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.     

Breast cancer screening knowledge and skills of students upon entering and exiting a medical school

PURPOSE: To assess needs for breast cancer screening education by comparing medical students' training and knowledge of breast cancer screening upon their entry to and exit from medical school. METHOD: Seventy-seven medical students at one medical school completed questionnaires as first-year students (in 1992) and again as fourth-year students (in 1996) that assessed their breast cancer screening knowledge. The fourth-year questionnaire included additional questions about the students' clinical training in breast cancer screening skills and their perceptions of needs for further training. RESULTS: Although the students performed significantly better on the knowledge-based questions in their fourth year than they did in their first year, considerable room for improvement remained. The students reported learning the most from surgery rotations and more from standardized patients than from faculty. Women medical students performed significantly more clinical breast examinations than did men students. CONCLUSIONS: Most of the medical students reported needing additional training in clinical breast examination. More curricular time devoted to education about breast cancer screening is needed.     

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.     

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.     

Histochemical detection of 4-hydroxynonenal protein in Alzheimer amyloid

Portfolio learning has not previously been reported for clinical undergraduate teaching. This open randomized study aimed to assess the effect of portfolio learning in the teaching of oncology to medical students. The project aimed to provide the student with a holistic understanding of the impact of the disease and its treatment on the patient and family, and the natural history of malignant disease, through long-term personal experience of a cancer patient. All undergraduate medical students entering Clinical Studies in October 1992 at the University of Wales College of Medicine were randomized to a study or control group. Both groups continued with the standard curriculum. Each study-group student followed a patient with cancer for 9 months, supported by bi-monthly small-group tutorials. Tutors were either general practitioners or hospital consultants, not necessarily oncologists; each was supplied with a tutor's resource pack of key oncology review papers. Students recorded triggers to learning and key items in a personal learning portfolio. Students' performances in clinical examinations and the contents of their portfolio was assessed. Final assessment was by hidden questions in the objective structured clinical examination (OSCE) in the final degree examination, when students in the study group showed higher marks in factual knowledge of oncology, particularly amongst the weaker students (P = 0.01). Those submitting portfolios for formative assessment had higher overall marks than those in the study group who did not (P = 0.04), representing the more motivated students. The whole study group showed a beneficial trend in their knowledge of oncology.     

Palliative care in undergraduate medical education. Status report and future directions

OBJECTIVE: To describe the status of palliative care education in the undergraduate medical curriculum and to offer recommendations for improvement. DATA SOURCES: Review of literature on palliative care and of recently submitted grants on medical education for end-of-life care. STUDY SELECTION: English-language reports of educational programs targeted toward medical students were examined, as well as surveys of medical schools. DATA EXTRACTION: Studies were reviewed by the authors to assess the quality of the educational program, evaluation methodology, and conclusions. From over 9000 citations on palliative care and related topics that were retrieved from MEDLINE searches from 1980 through 1995, and from reviewing 14 palliative care journals published from 1985 through 1996, 310 articles were identified that addressed medical education for end-of-life care, and 180 were carefully examined. DATA SYNTHESIS: While nearly all medical schools offer some formal teaching about end-of-life care, there is considerable evidence that current training is inadequate, most strikingly in the clinical years. Teaching about palliative care is received favorably by students, positively influences student attitudes, and enhances communication skills. However, curricular offerings are not well integrated; the major teaching format is the lecture; formal teaching is predominantly preclinical; clinical experiences are mostly elective; there is little attention to home care, hospice, and nursing home care; role models are few; and students are not encouraged to examine their personal reactions to these clinical experiences. CONCLUSIONS: The increasing attention to palliative care education has created major opportunities for improving education about care at the end of life. Educational programs should be rigorously evaluated to identify best educational practices.     

