Chinese herbs: a clinical review of Astragalus, Ligusticum, and Schizandrae

BACKGROUND AND OBJECTIVES: The objective structured clinical exam (OSCE) is increasingly being used to evaluate student clinical performance. However, scant literature exists pertinent to this approach in evaluating family medicine clerkship performance. In this study, we assess 8 years' experience with a family medicine clerkship OSCE. METHODS: Eight annual clerkship OSCEs and the performance of 696 students are described. Comparisons of faculty evaluation, written exam, and OSCE performance are made for 335 students. Post-OSCE student and faculty feedback regarding OSCE validity and utility is also presented. RESULTS: Student performance is highest in medical history taking and physical examination and lowest in information-sharing stations. OSCE results appear to be relatively consistent on a year-to-year basis. OSCE, faculty evaluation, and written exam results have low overall levels of correlation, particularly in assessing performance that differs substantially from the mean. Students and faculty agree that the OSCE experience reflects skills that students should possess, but there is less agreement that the OSCE reflects clerkship-related learning and actual student performance. Both students and faculty derive insight from the OSCE regarding the definition of specific learning needs. CONCLUSIONS: The family medicine clerkship OSCE we describe appears to provide consistent measures of student performance. Although content validity is high, further assessment is needed to assure construct validity. The OSCE experience provides students with a rich resource for defining clerkship-related learning needs. Study results strongly suggest that OSCEs, faculty evaluations, and written exams provide differing measures of student performance. The reasons for these differences merit further exploration.     

Choice of first line treatment for arterial hypertension: should one avoid dihydropyridines in diabetic patients?]

The learning experience during a medical school clinical rotation is largely shaped by students' patient encounters. This paper reports on how a log system for recording these encounters can be used for course planning and evaluation. Over the past 5 years, 960 third-year students completed log forms based on their clinical encounters during a required 4-week family medicine clerkship at UT Southwestern. These forms were then optically scanned and the information entered into a computerized database. Log form data revealed that the most common medical problems encountered by students in their ambulatory settings were similar to those reported in the general family practice literature. There was a great deal of consistency in the types of encounters from year to year. The data also showed some differences among clerkship sites in terms of patient demographics and the most frequently reported diagnoses. Information generated from student log forms has been used by the clerkship faculty to determine required readings, prioritize didactic topics and other teaching, adjust curriculum content, prepare support materials and develop examinations. Given the utility of the information obtained and the ease of use of optical mark encounter sheets, we recommend this system for other clerkships.     

Implementing problem-based learning in a family medicine clerkship

BACKGROUND AND OBJECTIVES: Problem-based learning (PBL) has been implemented in the curriculum of many medical schools, but limited information is available about the outcome of this learning technique. The educational intervention presented in this paper implemented a PBL learning component in our third-year family medicine clerkship and measured the outcomes of this curricular change. METHODS: One third of the curricular time devoted to didactic teaching in our family medicine clerkship was replaced with PBL activities. Simulated cases were developed and presented to students who, with the aid of faculty facilitators, studied the cases, gathered information about the cases, and developed diagnostic and management plans for the cases. The outcome of the intervention was measured by a) comparing students' scores on the National Board of Medical Examiners (NBME) family medicine clerkship examination to scores achieved by students in the year before PBL was introduced and b) students' evaluations of the relevance and success of PBL in the clerkship curriculum. RESULTS: Students' NBME clerkship examination scores increased from a mean of 66 the year before PBL began to 73 after PBL was implemented. More than 80% of students reported that PBL was a good way to learn family medicine, and 85% reported that the PBL technique provided sufficient information to formulate learning issues. CONCLUSIONS: PBL can be introduced into a third-year family medicine clerkship curriculum with general acceptance by students. Students rated the technique highly, and their examination scores improved.     

The art of mentoring

While the golden era of mentoring may have been the age of apprentice ships in medicine, the birth of the clinical clerkship in the late 1800s provided the structure for the relationship between faculty and medical student. The last few decades, however, have seen a dramatic change in the availability of faculty to mentor students in clinical teaching settings despite a 600% increase in the number of clinical full-time medical school faculty. This work explores some of the reasons for this deterioration in mentoring and looks at the role of the mentor in professional development, specifically in the area of medical education. Recommendations for implementing structured mentoring programs within a department of surgery are provided. The article concludes with discussion of individual characteristics of the effective mentor in surgical education.     

Early ambulatory experience in the undergraduate education of family physicians

A number of benefits have been claimed for early ambulatory experience in the training of family physicians, although few practical examples have been reported. This paper describes an approach to the education of first and second year medical students interested in family medicine which places heavy emphasis on community-based ambulatory care. During the first year, an elective introductory preceptorship permits students to participate in the office practice of a family physician in a limited role. Seminars are offered concurrently to provide integrating principles and perspective. In the second year, a nine-month-long continuity clerkship is offered in which students gain intimate contact with a small panel of families and practice the skills of primary care in the offices of family physicians. Clinical experience is accompanied by weekly seminars and integrated with elements of the required curriculum. Selected evaluation data are presented, which attest to the achievement of course objectives and provide support for the claim that this approach is beneficial to students seeking careers in primary care.     

