Research activities of medical students in Germany using as an example the Würzburg University Clinic

BACKGROUND AND OBJECTIVE: Many medical students in Germany take part in research at their university, as part of their work on a doctoral dissertation. There are alternatives to this model in other countries. To have a basis for comparison, the research activities of medical students at the University of Würzburg were analysed. METHOD: A questionnaire was sent to all members of the teaching staff of the medical faculty of the University Würzburg (n = 238). It contained 20 questions about the number of students whose research had been supervised, duration of the research, number of uncompleted research studies, cost of materials, resulting publications and estimate of value of the research done. Among those questioned were two groups of professors (50 and 66 respectively, 122 senior lecturers or titular professors). RESULTS: 106 faculty members answered the questionnaire sent to them (45%), 66 working clinically, 26 in a clinic-related institute and 14 in basic research. The students' research usually started in their 4th year and on average took up 216 full-time days. The average training period had lasted for 3 months, 10% of student broke off their research, and each faculty member supervised a mean of 4.5 students. Nonexperimental work (48.3%) cost on average DM 2300, experimental work (51.7%) DM 15,000. Generally two publications resulted and one or two posters/oral communications per student. Two-thirds of the faculty members thought that research undertaken by medical students was important for maintaining a qualitatively and quantitatively high publication level at a university clinic. CONCLUSION: Work on a doctoral dissertation not only promotes scientific thinking of the future doctor but also contributes towards maintaining scientific standards.     

Information Management and Technology (IM&T): training provision in postgraduate medical education

Information Management and Technology (IM&T) is assuming a greater role within the modern NHS and there is an increasing need for members of the medical, and other health care, professions to receive appropriate training and education in these areas. Over half the Postgraduate Deans, Regional Advisers in General Practice and the Medical Royal Colleges have made a conscious decision to supply training in IM&T-related areas. These courses are open to a wide range of health care professionals. However, the number of reported places is not adequate for the large number of people who require the training. Less than half the organizations employed staff with a remit to provide training but over half provided courses in collaboration with educational establishments. As the medical undergraduate curriculum changes and incorporates training in computer skills, the links between the postgraduate institutions and medical schools must be fostered and developed. This will lead to increasing opportunities for health professionals both in the range of subjects and the number of places available.     

A promotion ladder for teachers at Harvard Medical School: experience and challenges

The authors describe the development, implementation, and institutionalization at Harvard Medical School of a promotion ladder that recognizes the teaching and scholarly contributions of full-time clinical faculty. They also discuss the challenges that arose during this process, for example, how to make the new track creditable and attractive to both the appointed faculty and the faculty at large. The criteria developed for promotion focus on a candidate's skills and accomplishments in teaching, scholarship, clinical work, and departmental service. The authors present the elements of these criteria for the three professional levels of the ladder and outline the appointment process, including the steps for consideration of a given promotion. The development of this teacher-clinician ladder has had a positive influence on faculty who are committed to teaching by allowing recognition of their contributions in a track held to be the equal of the other full-time tracks in a medical faculty traditionally committed to research and patient care. Data are given for the 70 faculty who were promoted over the five years from 1989 to 1994. The true success of this promotion ladder will be measured only over time through its impact on the educational enterprise within the medical school and its hospitals, and its capacity to both successfully advance the careers of qualified medical educators and further the development of the field of medical education.     

Continuing medical education in Europe: a survey

The Continuing Medical Education (CME) in Europe Project is conducted by the World Federation for Medical Education, in conjunction with the Association for Medical Education in Europe, the Association for Medical Deans in Europe, and the European Office of the World Health Organization, with Upjohn Medical Sciences Liaison Division. The aim of the Project is to promote the development of CME in all European countries. It also has global relevance: all six Regions participated in initiating the Project, and its progress and outcomes will be generalized to the other five Regions. This Project coordinates information about the important developments in CME in all countries of Europe. In addition to this coordinating function, the Project has a dissemination function, promoting knowledge about good examples and CME experience (demonstration projects) in the countries of Europe. A survey was made of the methods of CME in each country, the informants being the members of the Project's CME Task Force. It consists of nominated representatives from the National Associations for Medical Education of countries in the European Region.     

