Evaluating Students' Achievement of Clinical Objectives

Patrick D. Bridge, PhD*, and Kenneth A. Ginsburg, MD

*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.

HTML (Browser) version of the article

PDF version of the article.


Clinical Teaching and OSCE in Pediatrics

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.

HTML (Browser) version of the article

PDF version of the article.


Volume 7  2002


Enhanced Web-Based Otitis Study Case vs Simple Paper-Case: Impact on Medical Student Objec-tive Structured Clinical Exam (OSCE) Performance

Michael H. Malloy, M.D.,M.S.
Department of Pediatrics
University of Texas Medical Branch
Galveston, Texas

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.

HTML (Browser) version of the article

PDF version of the article


Faculty Development Program in Dokuz Eylül School of Medicine: In the process of curriculum change from traditional to PBL

Berna Musal* Hakan Abacioglu Oguz Dicle Elif Akalin** Sülen Sarioglu†† Adil Esen‡‡

*Professor, Chair of Medical Education Deptartment
Professor, Department of Microbiology
Professor, Department of Radiology, Vice Dean
**Associate Professor, Department of Physical Therapy & Rehabilitation
††Professor, Department of Pathology
‡‡Professor, Department of Urology
Dokuz Eylül School of Medicine, Izmir, Turkey

Abstract: Introduction: In Dokuz Eylül School of Medicine (DESM) a faculty development program is being carried out by the "Trainers' Training Committee". DESM made a fundamental change in its curriculum from traditional to Problem-based Learning (PBL) in 1997. This was the first implementation of a PBL curriculum in Turkey. Faculty development activities were initiated in the same year. This paper describes the faculty development activities with a special emphasis on PBL courses.
Program description: Between 1997-2000 27 four-day long PBL courses were held for 343 participants. The curriculum consisted of PBL philosophy, PBL steps, role of the tutor and students in PBL process, effective case design, assessment principles and group dynamics. PBL simulations enabled the participants to play the roles of both tutors and students.
Process evaluation: At the end of the program most of the participants stated that length of the program, content, training methods and the course organization was appropriate. The majority of the participants (89.5%) found the program very useful. PBL steps, PBL practices and PBL philosophy were found as the most useful sessions.
Discussion: These courses gave medical staff the opportunity to develop their understanding of PBL methodology and theory. PBL courses and continuous educational activities such as weekly tutor meetings are being held and new courses on advanced tutoring skills are being planned for the near future in DESM.

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
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.

HTML (Browser) version of the article

PDF version of the article


Epistemological Beliefs and Knowledge among Physicians: A Questionnaire Survey

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

HTML (Browser) version of the article

PDF version of the article


Importance of Transferable Skills in Undergraduate Medical Education

Ravi P Shankar MD, Pranaya Mishra MPharm, Praveen Partha DNB

The Editor received a formal request to remove this manuscript from the Journal. The allegations accompanying the request were investigated according to Medical Education Online's complaint policy. The Editor in consultation with selected members of the Editorial Board determined that in their view these allegations were valid and this manuscript has been removed from the Journal.


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.

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
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

HTML (Browser) version of the article

PDF version of the article


Ambulatory Care Skills: Do Residents Feel Prepared?

Denise E Bonds, MD, MPH*†, Josyf C Mychaleckyj, MA, D Phil*‡§, Raquel Watkins, MD*, Shana Palla, MS, Pam Extrom*

*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.

HTML (Browser) version of the article

PDF version of the article


The First Clinical Skill: Students Teach Students to Take Vital Signs

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.

HTML (Browser) version of the article

PDF version of the article


Support of a Problem-Based Learning Curriculum by Basic Science Faculty

William L. Anderson, Ph.D. and Robert H. Glew, Ph.D.

Department of Biochemistry and Molecular Biology
School of Medicine
University of New Mexico
Albuquerque, NM 87131

Abstract - Although published reports describe benefits to students of learning in a problem-based, student-centered environment, questions have persisted about the excessive faculty time commitments associated with the implementation of PBL pedagogy. The argument has been put forward that the excessive faculty costs of such a curriculum cannot be justified based upon the potential benefits to students. However, the magnitude of the faculty time commitment to a PBL curriculum to support the aforementioned argument is not clear to us and we suspect that it is also equally unclear to individuals charged with making resource decisions supporting the educational efforts of the institution. Therefore, to evaluate this cost - benefit question, we analyzed the actual basic science faculty time commitment in a hybrid PBL curriculum during the first phase 18 months of undergraduate medical education. The results of this analysis do demonstrate an increase in faculty time commitments but do not support the argument that PBL pedagogy is excessively costly in terms of faculty time. For the year analyzed in this report, basic science faculty members contributed on average of 27.4 hours to the instruction of medical students. The results of the analysis did show significant contributions (57% of instructional time) by the clinical faculty during the initial 18 months of medical school. In addition, the data revealed a four-fold difference between time commitments of the four basic science departments. We conclude that a PBL curriculum does not place unreasonable demands on the time of basic science faculty. The demands on clinical faculty, in the context of their other commitments, could not be evaluated. Moreover, this type of analysis provides a tool that can be used to make faculty resource allocation decisions fairly.