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.     

A process for identifying marginal performers among students in a clerkship

PURPOSE: To evaluate a review process for identifying marginal performers among students in a clerkship. METHOD: To better identify the marginal performers among the students participating in the medicine clerkship at the University of Minnesota Medical School--Minneapolis, the Medicine Clerkship Committee reviewed in 1990-91 and 1991-92 all students rated by faculty or housestaff as below expectations for any of nine areas of clinical performance (27 students of 890, 3%). (In the past, a student was considered to be a marginal performer only if he or she was assigned an unsatisfactory numerical grade, calculated from the nine ratings, or if written comments by housestaff and faculty and the opinions of the attending faculty and clerkship site coordinator indicated that the student should fail.) Chi-square analysis was used to compare the number of students judged to be marginal performers under the review process with the number of marginal performers in 1988-89 and 1989-90. The two groups were also compared based on their preclerkship performances on standardized examinations. RESULTS: Ten of those reviewed (37%) were judged to have performed marginally. Although the study group's performance on standardized examinations was not different from that of students during the previous two years, significantly fewer students were identified as marginal performers before the review process began than afterwards (2 of 867, 0.2%, versus 10 of 890, 1.1%, p < .05). CONCLUSION: Without changing the way in which faculty and housestaff evaluated students, the review process improved the medicine clerkship evaluation system by identifying significantly more students who were marginal performers.     

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.     

Comparison of criteria for academic promotion of medical-school- and university-based psychologists.

43 Departments of psychiatry and 48 departments of psychology used the same criteria for promotion of tenure-track, full-time psychologists to all academic levels. Departments of psychiatry required more publications. Within departments, no difference was found in criteria used in promotion to associate professor or to full professor. Criteria given most consideration included publications, grants, teaching, and research. Few nontenure, full-time faculty were employed by departments of psychology. For departments of psychiatry, no difference was found in criteria for promotion from associate professor to full professor. Criteria included teaching, clinical service, publications, and administrative service. It is concluded that psychologists in medical school do not have greater difficulty in obtaining promotions than do university-based psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in medical students' perceptions of family practice resulting from a required clerkship

BACKGROUND: Career choice research has shown that exposing medical students to family medicine, through a special medical school emphasis or a required clerkship, correlates with an increased rate of selection of family practice. It has been hypothesized that actual exposure to family medicine mitigates the negative stereotypes held by many medical students. METHODS: This study used a qualitative strategy to examine how a family medicine clerkship altered medical students' perceptions and attitudes toward this specialty. A series of 12 focus groups were conducted with the students who had just completed a required family medicine junior core clerkship at our institution. RESULTS: Focus group findings confirmed the existence of negative stereotypes about family practice among medical students and provided additional information on their nature and origins. In addition, student comments indicated that a third-year family medicine clerkship experience dispelled this negative stereotyping and instilled in students a greater respect for and interest in family practice. CONCLUSION: Third-year clerkships can enhance students' perceptions of family practice by dispelling negative stereotypes and by providing medical students with a more accurate portrayal of the nature of this primary care specialty.     

Student and faculty collaboration in a clinic for the medically underserved

BACKGROUND AND OBJECTIVES: Growing numbers of uninsured and underinsured individuals in the United States have resulted in increased needs for health care for medically underserved populations. Educational strategies are needed that provide opportunities for students to develop the attitudes, knowledge, and skills necessary for providing quality health care for underserved patients. METHODS: Medical students, residents, and faculty of the University of Wisconsin-Madison Medical School worked together to establish extracurricular opportunities for first- and second-year students to participate in medical clinics serving the poor and homeless. The process for the development and operation of a volunteer clinic is described. RESULTS: In the last 2 years, 163 medical students, 27 residents, and 21 faculty have provided care to more than 1,000 patients. Patients, students, residents, and faculty reported high satisfaction with the experience. CONCLUSIONS: Medical students, residents, and faculty working in collaboration can provide increased access to care for the medically underserved. Engaging in community-oriented primary health care early in their medical education provided positive learning opportunities for medical students, especially those interested in generalist careers.     