The Medical Polyclinic: an approach to conflicting needs in a teaching hospital

University teaching hospitals have become increasingly aware of their responsibility to improve both the teaching of ambulatory care and the quality of care provided in their clinics. This paper describes how one department of medicine met this challenge by forming a "Medical Polyclinic." The majority of the department's faculty and house staff, at all academic and training levels, participate in a system of ambulatory care with the following objectives: each patient has a single physician whom he sees by appointment and who coordinates his care; all medical subspecialties are available in the same clinic session; the clinic is attractive and efficient. While these goals are not infrequently met in private group practices, they are unusual in a university teaching hospital, where faculty, house staff, students, and patients each have unique needs, not always compatible. The success and problems of the polyclinic approach are discussed.     

Contemplating a university clinical department

University clinics combine teaching, research and patient care. Some think that no single person (head of department) can perform all three tasks. Also, the head has to have the political skills necessary to manage the faculty society. The guidelines for university clinics, and for their heads in particular, are: (a) conscious pursuit of optimal quality, (b) giving the highest priority to training house staff and teaching students, (c) providing patient care and (d) ensuring that clinical research should serve the purpose of inspiring scientific attitudes in house staff. The 'product' of a university clinic is neither the sum of its publications nor the cured patient, but the medical specialist delivered to society.     

Applications submitted to regional research committees in 1976 and their outcome

In 1976 regional research committees in England and their equivalent in the Welsh Office judged 608 proposals for funding under the locally organised research scheme. Of these, 521 were new proposals and 87 were resubmissions. Medically and dentally qualified applicants made 451 (87%) of the new proposals; nearly two-thirds came from teaching areas and 21% from staff of academic departments. Two hundred and ninety new proposals were approved, 154 rejected, and 77 were referred back for modification. Approval was commoner for applications from teaching areas, from medical staff, and for the less expensive projects. Some regional committees did not support research into the organisation of health services. Under a quarter of the resubmitted projects were rejected. The scheme is not yet used by a wide range of health-care professions. Medical staff in teaching areas still use it most. In some regions prospective researchers, especially those without previous experience, need a comprehensive and easily identifiable counselling service, so that the fund may be exploited in the way originally intended and the number of unsuccessful proposals reduced.     

Clinical knowledge and skill priorities in substance abuse education: a nursing faculty longitudinal survey

The aims of this study were to: 1) determine which of 16 substance abuse content areas nursing faculty fellows considered important for their professional growth; 2) determine content areas in which faculty fellows planned to obtain knowledge and skill development during the coming year; and 3) to identify content areas faculty fellows thought undergraduate and/or graduate students should be taught. Questionnaires were mailed to the 43 nursing faculty fellows who were recipients of substance abuse federal training during the 1989-1994 academic years. The response rate was 81%. One and a half years later, 66% responded to the same items on a follow-up survey. The results showed that faculty ratings of knowledge and skill development needs for themselves and their students in nursing were stable over time. Findings can be used to guide faculty and curriculum development in alcohol and other substance abuse.     

Planning criteria for multicentre, multilingual telemedicine conferences

The international telemedicine conference Chinese TeleMed 96 was held in November 1996. This three-way teleconference included delegates in London (where the international telemedicine conference TeleMed 96 was taking place) and medical staff from one Beijing hospital and one Hong Kong medical faculty. In total, over 1000 health-care personnel across eight time-zones participated. The event demonstrated that the quality of teleconferencing technology was suitable for medical teaching, for providing medical consultations to remote locations and for stimulating medical exchanges. In general, planning a telemedicine conference requires a longer lead time, a wider representation of expertise in the organizing committee and more financial resources than conventional conferences. It is recommended that the aim and format of a telemedicine conference be determined at least one year before the target date. Criteria for improving the preparation of such conferences have been identified and a set of guidelines for future conference organizers has been drawn up.     