USSR: optimizing the teaching of health education in higher medical training institutions

The promotion of medical and health knowledge among the population is an integral aspect of the work of all physicians in the U.S.S.R. The coordination of different aspects of teaching on health education within the general training of the future physician is particularly important. A comprehensive interdisciplinary study was conducted by the Central Institute for Scientific Research in Health Education in several medical schools during the last 5 years in order to develop the preparedness of medical students for their future activities in health education. An experimental method on the "involvement of subjects in real-life situations" was used to evaluate the subjects' degree of preparedness. The experiment included 469 6th year medical students from 5 schools in the country. The results revealed that the students possessed a sufficient volume of knowledge in the field of health education, but the majority were unable to apply this knowledge in medical practice since they were not convinced of its necessity. An experimental educational scheme based on the findings of pedagogical and psychological studies aimed at improving teaching methods was worked out. The experimental training program included the development of scientific thinking, drawing up of a specially designed system of exercises for use as a teaching tool in developing the required intellectual skills, and application of programmed learning. The training scheme was experimentally tested with 211 students from the same 5 medical schools; the control group consisted of 235 students. The experimental training considerably improved the preparedness of students for health education activities. Most of the subjects developed the ability to act in various situations of medical practice and to select and apply proper educational treatment. This had not been the case before training. In the control group no significant difference was observed between the results obtained at the diagnostic stage and those of the control tests.     

Allogeneic bone marrow transplantation for relapsed and refractory Hodgkin''s disease and non-Hodgkin''s lymphoma

There is national and international interest in increasing the community-based component of undergraduate medical education, but more research is needed on its potential, practicability and effectiveness. The objective of the study was to examine the feasibility and efficacy of general practitioners teaching basic clinical skills to first year clinical medical students in the community. The structure and methods of evaluation of the programme are described. Evaluation tools included semistructured interviews of general practitioner tutors; student questionnaires; assessment of student performance; and costs of the programme. The great majority of the students found the programme enjoyable (81 out of 81, 100%) and educational (79 out of 81, 97%). Students' performance in the end of rotation Objective Structured Clinical Examination suggested that clinical skills are acquired at least as well in the community as in the hospital. Tutors identified the personal benefits of this teaching as development of their own clinical skills and the stimulation of teaching. The programme has been successfully expanded from 24 students to 230 students annually and has demonstrated that community-based teaching can usefully contribute to undergraduate medical education in the area of clinical skills teaching. Key practical issues for schools contemplating similar initiatives are presented.     

Physical diagnosis skills of physicians in training: a focused assessment

OBJECTIVE: To assess the proficiency of emergency medicine (EM) trainees in the recognition of physical findings pertinent to the care of the critically ill patient. METHODS: Fourteen medical students, 63 internal medicine (IM) residents, and 47 EM residents from three university-affiliated programs in Philadelphia were tested. Proficiency in physical diagnosis was assessed by a multimedia questionnaire targeting findings useful in emergencies or related to diseases frequently encountered in the ED. Attitudes toward diagnosis not based on technology, teaching practices of physical examination during EM training, and self-motivated learning of physical diagnosis also were assessed for all the EM trainees. RESULTS: With the exception of ophthalmology, the EM trainees were never significantly better than the senior students or the IM residents. They were less proficient than the IM residents in cardiology, and not significantly different from the IM residents in all other areas. For no organ system tested, however, did they achieve less than a 42.9% error rate (range: 42.9-72.3%, median = 54.8%). There was no significant improvement in proficiency over the three years of customary EM training. The EM residents who had received supervised teaching in physical diagnosis during training achieved a significantly higher cumulative score. The EM residents attributed great clinical importance to physical diagnosis and wished for more time devoted to its teaching. CONCLUSIONS: These data confirm the recently reported deficiencies of physical diagnosis skills among physicians in training. The results are particularly disturbing because they relate to EM trainees and concern skills useful in the ED. Physical diagnosis should gain more attention in both medical schools and residency programs.     

Psychologists in medical schools.

Describes the results of a survey conducted by the Committee on Psychology in Medical Schools for the Education and Training Board of the American Psychological Association, utilizing 84 reports from medical schools in 1967-1969 period. Psychology's growth in medical school has followed no standard pattern, but has developed in unique fashion at each school as a function of local constellations of factors. The great expansion of psychology in medical schools has occurred in the last 2 decades, but the period of rapid growth has now ended. While psychology is still most often based within the department of psychiatry, greater diversity of locations is found in schools where psychology was established more recently. Teaching is a major function of medical school psychologists. Their main teaching contribution is to medical education, but they are also involved at all levels of psychological education. Research, which covers the full range of psychological interests, and clinical services, which are beginning to reach out into the community, are the other main functions of medical school psychologists. The satisfactions found in the medical school as a professional environment relate to the vast array of clinical populations, research facilities, and disciplines available there. Dissatisfactions are primarily a result of inadequate recognition as an independent discipline. Overwhelmingly, medical school psychologists desire a more autonomous position for psychology, most often through the mechanism of an independent department of psychology. Other mechanisms recommended are the behavioral sciences department and the "single faculty model" in which 1 university department provides psychological training to all the schools of the university. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical evaluation--difficulties experienced by sessional clinical teachers of nursing: a qualitative study