HTML (Browser) version of the article

PDF version of the article


Personality Perceptions of Medical School Applicants

R. Blake Jelley, MA,* Michael A. Parkes, MA*, Mitchell G. Rothstein, PhD†

*Department of Psychology
† Richard Ivey School of Business
The University of Western Ontario

Abstract: Purpose To examine the extent to which medical school interviewers consider perceptions of applicant personality traits during a semi-structured panel interview, the interrater reliability of assessments, and the impact of such perceptions on individual admission decisions.
Method Semi-structured panel interviews were conducted with applicants to the Doctor of Medicine Program at the University of Western Ontario in London, Canada. Interviewers also provided voluntary, “research only” ratings of applicants on nine relevant personality traits. Data from 345 applicants under consideration for admission were available for analysis.
Results Significant correlations were observed between personality ratings and important operational variables (e.g., interview scores). Applicants who were most likely to be admitted to the program were perceived as high on certain traits (i.e., Achievement, Nurturance, Endurance, Cognitive Structure, & Order) and low on other traits (i.e., Abasement, Aggression, & Impulsivity). Statistically removing variance shared with personality ratings from interview scores resulted in different admission decisions for over 40% of the applicants. Interrater reliabilities for personality perceptions were relatively low. However, interrater reliability of the panel interview used to make admission decisions was acceptable. Nonlinear relations between personality perceptions and interview scores were also explored.
Conclusion Some evidence was found that interviewers’ perceptions of applicant personality may affect their judgments when assigning interview ratings. Given that non-cognitive characteristics are perceived as important in the admissions process and that perceptions of personality traits have implications for decisions about which candidates to admit, suggestions for identifying desirable non-cognitive characteristics and for increasing the quality of assessments are offered.

HTML (Browser) version of the article

PDF version of the article


The Building Partnerships Program: An Approach to Community-Based Learning for Medical Students in Australia

Frances M. Boyle, PhD, T. Natasha Posner, PhD, Allyson J. Mutch, BA(Hons)
Rebecca M. Farley, BBehSc, Julie H. Dean, MPsych(Clin), Anne-Louise Nilsson, BA

Centre for Primary Health Care
School of Population Health
University of Queensland, Australia

Abstract: - The Building Partnerships Program at the University of Queensland, Australia seeks to address the dual challenge of preparing doctors who are responsive to the community while providing a meaningful context for social sciences learning. Through partnerships with a diverse range of community agencies, the program offers students opportunities to gain non-clinical perspectives on health and illness through structured learning activities including: family visits; community agency visits and attachments; and interview training. Students learn first-hand about psychosocial influences on health and how people manage health problems on a day-to-day basis. They also gain insights into the work of community agencies and how they as future doctors might work in partnership with them to enhance patient care. We outline the main components of the program, identify challenges and successes from student and community agency perspectives, and consider areas that invite further development.

HTML (Browser) version of the article

PDF version of the article


Evaluation of World Wide Web-based Lessons for a First Year Dental Biochemistry Course

Alan E. Levine, Ph.D.

Department of Basic Sciences
The University of Texas Dental Branch at Houston
6516 M. D. Anderson Boulevard
Houston, TX 77030

Abstract: First year dental students at The University of Texas Dental Branch at Houston (Dental Branch) are required to take a basic biochemistry course. To facilitate learning and allow student self-assessment of their progress, WWW-based lessons covering intermediary metabolism were developed as a supplement to traditional lectures. Lesson design combined text, graphics, and animations and included learner control, links to other learning resources, and practice exercises and exams with immediate feedback. Results from an on-line questionnaire completed by students in two different classes showed that they completed 50% of the lessons and spent an average of 4 hrs. on-line. A majority of the students either agreed or strongly agreed that practice exercises were helpful, that the ability to control the pace of the lessons was important, that the lesson structure and presentation was easy to follow, that the illustrations, animations, and hyperlinks were helpful, and that the lessons were effective as a review. The very positive response to the WWW-based lessons indicates the usefulness of this approach as a study aid for dental students.

HTML (Browser) version of the article

PDF version of the article


Communication skills Assessed at OSCE are not Affected by Participation in the Adolescent Healthy Sexuality Program

D.A. Penava* and S. Stanojevic

*Department of Obstetrics and Gynaecology
St. Joseph's Health Centre
The University of Western Ontario

The University of Western Ontario

Abstract: Purpose: We proposed that first year medical students who voluntarily participated in the Healthy Sexuality adolescent program would perform better than their peers on an adolescent counseling station at the year-end OSCE (Objective Structured Clinical Examination). In addition we compared medical students’ communication skills at the time of the program as assessed by self, peers and participating adolescents.
Methods: Nineteen first year medical students voluntarily participated in the ongoing Healthy Sexuality program. Adolescent participants, medical student peer participants and medical students assessed communication components on a 7-point Likert scale at the end of the program. At the year-end OSCE, all first year medical students at the University of Western Ontario were assessed at an adolescent counseling station by a standardized patient (SP) and a physician examiner. Statistical analysis examined differences between the two groups.
Results: Students who participated in the Healthy Sexuality program did not perform better than their colleagues on the year-end OSCE. A statistically significant correlation between physician examiner and SP evaluations was found (r = 0.62). Adolescent participants communication skills assessments in the Healthy Sexuality Program demonstrated no significant correlation with medical student assessments (self or peer).
Conclusions:Voluntary intervention with adolescents did not result in improved communication skills at the structured year-end examination. Further investigation will be directed towards delineating differences between SP and physician examiner assessments.

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
University of Washington School of Medicine
Seattle, WA

Director of Medical Education
Madigan Army Medical Center
Tacoma, WA

Co-Director, Northern Illinois Perinatal Center
Rockford, IL

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


Simulation in Medical Education: Focus on Anesthesiology

D. John Doyle, MD PhD FRCPC

Department of General Anesthesiology
Cleveland Clinic Foundation

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


Evaluation of Speakers at a National Radiology Continuing Medical Education Course

Jannette Collins, MD, MEd, FCCP*, Brian F. Mullan, MD, John M. Holbert, MD, FCCP

*Department of Radiology
University of Wisconsin Hospital and Clinics
and Medical School
Madison, WI

