Volume 7

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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.

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.

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

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.

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

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.

^*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.

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

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.

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.

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

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

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.

Personality Perceptions of Medical School Applicants

*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.

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.

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

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.

^*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.

^*Assoc. Prof. of Pediatrics
University of Washington School of Medicine
Seattle, WA

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.

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.

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

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.

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Volume 7, 2002