Evaluation of nursing students in the clinical field requires the clinical teacher to make judgements regarding student progress in a number of areas. In this study concepts of role theory, oppressed group behaviour and the ethics of caring emerged and were used as conceptual frameworks to interpret the data relating to the evaluation of undergraduate students. The number of experienced faculty available for clinical teaching and evaluation has become inadequate and a large number of casual or sessional clinical teachers are employed to teach students in the clinical field. Despite the well documented problems associated with clinical teaching and the use of inexperienced clinical teachers, sessional clinical teachers are nevertheless expected to evaluate student success in meeting the clinical requirements of the nursing course, often resulting in disparate decisions for students. A phenomenological study was carried out using unstructured interviews and written clinical scenarios, to explore the evaluation process from the perspective of the sessional clinical teachers. Research findings indicate that although the sessional clinical teachers were skilled at identifying student problems, they were reluctant to make difficult evaluation decisions, due to low self-esteem, role conflict and their ethic of caring. It seems that gender socialization, patriarchal dominance and apprenticeship training had effected their confidence in their own decision making. The implications of such findings are of concern for the ongoing credibility and integrity of nursing courses, as clinical teachers have an influence on the nursing profession through the preparation of its practitioners.     

Specialty choice and understanding of primary care among Japanese medical students

To assess specialty choice and understanding of primary care among Japanese medical students, all students from seven Japanese medical schools (three public and four private) were surveyed, using a written questionnaire. A total of 3377 students provided data for the study. Of the students surveyed, 89.8% wanted to become clinicians, and 79.3% wanted to have general clinical ability. About half of the respondents, 54.9%, replied that they had some, or great, interest in primary care, but it was found that their understanding of primary care was inadequate. Almost half (56.3%) of the students answered that they had some idea of what a general practitioner did. This proportion was nearly the same through all years of medical school. While 1245 (36.9%) students (most of them in the fifth or sixth year) replied that they had received some clinical training while working in hospitals, only 203 (6.0%) students had worked in private clinics (the sites where most primary care is still provided), and 129 (3.8%) students had experience in providing home visits and home care. An even greater number, 64.3%, replied that they had inadequate information about the career options available to them. The study found that although many Japanese medical students want to obtain broad clinical competence, their understanding of primary care is insufficient. In order to increase the number of primary care providers the system of medical education in Japan must provide primary care doctors to act as role models, and must make available information about postgraduate primary care programmes. These programmes need to be increased, as do rewarding positions for programme graduates.     

On the importance and validity of medical accreditation standards

In late 1997, the authors conducted a national survey of communities of interest about the importance and clarity of 44 accreditation standards applied to teaching, learning, and evaluation in medical schools by the Liaison Committee on Medical Education (LCME). Questionnaires were mailed to deans and educational administrators at U.S. medical schools; current LCME members and surveyors and those who had served during the preceding five years; a random selection of residency program directors drawn from both general practice and speciality disciplines; sample groups of medical students and residents; and a cohort of practicing physicians not affiliated with academic medical institutions. Altogether 1,659 questionnaires were mailed, and 701 responses were received (42%). The recipients were asked to use a five-point Likert scale to rate each of the 44 standards both for its perceived importance as an indicator of the quality of undergraduate medical education and for the clarity with which the standard's intent was conveyed. Although the mean ratings of importance all fell in the "moderately important" and "highly important" areas across the respondent groups, the ratings divided into three groups, semantically and statistically. At the high end for importance are standards dealing with fundamental qualities of students, instruction, and the structuring of resources. At the low end of the importance scale are standards dealing largely with matters of process. The ratings for clarity were systematically lower than the ratings for importance, and in some cases the rating for clarity were even more widely discrepant with the ratings for importance. Individual comments by respondents about certain standards were critical of their complicated construction and of confusion about their meaning and measures of compliance. One or more of these hallmarks--being rated of lower importance or clarity, and being the target of criticism by survey respondents--distinguished most of the standards that earlier study had shown are often neglected by surveyors. The predictive validity of each of a number of standards was examined by testing the association between the standard (or its derivative) and outcomes expressed in annual student and school questionnaires and compiled in databases of the Association of American Medical Colleges and the American Medical Association. The result was a mixed bag, confounded by the absence of specific dimensions of many accreditation standards (independent variables) and the lack of discriminating measures of outcome (dependent variables). Nevertheless, the LCME's accreditation standards are believed to be important by those most affected by them. And beyond validating that medical accreditation is guided by relevant standards for teaching, learning, and evaluation, the results of this study point to ways by which the process can be made more precise and useful.     

