Volume 8

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Selected Physical Characteristics of Medical Students

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.

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.

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.

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

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.

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

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.

^*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

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.

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

^* 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.

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.

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.

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.

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

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.

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.

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.

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.

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

^†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.

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.

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

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.

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Volume 8, 2003