Department of Radiology
University of Iowa Hospital and Clinics
Iowa City, IA

Department of Radiology
Texas A&M University
Temple, TX

Abstract: Purpose: Evaluations of a national radiology continuing medical education (CME) course in thoracic imaging were analyzed to determine what constitutes effective and ineffective lecturing.
Methods and Materials: Evaluations of sessions and individual speakers participating in a five-day course jointly sponsored by the Society of Thoracic Radiology (STR) and the Radiological Society of North America (RSNA) were tallied by the RSNA Department of Data Management and three members of the STR Training Committee. Comments were collated and analyzed to determine the number of positive and negative comments and common themes related to ineffective lecturing.
Results: Twenty-two sessions were evaluated by 234 (75.7%) of 309 professional registrants. Eighty-one speakers were evaluated by an average of 153 registrants (range, 2 – 313). Mean ratings for 10 items evaluating sessions ranged from 1.28 – 2.05 (1=most positive, 4=least positive; SD .451 - .902). The average speaker rating was 5.7 (1=very poor, 7=outstanding; SD 0.94; range 4.3 – 6.4). Total number of comments analyzed was 862, with 505 (58.6%) considered positive and 404 (46.9%) considered negative (the total number exceeds 862 as a “comment” could consist of both positive and negative statements). Poor content was mentioned most frequently, making up 107 (26.5%) of 404 negative comments, and applied to 51 (63%) of 81 speakers. Other negative comments, in order of decreasing frequency, were related to delivery, image slides, command of the English language, text slides, and handouts.
Conclusions: Individual evaluations of speakers at a national CME course provided information regarding the quality of lectures that was not provided by evaluations of grouped presentations. Systematic review of speaker evaluations provided specific information related to the types and frequency of features related to ineffective lecturing. This information can be used to design CME course evaluations, design future CME course outcomes studies, provide training to presenters, and monitor presenter performance.

HTML (Browser) version of the article

PDF version of the article


Volume 8  2003


Selected Physical Characteristics of Medical Students

L. Ángyán, T. Téczely, B. Mezey. and Z. Lelovics

Institute of Human Movement Sciences,
Medical School, University of Pécs,
Pécs, Hungary

Abstract: The purpose of this study was to measure selected anthropometrical characteris-tics, motor abilities and cardiorespiratory functions of medical students. Eighty-seven students were involved in this investigation. The students were categorized into five groups: (1) recreational, doing sport activities irregularly, (2) basketball and (3) handball players, having training at least two times per week, as well as men (4) and women (5) students entering medical school. In all groups the mean body mass index and waist-to-hip ratio were at the upper level of the normal range, while body fat percentage was similar to standards for sedentary subjects. Better motor per-formances were obtained from the basketball and handball players than from the other groups. Static strength for the sample was somewhat above the normal sedentary level. The resting blood pressure and heart rate for most subjects were in the normal. Cardiovascular risk factors were found in six students. Their systolic blood pressure was above 140 mm Hg. There were no sub-jects identified with low blood pressure. The heart rate was elevated for three students from the recreational group, and in the women. Bradycardia did not occur. The vital capacity and the ability to hold one’s breath was at the upper level of the normal range. The present results emphasis the need to improve the students` prevention oriented life style through participation in exercising.

HTML (Browser) version of the article

PDF version of the article


ECG Wave-Maven: An Internet-based Electrocardiography Self-Assessment Program for Students and Clinicians

Seth McClennen, MD, Larry A. Nathanson, MD, Charles Safran, MD,
Ary L. Goldberger, MD

Abstract: Purpose: To create a multimedia internet-based ECG teaching tool, with the ability to rapidly incorporate new clinical cases.
Method: We created ECG Wave-Maven (http://ecg.bidmc.harvard.edu), a novel teaching tool with a direct link to an institution-wide clinical repository. We analyzed usage data from the web between December, 2000 and May 2002.
Results: In 17 months, there have been 4105 distinct uses of the program. A majority of users are physicians or medical students (2605, 63%), and almost half report use as an educational tool.
Conclusions: The internet offers an opportunity to provide easily-expandable, open access resources for ECG pedagogy which may be used to complement traditional methods of instruction.

HTML (Browser) version of the article

PDF version of the article


Wireless Handheld Computers in the Preclinical Undergraduate Curriculum

Anand C. Ganger, BS and Matt Jackson, PhD

Abstract: This report presents the results of a pilot project using wireless PDAs as teaching tools in an undergraduate medical curriculum. This technology was used to foster a transition from a passive to an interactive learning environment in the classroom and provided a solution for the implementation of computer-based exams for a large class. Wayne State Medical School recently provided model e570 Toshiba PocketPCs® (personal digital assistants or PDAs), network interface cards, and application software developed by CampusMobility® to 20 sophomore medical students. The pilot group of preclinical students used the PDAs to access web-based course content, for communication, scheduling, to participate in interactive teaching sessions, and to complete course evaluations. Another part of this pilot has been to utilize the PDAs for computer-based exams in a wireless environment. Server authentication that restricted access during the exams and a proctoring console to monitor and record the PDA screens will be described in this report. Results of a student satisfaction survey will be presented.

HTML (Browser) version of the article

PDF version of the article


The Impact of an Evidence-Based Medicine Workshop on Residents’ Attitudes towards and Self-Reported Ability in Evidence-Based Practice

Karyn D. Baum, M.D.

Abstract: Background: Evidence-based medicine (EBM) is a part of many medical school and residency curricula worldwide, but there is little research into the most effective methods to teach these skills.
Purpose: To evaluate whether a course on EBM utilizing adult learning principals leads to both immediate and short-term attitudinal, confidence, and behavioral change.
Methods: Seventy-three (73) Internal Medicine and Internal Medicine/Pediatric residents attended a half-day seminar on EBM. Participants completed pre- and post-course 5-point Likert questionnaires, and set two personal goals for integrating EBM into their daily practice. We performed nonparametric two-sample Wilcoxon Rank-Sum tests to compare responses. We also elicited the self-reported success of the residents in meeting their goals one-month post-course.
Results: Attitudes about EBM improved (3.5 pre-course vs. 3.7 post-course), as well as self-reported EBM skills (3.0 vs. 3.3). Seventy-two percent of residents reported having met at least one of their two goals for the integration of EBM into their practice.
Conclusions: An EBM workshop based upon adult learning principles was successful in meeting multiple educational goals. The links between andragogy, learners’ internal drive for behavior change, and successful EBM education should be further explored.