Educational programs in US medical schools, 1997-1998

To describe the current status of medical education programs in the United States, we used data from the 1997-1998 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and from other sources. There were 96733 full-time medical school faculty members, a 1.2% increase from 1996-1997. The 43020 applicants for the class entering in 1997 represents an 8.4% decrease from 1996. The number of 1997 applicants who were members of underrepresented minority groups decreased 11.1 % from 1996, and the number of entering underrepresented minority group students decreased 8.4%. More than half of medical schools reported that the number of inpatients available for medical student education had decreased in at least some of their clinical sites or in some disciplines during the past 2 years. Thirty-nine medical schools (31.2%) reported having more difficulty recruiting or retaining volunteer clinical faculty to participate in medical student teaching in 1997 than in 1995.     

Training teachers in the anatomical sciences

A number of medical schools have initiated workshops to improve faculty teaching skills. Little effort, however, has been directed toward the pedagogical training of graduate students who are destined to become future medical science teachers. To help solve this problem, the faculty of the Department of Anatomy in the University of Nebraska College of Medicine recently developed a prototype teacher training program for graduate students in anatomy. Through formal course work and practical classroom experience, students are developing the skills requisite for effective teaching of the anatomical sciences. Student and faculty response to the training program has been enthusiastic, and the objectives and structure of the program can be applied to the production of competent and skilled teachers in other areas of the basic and clinical sciences.     

Psychiatry clerkship success: skills and styles

In recent years, medical students and psychiatry have been a provocative mix, causing much concern among students and faculty. Disagreement has been frequently offered regarding clerkship content, degree of learning, and even the basic importance of the topic of psychiatry itself. To help overcome these problems, 10 suggestions are offered for a curriculum learning skill foundation and 13 suggestions for clerkship teaching staff approach. These truism ingredients have been the major formula of a successful psychiatry teaching program as consistently reported by almost a decade of students and faculty. It is believed these principles might have wider applicability for enhancement of student recruitment to psychiatry residencies and for general stimulation of interest and learning in clerkship programs of various medical disciplines. Relevant literature is cited which addresses some of these individual issues.     

Medical education of tomorrow: a glance into the (near) future

Educational reform is a topical subject in Dutch medical schools. Public visitation reports were issued in 1992 and 1997. In 1994 an 'outline plan' was presented, setting forth communal training requirements (final results). An important consequence will be reorganization of (assistant) housemanships. Options are to start already in the 3rd- and 4th-year with a few (assistant) housemanships, to reduce the number but increase the duration of the (assistant) housemanships and to introduce a more comprehensive training (including elements from several disciplines). Other areas for special attention are the insufficient professionalization of teachers in medicine, the bureaucracy weighing down the teaching and the continuing need of educational research. Regarding the future doctors' image of their profession, emphasis should be placed on the international trend toward more attention for prevention and cost control, apart from the physician's traditional curative task. With respects to curriculum reorganization, six items should be considered: the need of a basic philosophy (per faculty), the priority to be given to the process of medical problem solving over that of acquiring knowledge and information, the desirability of increasing orientation to practice, the necessity of an integrated approach of medical teaching (teaching elements to be deduced from the final terms, instead of vice versa), development of a professional attitude and the realization of a master-apprentice relationship in medical education.     