Skinning vulvectomy for the treatment of vulvar intraepithelial neoplasia 2-3: a study of 21 cases

The authors compare innovative learning strategies in medical education today with the traditional educational methods of Jewish Talmudic study. These methods began to be developed in yeshivas (the highest Jewish educational institutions) in the third century BC and continue to be used in yeshivas today. The teaching in thousands of yeshivas of Talmudic study worldwide emphasizes student-centered, problem-based, small-group, and lifelong learning. Further, in the yeshivas rote memorization is discouraged; students are selected on the basis of merit rather than social status; and the teachers (particularly master teachers) are expected to act as role models for all aspects of living. Over the centuries, the yeshiva has been slightly modified and specialized, and the number of students has increased, but the institution has retained its basic instructional format. The authors briefly describe each aspect of Talmudic study and how it relates to current educational practices in medical schools. They argue that comparing these two educational institutions--the yeshiva and medical school--is valuable, in that the history of the yeshiva educational system, which has successfully produced generations of creative scholars, educators, and leaders, as well as an enormous body of literature, validates the innovative teaching approaches being used in medical schools today.     

General practitioner teaching in the community: a study of their teaching experience and interest in undergraduate teaching in the future

BACKGROUND: In line with the General Medical Council (GMC) recommendations for undergraduate teaching, many medical schools are implementing new programmes of community-based teaching. Little is known about the enthusiasm of general practitioners (GPs) for, or their ability to undertake, an additional teaching role. AIM: To assess the reservoir of teaching experience among GPs and, in particular, their undergraduate teaching experience, their views on the rewards and problems of teaching, their interest in teaching in the future, and their needs for support. METHOD: Postal questionnaire sent to all 417 GP principals with Lambeth, Southwark, and Lewisham family health service authorities (FHSAs) in January 1995. RESULTS: We achieved a 74% (310/417) response rate. A total of 86% (261/303) of GPs have some sort of teaching experience in their current practice. A large number of medical and non-medical subjects are already being taught. Overall, 75% (228/303) of GPs had experience of undergraduate teaching. Only 13% (41/303) had no teaching experience of any kind. Very few responders felt that teaching was best done in hospital. Different rewards and problems of teaching were perceived by undergraduate teaching GPs and other GPs. There was a high level of interest in undergraduate teaching in the future and a demand for a variety of support measures from medical schools. CONCLUSIONS: New community-based programmes are likely to receive support from GPs, but the vital issues of time, adequate financial reward, and teacher training must be addressed by medical schools if large-scale changes in undergraduate teaching are to be achieved.     

From the desert: transcultural aspects of cancer nursing care in Israel

BACKGROUND: Medical students may be at high risk for occupational exposures to blood. OBJECTIVE: To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN: Review of all exposures reported by medical students at the University of California, San Francisco, School of Medicine. SETTING: Teaching hospitals affiliated with the University of California, San Francisco. PARTICIPANTS: Third- and fourth-year medical students from the classes of 1990 through 1996 at the University of California, San Francisco, School of Medicine. INTERVENTIONS: A needlestick hotline service was instituted at teaching hospitals affiliated with the University of California, San Francisco, and a required course was created to train students in universal precautions and clinical skills before the beginning of the third-year clerkship. MEASUREMENTS: Reports of exposures made to the needlestick hotline service, including type of exposure, training site, clerkship, and time of year. RESULTS: 119 of 1022 medical students sustained 129 exposures. Of these exposures, 82% occurred on four services: obstetrics-gynecology, surgery, medicine, and emergency medicine. The probability of exposure was not related to graduation year, clerkship location, previous clerkship experience, or training site. Surveys of two graduating classes at the beginning and end of the study showed that the percentage of exposures reported increased from 45% to 65% over the 7-year study period. Thus, the reported injury rates represent minimum estimates of actual occurrences. Human immunodeficiency virus infection and hepatitis were not reported, although follow-up was limited. CONCLUSIONS: Instruction in universal precautions and clinical procedures is not sufficient to prevent exposures to blood during medical training. Medical schools must assume greater responsibility for ensuring that students are proficient in the safe conduct of clinical procedures and must develop systems that protect students so that they can report and learn from their mistakes.     