HTML (Browser) version of the article

PDF version of the article


A Mixed Learning Technology Approach for Continuing Medical Education

Vernon Curran, PhD*, Fran Kirby, MEd*, Michael Allen, MD, Joan Sargeant, MEd

*Faculty of Medicine
Memorial University of Newfoundland

Continuing Medical Education
Dalhousie University

Abstract - Introduction: Distance learning technologies have been used for many years to provide CME to rural physicians. The purpose of this study was to evaluate the utility and acceptability of a mixed learning technology approach for providing distance CME. The approach combined audio teleconferencing instruction with a Web-based learning system enabling the live presentation and archiving of instructional material and media, asynchronous computer conferencing discussions, and access to supplemental online learning resources.

Methodology: The study population was comprised of physicians and nurse practitioners who participated in audio teleconference sessions, but did not access the Web-based learning system (non-users); learners who participated in audio teleconferences and accessed the Web-based system (online users); and faculty. The evaluation focused upon faculty and learners’ experiences and perceptions of the mixed learning technology approach; the level of usage; and the effectiveness of the approach in fostering non-mandatory, computer-mediated discussions.

Results and Discussion: The users of the Web-based learning system were satisfied with its features, ease of use, and the ability to access online CME instructional material. Learners who accessed the system reported a higher level of computer skill and comfort than those who did not, and the majority of these users accessed the system at times other than the live audio teleconference sessions. The greatest use of the system appeared to be for self-directed learning. The success of a mixed learning technology approach is dependent on Internet connectivity and computer access; learners and faculty having time to access and use the Web; comfort with computers; and faculty development in the area of Web-based teaching.

HTML (Browser) version of the article

PDF version of the article


Evaluating a Residency Program Using Reflections of Recent Resident Graduates and their Pediatric Colleagues

Robert K. Kamei, MD* and Theodore C. Sectish, MD

*Department of Pediatrics
University of California
San Francisco School of Medicine
San Francisco, CA.

Department of Pediatrics
Stanford University School of Medicine
Palo Alto, CA.

Abstract: Background and Purposes: In response to the new Accreditation Council for Graduate Medical Education (ACGME) mandate for residency programs to use feedback to improve its educational program, we piloted a novel evaluation strategy of a residency program using structured interviews of resident graduates working in a primary care practice and their physician associates.
Methods: A research assistant performed a structured telephone interview. Quantitative data assessing the graduate’s self-assessment and the graduate’s clinical practice by the associate were analyzed. In addition, we performed a qualitative analysis of the interviews.
Results: Thirteen resident graduates in primary care practice and seven physician practice associates participated in the study. Graduate self-assessment revealed high satisfaction with their residency training and competency. The associates judged our graduates as highly competent and mentioned independent decision-making and strong interpersonal skills (such as teamwork and communication) as important. They specifically cited the graduate’s skills in intensive care medicine and adolescent medicine as well as communication and teamwork skills as important contributions to their practice.
Conclusions: The ACGME Outcomes Project, which increases the emphasis on educational outcomes in the accreditation of residency education programs, requires programs to provide evidence of its effectiveness in preparing residents for practice. Direct assessment of the competency of our physician graduates in practice using structured interviews of graduates and their practice associates provide useful feedback information to a residency program as part of a comprehensive evaluation plan of our program’s curriculum and can be used to direct future educational initiatives of our training program

HTML (Browser) version of the article

PDF version of the article


Creating Online Lessons: A Faculty Development Seminar Series

Deborah Sleight, PhD, Christopher Reznich, PhD, Stephen Yelon, PhD, Professor Emeritus and John Williamson, MA

Office of Medical Education Research and Development
Michigan State University
East Lansing, MI

Abstract: The World Wide Web is being used increasingly to deliver instruction in medical education. Consequently, there is a need to train faculty in developing and implementing online instruction. We developed and implemented a seminar series to teach faculty to create educationally sound, well designed online instruction.

Instruction was delivered to 15 participants via a six session seminar on developing web based lessons, supplemented with web-based instruction. First, the participants learned the basics of instructional design via a web based module. They then completed content outlines for their online lessons prior to the first seminar. Lesson development, web site development and the use of a web based instructional shell to implement the online lessons were each taught in two two hour sessions.

Eight participants developed online lessons and four actually implemented them. Feedback was mostly positive, with suggestions for improvement. All eight participants who completed the series said they would recommend it to their colleagues.

Because a longitudinal workshop type of seminar series requires a large amount of participant time outside of class, a six month seminar series may be too long. It is important at the beginning of the series to help participants select topics suitable for online instruction and to help them narrow their topics. We may change the attendance guidelines so faculty would attend only the session on instructional design and have their staff attend the technical sessions on web site design, HTML editing and online course delivery systems. This would better match the actual practice of faculty designing the instruction and staff developing it.

HTML (Browser) version of the article

PDF version of the article


A Modified OSCE Assessing the Assimilation and Application of Ethical Principles Relevant to Obstetric and Gynaecological Practice

Dr H van Woerden, Dr F Agbo*, Mr NN Amso, Mr I Stokes

* Senior House Officer, Obstetrics and Gynaecology
University Hospital Wales, Cardiff, CF14 4XN.

Senior Lecturer/Honorary Consultant,
University of Wales College of Medicine
and the University Hospital of Wales, Cardiff, CF14 4XN.

Consultant Obstetrician and Gynaecologist,
Nevill Hall Hospital, Abergaveny, NP7 7EG.

