The teaching of clinical oncology in Italian medical schools. A survey among teachers and students

BACKGROUND: Oncologists, health care workers and health organizations consider well-performed teaching programs in clinical oncology a fundamental step in cancer control. The aim of our study was to assess the views of teachers and students on the present status of oncology teaching in Italian medical schools and on the most common shortcomings in cancer education. MATERIALS AND METHODS: A survey was carried out among teachers and students of 17 Italian medical schools using two different questionnaires. Six hundred forty-seven students of Northern, Central and Southern Italy in the final two years (5th and 6th) of their medical curriculum and 87 professors of pathology, surgery, internal medicine and medical oncology completed the questionnaires. RESULTS: Doctor/patient relationships and integration among disciplines were the most unsatisfactory aspects of oncology teaching, according to students. Biology, epidemiology, radiotherapy, and medical treatment were felt to be insufficiently treated, whilst diagnostic aspects, clinical management and surgery were rated sufficient. The median number of cancer patients to whom each student had access during his/her training was limited, averaging only 13 patients; however, a high degree of variability was noted. A larger number of patients was generally observed in smaller, less crowded medical schools, with notable exceptions. Although the majority of teachers had clinical practices related to their disciplines, only a small number of students underwent a period of clinical training. Traditional methods of teaching were preferred to innovative methods, while interaction among disciplines was uncommon. CONCLUSIONS: This survey emphasizes the dualism between students' expectations and teachers' ideas about cancer teaching. Doctor/patient relationships and poor attention to practical clinical problems seem the most critical issues for clinical oncology training in Italian medical schools.     

Sophomore medical students as substance abuse prevention teachers

Medical education should emphasize health promotion and disease prevention and should offer educational experiences that require students to be active, independent learners and problem solvers. The purpose of this project was to enable sophomore medical students to apply their own innovative methods of instruction to a program for adolescent substance abuse prevention. Medical students developed and taught a school-based prevention program to 36 middle school students who represented a variety of socioeconomic backgrounds and abilities. They used demonstrations, role-playing, and drug abuse prevention commercials created by the adolescents for their peers. Medical students kept weekly journals to record their thoughts about and activities used in teaching substance abuse prevention to adolescents. The journals revealed an increased understanding of adolescent thinking and behavior and an increased confidence in teaching substance abuse prevention to adolescents.     

The future of protein secondary structure prediction accuracy

In order to investigate the path of medical education in Iran, indicators of medical education were searched from 1970 to 1994. There have been rises in the number of educational institutions from 10 to 46; student admissions in programmes of medical sciences from 1387 to 18,141; medical student admissions from 632 to 3630; teaching staff from 1573 to 7979; and teaching-bed to student ratio from 1.05 to 2.08. The numbers of students in clinical specialty and MS degrees have increased, and various programmes in clinical sub-specialty and PhD degrees have been initiated. The quality of medical education has improved with increasing field and ambulatory care training, with more emphasis on teaching preventive medicine and a significant rise in the research activities. Most qualitative and quantitative progress has been achieved following the establishment of a joint Ministry of Health and Medical Education in 1985. The results of this review demonstrate the success of Iran in upgrading medical education by the unification of health services and medical education in one ministry.     

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.     

Integration of education and services as a base for the formation of human resources in health care]

It will be necessary to coordinate the University role with health institutional policies concerning the definition of health goals, and personnel functions as the latter should be trained if and when they are offered the opportunities of grasping both theory and practice in an environment closely related to everyday problems and realities. Accordingly, health care changes must precede health educational changes. There are two factors that interfere with a proper integration between the education care system: 1) an excess number of medical (or health students that overcome teaching facilities and 2) the correct trend in health care, based on specialists, attached to large hospital centers in urban environments. No attention is paid in this way to the importance of the health team, to health promotion, health education, preventive measures, etc. In several Mexican schools new curricula have been developed in which students face actual health problems from the beginning of the studies and they are trained as another resource of the health system being involved in all type of health activities in health centers, schools, nurseries, out-patient community clinics, etc.     

Cultivating curricular reform

Since the 1960s there has been pressure to reform medical education in a more humanistic direction. One reason this has been difficult is that most medical schools have been forced to maintain themselves on resources allocated to support research and the technology of specialized tertiary care. Nevertheless, many people believe that medical education can still change because of changes taking place outside the sciences, such as a redefinition of the meaning of health and the need to provide better health care to the U.S. population at a lower cost. Taking this optimistic view will help strengthen reformers' resolve for curricular change and the incorporation of important areas such as family violence into medical students' education. There are numerous barriers to curricular change. Yet there are useful principles that can guide reform efforts, such as having an explicit rationale for the desired change, focusing on educational goals rather than on resources for their implementation, recruiting support from the departmental and school leadership, anticipating negative reactions, and recognizing the need for negotiation. There are also principles to foster successful implementation, the most important of which is to have everyone involved agree on the goals of the new program and participate in the process. The way to increase an emphasis on family violence issues is to find areas in the curriculum where these issues can be integrated with current teaching. Finally, a medical school curriculum on family violence does not need to be all-inclusive, but instead should prepare a good foundation so that students can expand their knowledge and skills during residency training and medical practice.     