Doctoring III: innovations in education in the clinical years

Despite recent major changes in the practice of medicine, there has been relatively little change in medical education, particularly in the clinical years. Important areas such as ethics, domestic violence, nutrition, preventive medicine, and clinical decision making have been neglected in the curriculum. However, in 1994 the UCLA School of Medicine began to implement Doctoring III, a multidisciplinary, centralized, longitudinal course that spans the third year of medical school. This course addresses many underrepresented topics. Students spend one day every other week in Doctoring III. Half of the day is spent in community-based clinical sites and the other half is spent in small-group teaching sessions. In the small groups, students and faculty follow and manage a panel of simulated patients over the course of the year. The students thus have the opportunity to develop a sense of the progression of common illnesses over time and to explore related ethical, social, and other concerns. The approach taken in Doctoring III has enabled the UCLA School of Medicine to overcome many barriers to curricular change, and it may serve as a model for incorporating the teaching of underrepresented topics in the clinical years.     

Teaching portfolios: reflecting upon and improving teaching

A number of benefits can be seen for academic medical faculty and their learners as a result of using the teaching portfolio to focus on faculty's work as educators. While the portfolio's initial purpose may be to document the extent and quality of teaching, thoughtful reflection on and documentation of the process and outcomes of teaching can lead faculty to advance in their teaching skills as medical practitioners who are charged with inducting new learners into the profession.     

Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989-93

Drug-related deaths have become a major source of premature mortality. This paper presents an analysis of deaths due to acute adverse drug reactions caused by opiates or cocaine in the city of Barcelona over a 5-year period during which figures were stable. Annual mortality rates due to adverse drug reactions of city residents for the 1989-93 period were estimated to be 15.3 per 100,000 people in the 15-49-year age group. Mortality rates for men (25.0) are consistently higher than mortality rates for women (5.8). Mortality rates by age group show different patterns by gender. Males in the 25-29-year group have the highest mortality rate (62.8), almost doubling the rates for the 20-24 (36.1) and 30-34 (33.3)-year groups. The highest differential in age-specific mortality by gender is seen in the 35-39-year age group, where mortality rates for men (21.5) are eight times higher than for women (2.6 per 100,000). The distribution by place of residence, stratifying data across city neighbourhoods and municipal districts displays wide differences between districts in the mean annual rates, ranking between 77.3 and 8.3 per 100,000, a nine-fold magnitude. Differences are even steeper when we break down data by neighbourhood. Although all areas with high adverse drug reactions mortality are areas of low socio-economic level, a more complex association between deprivation and drug use must exist, as other areas with similarly low socio-economic indicators do not suffer from such high mortality. A cross-tabulation of place of residence and district of death shows that for most adverse drug reaction deaths, death takes place in the district of residence but patterns related to districts who attract drug-related deaths and districts who export them may be observed. These results provide new insights into the epidemiology of substance abuse in Barcelona, where it follows patterns that may be similar to those of other major urban areas in Spain, but also in other Southern European countries.     

Antiamoebic activity of Piper longum fruits against Entamoeba histolytica in vitro and in vivo

Proposed changes in postgraduate surgical training must be seen in the context of changes being implemented in medical schools. The reorganization of discipline-based departments into large units of biomedical science; the reduction in time allotted to anatomy, particularly to dissection by students; the development of integrated courses with multidisciplinary examinations in which poor performance in anatomy can be compensated by good marks in other subjects; the decline in staff numbers (faculty) with expertise in human anatomy and corresponding enthusiasm for teaching it; and the loss of demonstratorships available to surgical trainees are all factors that leave today's medical graduates who embark upon surgical training programs poorly equipped in their knowledge of anatomy. This deficiency is not easily remedied by the proposed changes in Basic Surgical Training and is not adequately identified by the examination arrangements. It is argued that a structured oral examination with a wide spectrum of components, including dissections, living and surface anatomy, osteology, radiographs and scans, and microanatomy, would be the best way of assessing the familiarity of candidates with anatomy and their suitability to proceed to Higher Surgical Training.     

Case 6--1998. Perioperative anesthetic management of a patient presenting for resection of a tracheal mass

PURPOSE: Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers. METHOD: The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals. RESULTS: Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention. CONCLUSION: Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.