Abstract: Objective. To develop and evaluate a modified OSCE assessing the assimilation and application of a range of ethical principles relevant to Obstetric and Gynecological practice.
Setting. Candidates for an SpR training rotation
Methods. Twenty six candidates working in Obstetrics and Gynecology were presented with four questions covering a range of relevant ethical scenarios. Their responses were assessed using a marking schedule. The marking schedule was evaluated against a checklist developed for assessing postgraduate medical examinations. Inter-rater reliability was assessed by calculating Kappa values for each question. The items in the marking schedule were also assessed to determine the level of agreement between the two examiners. To assess the contribution of each question to the total score, the question to total score correlations were calculated. The discriminatory capacity of each question was also assessed.
Results. The development of the examination met almost all of the criteria in the checklist for developing a postgraduate examination. Inter-rater reliability was reasonable (4 weighted Kappas ranged from 0.53 - 0.75). There was a high level of agreement between examiners as to whether a candidate had answered an item on the marking schedule correctly. The degree of discrimination of items in the marking schedule was consistent with clinical opinion on the importance of questions.
Conclusion. This modified OSCE examination demonstrates the feasibility of testing ethical principles relevant to practice in Obstetrics and Gynecology in candidates for postgraduate posts. It meets most of the criteria laid down in a checklist developed to assess postgraduate medical examinations.

HTML (Browser) version of the article

PDF version of the article


A Study of Prospective Ophthalmology Residents’ Career Perceptions

JR Scott, EdD, MPH and CA Gunderson, MD

Department of Ophthalmology and Visual Sciences;
University of Texas Medical Branch

Abstract: Objectives: The purpose of this study was to identify differences in ophthalmology resident candidates and practicing ophthalmologists’ career perceptions. A secondary aim was to evaluate specific demographic factors (e.g., gender, ethnicity, career interests, etc.) among residency candidates regarding their career perceptions.
Methods: A survey instrument (Critical factors in Career Perceptions) was sent by e-mail to prospective residents (n= 122). Group differences were calculated using a one sample t-test analysis.
Results: Compared to practicing ophthalmologists (n = 56), residency candidates were more likely (p < 0.05) to expect greater professional job satisfaction from a number of career factors (e.g., time with patients, physician teamwork, etc.); family-personal factors (e.g., diversity of job skills, sole professional responsibility, etc.); and financial factors (i.e., income and security) than those in practice. Gender differences between candidates revealed that women were more interested in spending time with patients and in computer technology applications.
Conclusions: These results suggest that medical school and residency program leaders to consider specific factors ophthalmologists encounter in their profession so that residency candidates have a more realistic view of their chosen profession. Several recommendations for resident recruitment and curriculum development are provided.

HTML (Browser) version of the article

PDF version of the article


A Content Analysis of Interviewee Reports of Medical School Admissions Interviews

A. Elizabeth Rippentrop, BA*, Matthew Yung-Sang Wong, MA*, Elizabeth M. Altmaier, PhD

*Division of Psychological and Quantitative Foundations
College of Education
University of Iowa

Division of Psychological and Quantitative Foundations,
College of Education, and
Department of Community and Behavioral Health
College of Public Health
University of Iowa

Abstract: Introduction. Prospective medical school applicants use Internet websites to gain information about medical school interviews as well as to offer their experience in such interviews. This study examined applicants’ reported experiences of interviews and compared them to the purposes of the interview as purported by medical schools.
Method. Content analysis of student feedback regarding medical school interviews at 161 medical schools was conducted for entries of over 4600 students applying to medical school who anonymously and voluntarily completed an online questionnaire.
Results. Across all medical schools, nearly one half of all cited interview questions addressed non-cognitive characteristics of the applicants. Top ranked medical schools were reported to ask significantly more interpersonal and illegal questions and fewer academic/general knowledge questions than other medical schools. Lower ranked schools did not differ significantly in the types of questions reportedly asked applicants compared to other medical schools.
Discussion. Medical school interviews are generally gathering types of information about applicants that admissions personnel identify as important in the admission decision. In addition to measuring interpersonal characteristics, medical school admissions interviews are assessing cognitive abilities and ethical decision-making. Sources on the Internet provide actual medical school interview questions to prospective students. This practice can help them gain an undue advantage in interviewing. Admissions committees and faculty who interview students may want to consider how best to obtain accurate and valid responses from applicants.

HTML (Browser) version of the article

PDF version of the article


A 3 Week Geriatric Education Program for 4th Year Medical Students at
Dalhousie University

Laurie Mallery, M.D., FRCPC, Janet Gordon, M.D., FRCPC, Susan Freter, M.D., FRCPC

Dalhousie University,
Department of Medicine
Division of Geriatric Medicine
Halifax, Nova Scotia, Canada

Abstract: Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings.
Results - The curriculum was successfully implemented. An examination, held at the end of each 3-week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program.
Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly population.

HTML (Browser) version of the article

PDF version of the article.


Skills Training in Laboratory and Clerkship: Connections, Similarities, and Differences

Dorte Guldbrand, Medical Student, Nielsen, Anne Mette Moercke, M.D., Gitte Wickmann-Hansen, M.Ed., Berit Eika, M.D., Ph.D.

Unit of Medical Education
University of Aarhus, Denmark

Abstract: Context: During the third semester of a 6 year long curriculum medical students train clinical skills in the skills laboratory (2 hours per week for 9 weeks) as well as in an early, 8 week clinical clerkship at county hospitals.
Objectives: to study students’ expectations and attitudes towards skills training in the skills laboratory and clerkship.
Subjects: 126 medical students in their 3rd semester.
Methods: During the fall of 2001 three consecutive, constructed questionnaires were distributed prior to laboratory training, following laboratory training but prior to clerkships, and following clerkships respectively.
Results: Almost all (98%) respondents found that training in skills laboratory improved the outcome of the early clerkship and 70% believed in transferability of skills from the laboratory setting to clerkship. Still, a majority (93%) of students thought that the clerkship provided students with a better opportunity to learn clinical skills when compared to the skills laboratory. Skills training in laboratory as well as in clerkship motivated students for becoming doctors. Teachers in both settings were perceived as being committed to their teaching jobs, to demonstrate skills prior to practice, and to give students feed back with a small but significant more positive rating of the laboratory. Of the 22 skills that students had trained in the laboratory, a majority of students tried out skills associated with physical examination in the clerkship, whereas only a minority of students tried out more intimate skills. Female medical students tried significantly fewer skills during their clerkship compared to male students.
Conclusions: Students believe that skills laboratory training prepare them for their subsequent early clerkship but favour the clerkship over the laboratory.