Characterization and evolution of mariner elements from closely related species of fruit flies (Diptera: Tephritidae)

The authors reviewed the literature published from 1966 to 1996 to identify enrichment programs for underrepresented minority precollege students sponsored by medical schools and affiliated programs, finding 19 articles describing 27 programs. The authors categorized the reported programs according to the components they contained. Most programs contained more than one component type. Twenty-four programs had an academic enhancement component. Two thirds had a motivational component to encourage students to consider medical and other health careers. Two programs set up mentoring relationship between students and health professionals. There were four research apprenticeships and three academic partnerships between medical schools and local school districts. Twelve of the 27 programs were evaluated in the literature. Eight evaluations focused on identifying the numbers of students who continued their education into college and professional schools. Five programs reported participant satisfaction or identified other short-term outcomes such as gains on standardized tests. While the percentage of participants completing college and entering health care careers is impressive, the authors do not believe that the educational success of participants can be attributed to involvement in these programs. The authors recommend ways to improve the quality and interpretability of enrichment program evaluations. Evaluators should adopt common terminology for activities and outcomes. Participants' economic and educational disadvantages should be described. Programs' theoretical underpinnings should be identified and related to evaluation. Measures should include immediate effects as well as long-term outcomes. Where possible, data from comparison groups should be reported to support conclusions. Adequate funding needs to be available to design and complete reasonable evaluations.     

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.     

Medical history in the undergraduate medical curriculum

History has long played a role in the education of American physicians, but the uses of medicine's past have changed over time. In the late nineteenth century, some physicians taught medical history to their students to supply a sense of continuity with professional traditions in times of rapid and bewildering change. Other physicians believed that instruction in medical history would impart a sense of refinement to medical practitioners. In the late twentieth century, medical history is increasingly viewed as a significant dimension of the professional, intellectual, and humanistic development of medical students. Further, it is one of the principal means by which recent, radical changes in health care can be given needed perspective. The knowledge that medicine and the medical sciences are fundamentally social enterprises is an important lesson for medical students. Through exposure to the history of health care, students also learn that medical knowledge is itself subject to change and is acquired in specific contexts. In the 1990s, medical history is taught in a variety of settings. In some schools, history is integrated into the teaching of medical humanities. Where medical history is institutionally distinct from the humanities, courses in medical history may be either elective or required. In order to reach students at every stage of their medical education, historians and clinicians can join forces to teach history in innovative and flexible programs.     

Evaluation of an occupational health education program among 11th grade students

BACKGROUND: There is a paucity of publications on occupational health as part of the educational curricula in high schools. We investigated the extent to which a new occupational health education program for 11th graders succeeded in achieving changes in their knowledge and attitudes. METHODS: Six classrooms were randomly assigned to either 96 participating students or to a control group (n = 100) that did not participate. Data on knowledge, attitudes, and beliefs were collected before and 4 months after completion of the course by means of an anonymous self-reported questionnaire. One point was assigned to each answer that was either correct or in the desired direction. Scoring was measured by adding up the points and then converting the total into a scale of 100. RESULTS: The experimental group had a statistically higher mean score (from 24.56 to 80.74) after completing the course. The control group had low scores at both time 1 (20.15) and time 2 (17.00). At least 50% more students of the experimental group gave correct answers after the course, while there was no such change in the control group. CONCLUSIONS: Our findings indicate that occupational health learning can occur in the secondary school setting and confirm the program's effectiveness in achieving desired changes in the immediate outcome of knowledge, attitudes, and beliefs in different areas of occupational health. The subject of occupational health is a topic with relevance to larger educational objectives and policies. In many countries all over the world as well as in Israel, this curriculum can potentially be integrated into the body of the current instruction of "Life Abilities," which are courses that cover topics that prepare the youngsters for adult lifestyles.     

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.     

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.     

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.     

PCB congener 77-induced ultrastructural alterations in the rat liver: a quantitative study

In this contribution, the role of health informatics in the medical curriculum is discussed. Firstly, trends in healthcare are presented that may have an impact on the use of IT in healthcare and consequently on education. Then, the traditional educational system is discussed and it is argued that the educational system should be changed. The problem-based approach is presented as an example of a new approach. The implications for education and training in health informatics are given. Given the lack of knowledge with respect to the basics of health informatics of both health professionals and students, attention has to be paid to learning materials. Both IT-EDUCTRA and NIGHTINGALE are presented as European projects that focus on education and training.     