Concomitant rotavirus serotypes 1 and 4 infections in a diarrhoeic child from Belém, Brazil

With the discussion of the quality of medical education in Germany the importance of evaluating the curriculum has grown. A working group of representatives of the German scientific societies for general medicine and the so-called "psychosocial" disciplines in medical education had adapted a questionnaire from Harvard Medical School and tested this version for the first time in summer 1995. 56 teachers and 1250 students took part in this pilot study. The instrument proved to be sufficiently valid to evaluate the quality of different types of teaching lessons. The disciplines (Medical Sociology, Medical Psychology, Social Medicine, General Medicine, Psychotherapy/Psychosomatics) were valued equally with concern to their relevance for medical education. They got significantly better values for quality of teaching and teaching engagement of the professors. It is recommended to notice these results in the actual debate on the reform of the medical curriculum and to include other disciplines in further evaluative investigations.     

The teaching of pharmacology in Italian medical schools: the point of view of Italian doctors

OBJECTIVE: A survey was carried out to gather the opinions of doctors about the current method of teaching pharmacology in Italy. METHODS: A questionnaire was mailed to 3860 doctors, who were asked a series of questions regarding the teaching of pharmacology to medical students in Italian universities. RESULTS AND CONCLUSIONS: The great majority of those who replied considered the teaching they received to be mainly theoretical. The doctors thought that much more time and attention should be dedicated to those pharmacology subjects that are more closely connected to physiopathology and clinical practice (clinical pharmacology).     

Critical appraisal by reading for medical students--a case study from Pakistan

Doctors read literature to keep abreast of medical advances. A recommendation from the 1993 World Summit for Medical Education is that medical schools should teach medical students to critically appraise scientific reports. The Department of Community Health Sciences of Aga Khan University Medical College teaches basic research methods to medical students. This is now supplemented with "Critical Reading". Critical reading was first taught to 67 third year students between October, 1993 and May, 1994. A "validity check-list for critical readers" was introduced in a two week orientation consisting of three one-hour classroom sessions and four one-hour small group sessions. Thereafter, small groups met monthly to critique clinical epidemiological reports relevant to current organ system teaching. The students reading attitudes and critical appraisal skills were assessed through continuous assessment and a written final examination with questionnaire. All but three students passed the final examination (mean score (74%, standard deviation 12%). Sixty-four of 67 (96%) completed questionnaires. All (73% strongly) agreed that critical reading skills were essential, but only 30% strongly agreed that they had, indeed, mastered the skills. Ninety-seven percent (56% strongly) disagreed that year three was too early to start critical reading. Clinical teaching staff expressed interest in learning these skills. Students benefited from and enjoyed this first critical reading course. It strengthened ties between clinical and community health sciences teaching staff. The critical reading skills of the clinical teaching staff is being addressed in seminars to strengthen institutional research capacity.     

Teachers' attitudes toward change and subsequent improvements in classroom teaching.

The relation between teachers' attitudes toward teaching practices presented in inservice training and the subsequent use of these practices was investigated. Three groups of junior high teachers (N?=?19) attended five workshops on effective teaching and received different between-workshop activities. Pre- to posttraining observations, questionnaires, and interviews were used to assess behavior changes and attitudes. Correlational analyses indicated that teachers' posttraining ratings of the importance of using the practices (philosophical acceptance) was predictive of their use by teachers. Qualitative data analyses revealed that improving teachers differed from nonimproving teachers in their willingness to experiment in their classrooms and in their growth in self-efficacy. Nonimproving teachers tended to defend their natural style of teaching, to attempt few changes, and to have low expectations for themselves and for their students. Staff developers need to attend to philosophical acceptance, self-efficacy, and the importance of the suggested practices during inservice training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)