HTML (Browser) version of the article

PDF version of the article.


An Alternative Teaching Method for the Regulation of the Immune Response

Ana Cecília Michel da Rosa, Luiz Felipe Osowski, Andréa Goya Tocchetto, Carlos Eduardo
Niederauer, Cristiane Maria Benvenuto Andrade and Maria Lúcia Scroferneker

Department of Microbiology
Universidade Federal do Rio Grande do Sul
Porto Alegre
Brazil

Abstract: Purpose: Our teaching experience has shown that dealing with the molecular aspects of the immune response regulation poses several difficulties. Therefore, we developed a panel board to verify whether or not this active-learning exercise could enhance students’ learning and arouse their interest in subjects that are basically theoretical and complex.
Methods: Twenty cardboard pieces labeled with the names of major regulators of the immune response and three panel boards with explanations on how major regulators work. Students had to match the cardboard pieces with the corresponding explanation.
Results: One hundred forty students participated in this study. The overall response of the students to the game was very positive: 95.71% considered the panel board interesting and 95% said the panel board facilitated the understanding of the subject matter. The students’ grades significantly improved (P<0.0001).
Conclusion: The results obtained show the importance of using the panel board when trying to approach a subject that is vast and complex not only for students but also for professors.

HTML (Browser) version of the article

PDF version of the article.


Medical Students’ First Male Urogenital Examination: Investigating the Effects of Instruction and Gender on Anxiety

Lisa D. Howley, PhD*, Karen Dickerson, PhD

*The University of North Carolina at Charlotte
The University of Virginia

Abstract: Objectives: To investigate the effect that standardized instruction of the male urogenital examination had on the anxiety levels of students and to determine what influence, if any, the gender of the student had on this experience.
Methods: One hundred thirty six second year medical students were asked to report their level of anxiety before and after participation in a small group teaching session on the male urogenital examination. We gathered both qualitative and quantitative information to better understand students’ anxiety surrounding this instruction.
Results: Students had significantly lower state-anxiety scores following the instruction than before (F(1, 76)=102.353, p=.000, eta2=.574) and female students were more likely to have greater state-anxiety than male students (F=6.952, p=.010, eta2=.084). Ninety-nine percent of students reported that the teaching associates successfully reduced their anxiety. This decrease was attributed predominantly to the personal qualities of the teaching associates and to the format of the instruction.
Conclusions: This study provides both quantitative and qualitative evidence that the use of male teaching associates to provide standardized instruction on the urogenital exam is effective at reducing students’ anxiety, particularly with regard to female students. Added standardized instruction may lead to increased confidence, skill, and future compliance with intimate physical exam screening practices.

HTML (Browser) version of the article

PDF version of the article.


Pediatric Resuscitation: Evaluation of a Clinical Curriculum

Joseph V. Dobson, MD*, David S. Brancati, DO, Rollin Nagel, PhD

*Medical University of South Carolina
Charleston, SC

St. Vincent Mercy Medical Center
Toledo, Ohio

Pediatrics and Family Medicine
Medical College of Ohio
Toledo, Ohio

Abstract - Objective: To assess the impact of a 6-hour pediatric resuscitation curriculum on the comfort levels of resident physicians’ evaluation and treatment of critically ill pediatric patients.
Methods: An evaluation instrument assessed resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the curriculum, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations.
Results: Thirty-one residents participated in the study: 51.6% were pediatric, 12.9% were medicine/pediatric and 35.5% were emergency medicine residents. Participants in the curriculum had little previous experience with pediatric resuscitation (83% had been involved in five or fewer pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.002; Wilcoxon Signed Rank Tests). The most significant changes were observed for the following items: resuscitation of pulseless arrest, performance of cardioversion and defibrillation, performance of intraosseous needle insertion, and drug selection and dosing for rapid sequence intubation. Fewer than 48% of learners rated themselves as comfortable in these areas prior to training, but after completion, more than 80% rated themselves in the comfortable range. All residents but one received passing scores on their written examinations (97%). During the mock resuscitation scenarios and oral examination, 100% of the residents were assessed to have ‘completely’ met the learning objectives and critical actions
Conclusion: Implementation of a pediatric resuscitation curriculum improves pediatric and emergency medicine residents’ comfort with the evaluation and treatment of critically ill pediatric patients. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child. The results reported in this study support using this model of instructional design to implement educational strategies, which will meet the requirements of graduate education.

HTML (Browser) version of the article

PDF version of the article.


Opinions of Tutors and Students about Effectiveness of PBL in Dokuz Eylul University School of Medicine

Berna Musal*, Cahit Taskiran*, Ann Kelson

*Medical Education Department
Dokuz Eylul University School of Medicine
Turkey

Medical Education Department
Southern Illinois University School of Medicine
USA

Abstract:- Introduction: The aim of this study is to determine the opinions of tutors and students about the effectiveness of Problem-based Learning in Dokuz Eylul University School of Medicine.
Methods: A questionnaire with a five-point Likert scale, with 1:minimum, 5;maximum, rating PBL effectiveness was administered in February and March of 2001 to tutors and students. Response rates of tutors and students were respectively 65.0% (130 out of 201) and 82.4% (346 out of 420). The reliability of the scale was high (Cronbach ?= 0.90).
Results: Ratings of tutors and students respectively on identified outcomes of PBL varied between 3.80-4.69 and 3.69-4.27 out of 5 points. Both groups gave high ratings to the areas of clinical reasoning, communication and problem solving and gave lower ratings to gaining basic science knowledge. Basic science tutors rated the areas of problem solving, gaining basic science knowledge and intrinsic motivation of students significantly higher than did clinical science tutors.
Discussion: According to the results of this study, tutors` and students` opinions about PBL outcomes were similar to those previously reported in the literature. Both groups had positive opinions about PBL’s effectiveness. As has been reported in other studies, tutors and students gave the lowest ratings to the area of gaining basic science knowledge. However, the ratings of basic science tutors were higher than those of clinical science tutors in this area. This may be due to pre-existing beliefs of clinical science tutors regarding the effectiveness of PBL for teaching factual basic science knowledge.