Library faculty role in problem-based learning: facilitating small groups

Since 1986, the library faculty of the McGoogan Library of Medicine at the University of Nebraska Medical Center (UNMC) has participated in small group activities during the week-long orientation for first-year medical students. This involvement paved the way for library faculty members to act as facilitators for small groups of medical students within the new problem-based learning (PBL) curriculum introduced in 1992 by the College of Medicine. The UNMC curriculum consists of traditional PBL groups as well as Integrated Clinical Experience (ICE) small groups. The ICE groups provide opportunities for discussion of the social and behavioral issues that arise in medicine, with the majority of the sessions designed to give students interviewing practice with simulated patients. The ICE small groups meet once a week with either one or two facilitators. Several library faculty members act as facilitators for ICE groups. As a result of this involvement, librarian contacts with College of Medicine faculty have grown in number and depth, there has been a corresponding increase in related activities with the first- and second-year medical students. Participation in ICE groups has caused some difficulties with respect to library work schedules, but it has been immensely rewarding and enriching in terms of professional growth. This paper describes the UNMC curriculum, the evolution and extent of the librarians' involvement, and the future involvement, ramifications, and challenges envisioned for McGoogan faculty and their medical library colleagues.     

Assessment of curriculum by medical students: comparison of participants and non-participants in voluntary anamnesis groups. An empirical study

A representative sample of medical students (n = 121) was given a questionnaire to assess parts of their medical education (lectures, seminars, clerkships) and to design a subjectively ideal timetable, which was compared with the real faculty program. Overall traditional lectures received a low rating (n = 0.17) and individual studies with the textbooks a high rating (n = 0.53). The information given in programs in psychiatry and psychosomatics in significantly less motivating than information to be learned in other medical subjects. This is surprising because the ground work for training in the doctor-patient relationship should be in these fields. Students with former group experience (participation in peer groups on history taking (wish to have more practically oriented education compared with the students without group experience. It is not clear whether the important factor is participation in group experience before starting medical school. (64% of the participants had group experience in the first group as opposed to only 45% of the other group). This information should be taken into consideration when reforming medical school programs.     

Evaluation of a method to teach cardiothoracic surgery to medical students

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty-three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia. Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre-test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.     

Educational practice guidelines for a surgical clerkship

Similar to the Residents Review Committee's "Essentials for a Residency Training Program," this article provides Educational Practice Guidelines for a required surgical clerkship. The Guidelines presented are ones that can be adopted by any department of surgery in the United States, but in some cases not without significant increase in resources and faculty effort. The 10 essential components provide an opportunity for intensive program evaluation of all medical student clerkship experiences.     

Applying crisis intervention methodology to the retention of students: a case study

This article presents the application of crisis theory and the adaptation of Aguilera's crisis intervention model for use in the retention of four at-risk students. Knowledge of student learning styles/preferences along with prior knowledge of faculty teaching and testing styles facilitated the selection of appropriate learning strategies to guide these students to successful completion of a course, the subsequent successful completion of the nursing program and entry into professional practice.     

A student-centred, problem-based curriculum: 5 years' experience

In 1987, the University of Sherbrooke's school of medicine implemented a student-centred, problem-based learning (PBL) curriculum. The experience of the first 5 years is reviewed; program goals, the schedule of learning activities, the instructional format and assessment of student learning are described. The new program is more demanding of teachers and requires better faculty training in pedagogy. No new financial resources have been available. The preclinical reform has led to revision of the clerkship, where sessions on clinical reasoning are now based on the PBL philosophy. Student reactions to the program are reported. The Sherbrooke experience has demonstrated that it is both possible and feasible to shift from a traditional to a problem-based curriculum.     

Educational programs in US medical schools, 1996-1997

We use data from the 1996-1997 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, to describe medical education programs in the United States. In the 1996-1997 academic year, there were 95 568 full-time medical school faculty members, a 4.5% increase from 1995-1996. In clinical departments, the largest increases were in emergency medicine (a 29% increase from 1995-1996) and family medicine (a 13% increase). Of all full-time faculty members in clinical departments, 76.9% have an MD or DO as the highest degree, 4.5% have both an MD and PhD, 13.9% have a PhD, and 4.7% have an academic or professional bachelor's or master's degree as their final degree. The total number of applicants for the class entering in 1996 was 46968 (0.8% increase from 1995), while the number of first-time applicants decreased 1% from 1995. First-year medical students who were members of underrepresented minority groups numbered 2236, a 4% decrease from 1995. In 1996-1997, the total number of medical students was 66712 (0.3% less than in 1995-1996). For students graduating during the 1995-1996 academic year, 13% took longer than 4 years to complete the program. There were 47 medical schools that reported that 1 or more hospitals used for required clinical clerkships had changed ownership, merged, or closed during 1996. Medical schools used an average of 6 (range, 1-36) hospitals for core clinical clerkship. Ninety-five schools required a passing grade on Step 1 of the US Medical Licensing Examination (USMLE) for promotion or graduation; 54 schools required a passing grade on Step 2 of the USMLE.     

Psychiatry, the healthy invalid

The author examines the reasons that have been offered in support of a pressimistic appraisal of psychiatry's future. The consequences for psychiatry of increasingly detailed knowledge of the interaction of psychological and physiological processes are emphasized, and the author concludes that psychiatry will continue to play a dominant role in the study and treatment of medical and surgical illness. Thus, although the field is in a transition period, it is certainly not moribund.