Endothelial changes following repeated effect of vasoconstrictive substances in vitro

A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.     

Characteristics of health education among secondary schools--School Health Education Profiles, 1996

PROBLEM/CONDITION: School health education (e.g., classroom training) is an essential component of school health programs; such education promotes the health of youth and improves overall public health. REPORTING PERIOD: February-May 1996. DESCRIPTION OF SYSTEM: The School Health Education Profiles monitor characteristics of health education in middle or junior high schools and senior high schools. The Profiles are school-based surveys conducted by state and local education agencies. This report summarizes results from 35 state surveys and 13 local surveys conducted among representative samples of school principals and lead health education teachers. The lead health education teacher is the person who coordinates health education policies and programs within a middle or junior high school and senior high school. RESULTS: During the study period, almost all schools in states and cities required health education in grades 6-12; of these, a median of 87.6% of states and 75.8% of cities taught a separate health education course. The median percentage of schools that tried to increase student knowledge on certain topics (i.e., prevention of tobacco use, alcohol and other drug use, pregnancy, human immunodeficiency virus [HIV] infection, other sexually transmitted diseases, violence, or suicide; dietary behaviors and nutrition; and physical activity and fitness) was > 72% for each of these topics. The median percentage of schools that tried to improve certain student skills (i.e., communication, decision making, goal setting, resisting social pressures, nonviolent conflict resolution, stress management, and analysis of media messages) was > 69% for each of these skills. The median percentage of schools that had a health education teacher coordinate health education was 33.0% across states and 26.8% across cities. Almost all schools taught HIV education as part of a required health education course (state median: 94.3%; local median: 98.1%), and more than half (state median: 69.5%; local median: 82.5%) had a written policy on HIV infection among students and school staff. A median of 41.0% of schools across states and a median of 25.8% of schools across cities had a lead health education teacher with professional preparation in health and physical education, and < 25% of schools across states or cities had a lead health education teacher with professional preparation in health education only. Across states, the median percentage of schools, whose lead health education teacher had received in-service training on certain health education topics, ranged from 15.6% for suicide prevention to 51.4% for HIV prevention; across cities, the median percentage ranged from 26.2% for suicide prevention to 76.1% for HIV prevention. A median of 19.7% of schools across states and 18.1% of schools across cities had a school health advisory council. Of the schools that received parental feedback (state median: 59.1%; local median: 54.2%), > 78% reported receiving positive feedback. INTERPRETATION: More than 75% of schools have a required course in health education to help provide students with the knowledge and skills they need to adopt healthy lifestyles. ACTIONS TAKEN: The School Health Education Profiles data are being used by state and local education officials to improve school health education and HIV education.     

Medical schools seeking new ways to cope with funding cutbacks

Cuts in government funding mean that Canada's medical schools have to seek new ways to raise funds. Susan Thorne examines some of the ways faculties of medicine are coping with change. In the brave new world of medical education, schools are combining classes for medical students and other health professionals, seeking business alliances, encouraging attendance by full-tuition students from other countries and diversifying revenue bases through new programs, such as McGill's new 5-year MD-MBA degree.     

The community continuity experience: generalist training for preclinical medical students

Many medical schools are planning community-based experiences for preclinical students. In August 1994, The University of Texas Medical Branch at Galveston began placing all 200 first-year medical students in generalists' offices in a new course called the Community Continuity Experience. The office nurse served as site facilitator. Activities during the second term provided more opportunities for students to interview patients as well as to observe the site physicians. The course committee used feedback from student evaluations and focus groups to change the implementation of the curriculum. We found that nurses as site facilitators effectively managed the students' activities, that continuity of site was more important to students than breadth of exposure, that the optimum focus of activities was the examination room, that training in actual skill development (e.g., methods of patient education) was desired before site activities, and that careful integration of preclinical patient-oriented courses was important to expose students to a coherent approach to learning skills for patient assessment.     

The Family Life Cycle: Orientation for Interdisciplinary Training.

The Family Life Cycle Studies Program and Referral Clinic at Michigan State University engages in training at two levels: It offers an intensive, year-long internship to doctoral students in the mental health professions, primarily from clinical and counseling psychology, who wish to develop expertise in evaluation and treatment of families and who also are often engaged in research on some aspect of family process; and we carry out a wide range of educational and consultative activities with students in the health care professions and with personnel in the schools, the probate court system, and community agencies. The goals of these educative efforts are to develop a family perspective on individual medical, social, and academic problems and to provide at least a rudimentary understanding of family process and some skills in interviewing family groups. The program considers participation in this second set of activities a vital part of the training of our clinical interns. The program expects that they will not only become competent family therapists, but will also be able to teach concepts of family process and function to students in other disciplines and be prepared to serve as resource persons in any community in which they find themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)