HTML (Browser) version of the article

PDF version of the article.


Student Perceptions of the Professional Behavior of Faculty Physicians

Karen Szauter MD, Betty Williams PhD, Michael A. Ainsworth MD,
Michael Callaway MS, Robert Bulik PhD, Martha G.Camp PhD

Department of Internal Medicine and Office of Educational Development
The University of Texas Medical Branch,
Galveston Texas

Abstract: This study was conducted to obtain a baseline understanding of the professional behavior of clinical faculty physicians from the medical students’ perspective. Students completed a professionalism evaluation of supervising faculty at the end of each required third-year clerkship over a one year period. Results were analyzed by specific behaviors and across clerkships. Differences were noted in the frequency of the types of problems seen, and varied by clerkship discipline. The most common transgressions of professional behavior reported were the use of derogatory language towards other services or patients and the disrespectful treatment of others. Our study served to provide objective feedback to the faculty about student perceptions of faculty as role models for professionalism while on clinical rotations.

HTML (Browser) version of the article

PDF version of the article.


  Development and Evaluation of an Internet-Based Airway Evaluation Tutorial 

Tammy Y. Euliano, MD*, Amy I. Lee, Jeremy Melker, MD, Ilona M. Schmalfuss, MD§

*Associate Professor of Anesthesiology
Medical Student
Resident in Otolaryngology
§Assistant Professor of Radiology

University of Florida College of Medicine,
Gainesville, Florida

Abstract: Airway evaluation and basic management are essential skills for all physicians. Identifying patients for whom mask ventilation or endotracheal intubation will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. To ensure a thorough understanding of airway anatomy and evaluation, as well as exposure to various abnormal findings, we developed an Internet-based module including interactive components, graphics, animation, video, and a self-assessment tool. The site received more than 1800 visits in its first nine months of operation, with uniformly laudatory comments. Eighty subjects over a six-month period completed a pre- and post-test quiz structured to evaluate the utility of the site. Of those completing the on-line survey, more than 76% rated the site very useful. Most felt their knowledge of airway examination improved after completion of the site (p<0.00004). The median amount of time spent on the site was 29.5 minutes. Judging from the overwhelming response to this site from around the world and across disciplines, such interactive training tools that exploit the technological capabilities of the Internet provide useful adjuncts to traditional teaching methods.

HTML (Browser) version of the article

PDF version of the article.


Volume 9   2004


Teaching Physicians Procedural Skills at a National Professional Meeting

Patrick C. Alguire, MD

Director of Education and Career Development
American College of Physicians
Philadelphia, PA

Abstract: Background: Practicing physicians often wish to improve their procedural skills but have limited educational opportunities to do so.
Description: To summarize the effects of two procedural workshops on participants’ confidence, proficiency, and practice patterns.
Evaluation: Following completion of a skin biopsy or arthrocentesis workshop, participants completed a post-course and an 8-month follow up evaluation. Recipients of this training rated it highly and reported that following training they performed more procedures, referred less, and noted an increase in their confidence that was still evident eight months after the workshop.
Conclusion: Skin biopsy and arthrocentesis/joint injection skills can be taught to practicing physicians in a workshop setting at national professional meetings. Key Words: clinical competence; internal medicine; teaching; educational measurement

HTML (Browser) version of the article

PDF version of the article.


Making the Most of Medical Orientation – A New Approach

Dr Jonathan Taitz, FRACP* Dr Michael Brydon, FRACP, Mr Damian Duffy

*Sydney Children’s Hospital,
High Street, Randwick,
Sydney, Australia

Children’s and Women’s Health Centre of British Columbia,
Oak Street,
Vancouver, Canada.

Abstract: Orientating new junior medical staff can be a complex and time consuming task. Traditional models have typically involved a day or longer of lectures. This involves a large number of senior staff being available on the first day of term. It also means that junior staff not present on the first day had any access to an orientation program at all. Evaluation of our program confirmed the belief that the day was dull and that there was simply too much information for new staff to absorb. As a result of this feedback we extensively updated our orientation program. Pre-reading of the junior staff manual became compulsory. We departed from the traditional lecture style program and devised a new ten- station scenario based interactive program. The stations were designed to cover aspects of the hospital’s mandatory education and key educational requirements in order to function effectively on our campus. Station leaders were selected and trained in the goals of the new process. Several of our secondment sites were engaged in the development of the project topics. We hoped that our secondment sites would be relieved of some orientation responsibility if core material was delivered centrally.

The strength of the new orientation is that it is portable, reproducible and uniform. It is also available via video conferencing. A single person can educate new staff in three hours if the need arises. Most importantly all new staff will have access to the program within a week of starting a term at our hospital.

HTML (Browser) version of the article

PDF version of the article.


Medical Student Summer Externship Program: Increasing the Number Matching in Family Practice

Holly Cronau, MD, Danell J. Haines, PhD

Department of Family Medicine
The Ohio State University

Abstract: Background and Objectives. The number of US allopathic medical school graduates choosing a residency in family medicine has fallen from 13.4% in 1999 to 10.5% in 2002. Concern about declining numbers has led to the development of programs to provide medical students exposure to family medicine outside the clerkship. This paper reports on the development and longitudinal achievements of a clinical summer externship program 1993 to 1999.
Methods. The program description, practice settings, students’ experiences, and department commitment are described. The purpose of this prospective study is to determine the percentage of family medicine summer externship participants (n=115) who match into family medicine.
Results. During the six years studied, 49 (43.4%) of the participants matched into family medicine. Program participants viewed the program favorably, mean = 5.82 out of 6.
Conclusions. The Ohio State University Department of Family Medicine Medical Student Summer Externship Program demonstrates an effective educational experience that can increase and/or attain the proportion of students going into family medicine at the time of graduation.

HTML (Browser) version of the article

PDF version of the article


Attitudes and Views of Medical Students toward Science and Pseudoscience

Adolfo Peña, MD, Ofelia Paco, MD

San Marcos National University. Lima-Peru.

Abstract: Objectives: To know opinions, attitudes and interest of medical students toward science and pseudoscience.
Design: A questionnaire was administered to 124 medical students of the San Marcos University in Lima, Peru.
Results: 173 students were surveyed. The response rate was 72%. Eighty-three percent (100/121) of respondents said that science is the best source of knowledge, 67% (82/123) said they were interested in science and technology news, 76% said they had not read any science magazine or book (other than medical texts and journals) in the last five years. Thirteen percent (16/124) of respondents said that astrology is “very scientific” and 40% (50/124) stated that it is “sort of scientific.” 50% of respondents shared the opinion that some people possess psychic powers.
Conclusions: Medical students' attitudes toward science are generally not favorable.

HTML (Browser) version of the article

PDF version of the article


Development, Implementation and Evaluation of an M3 Community Health Curriculum

Barbra Beck, PhD, Marie Wolff PhD, Tovah Bates, PhD, Sarah Beverdorf, MPH/MSW,
Staci Young, MS and Syed Ahmed, MD, MPH, DrPH

Center for Healthy Communities
Department of Family and Community Medicine
Medical College of Wisconsin

Abstract: Objectives: This paper describes the development, implementation and evaluation of an M3 community health curriculum that responds to recent changes within the health care finance and delivery system.
Methods: The new curriculum was developed based on AAMC recommendations, LCME requirements, a national review of undergraduate community health curricula, and an internal review of the integration of community health concepts in M3 clerkships.
Results: The M3 curriculum teaches: 1) the importance of being a community responsive physician; 2) SES factors that influence health; 3) cultural competency; and 4) the role of physicians as health educators. Student evaluations for the first twelve months of implementation indicate that students are most satisfied with presentations and less satisfied with required readings and a patient interview project.
Discussion: Most students agree that at the completion of the course they understand what it means to be a community-responsive physician, and they have developed skills to help them become more community responsive. Evaluation tools need to be developed to assess if students’ behavior has changed due to course participation

HTML (Browser) version of the article

PDF version of the article


Academic Support Services in U.S. and Canadian Medical Schools

Norma S. Saks, EdD*, Sarah Karl, PhD

*Assistant Dean for Educational Programs
UMDNJ-Robert Wood Johnson Medical School

Director, Office of Academic Development
UMDNJ - New Jersey Medical School

Abstract: Background: Academic support services play a critical but largely undocumented role in helping medical students meet the challenges of the curriculum.
Purpose: To determine the prevalence of academic support programs in medical schools,
and to find out how these are conceptualized and implemented.
Methods: Questionnaires were sent to medical schools in the US and Canada. Questions addressed specific services, providers, and funding.
Results: The survey was returned by 86 of the 135 (67.7%) schools. Almost all (95.3%) provide academic support in the first two years, and a large majority in third (82.6%) and fourth (79%) year. Great variability exists in the infrastructure and funding of the programs, and in the training of the providers.
Conclusions: Academic support is common, but has broad interpretation; services are varied. Programs are conceptualized differently, some to provide specific assistance to pass courses, and others for skill development, to enhance self-directed, life-long learning.

HTML (Browser) version of the article

PDF version of the article


The Value of the Subinternship: A Survey of Fourth Year Medical Students

Eric H. Green, MD MSc, Warren Hershman, MD MPH; Suzanne Sarfaty†,‡, MD MPH

Section of General Internal Medicine,
Evans Department of Medicine and
Office of Student Affairs,
Boston University School of Medicine
Boston, MA

Abstract: Background: Although the subinternship is often regarded as an important part of many fourth year curricula it is rarely studied.
Purpose: We aimed to understand the how well the subinternship prepared medical students to perform core clinical skills.
Methods: Senior medical students at Boston University School of Medicine rated their perception of the effectiveness of the subinternship and “medical school overall” in preparing them to perform core clinical skills using a written survey.
Results: Overall, 69% (101) of students responded. Students believe that the subinternship prepares them to perform most key skills involved in day-to-day medical care. However, students feel less prepared by either their subinternship or overall medical school experience to carry out some complex patient communication skills including delivering “bad news” and discussing end-of-life wishes.
Conclusions: The subinternship appears to be effective in preparing students for many of the challenges they will face as an intern and beyond. However, students identified several complex communication skills that could be addressed in part by the subinternship for which they felt unprepared. Student learning would likely be enhanced by creating a longitudinal program to teach these higher-level communication skills during medical school and by integrating practice and feedback of these skills into the subinternship.

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
Department of Infectious Diseases
General Physician
Tehran University of Medical Sciences

Abstract: Purpose: To evaluate medical students' satisfaction with clinical education during medical internship and the effects of variables in the organizational domain on satisfaction.
Method: A cross-sectional descriptive analytic study in 2000 identified students' satisfaction with clinical education in medical students of Tehran University of Medical Sciences. Students' satisfaction was assessed by a modified job satisfaction questionnaire. Clinical education was classified into; outpatient, bedside and theoretical teaching.
Results: Overall satisfaction with clinical education was 38.8%; outpatient and bedside teaching 52% each and theoretical education 70.8%. Overall satisfaction had a significant association with approach to common and epidemic diseases, class size, and the course planning.
Conclusion: Based on the present study, we conclude that clinical education should be reevaluated in our university with the specific attention to the class size, variety of diseases and course planning considered for each session in clinical education.

HTML (Browser) version of the article

PDF version of the article



Medical Education Online Editor@Med-Ed-Online.org