The Malm? model: a problem-based learning curriculum in undergraduate dental education

A new undergraduate dental curriculum was introduced in Malm? in 1990 which is based on problem-based learning (PBL). The principles of PBL are strongly influenced by evidence from cognitive psychology and they form the educational strategy throughout the whole curriculum. Two further essential principles underpin the curriculum: a holistic attitude to patient care, and the promotion of oral health. Basic sciences and clinical dentistry are integrated within a structure based on oral conditions prevalent in the community. Students are encouraged to build their new knowledge, understanding and skills into the context of what they have already learned. This approach is facilitated by the presentation of conceptual models, one of which, The Oral Ecosystem is described in detail. The educational programme also gives students opportunities to learn in the clinical context from an early stage, and we endeavour to promote a scientific attitude from the very beginning of the programme. This paper describes the curriculum at three organisational levels (whole curriculum, single course, individual week).     

Writing a scientific paper as part of the medical curriculum

The curriculum at the Medical School, University of Troms? reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979-89) from Troms? 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.     

Kentucky physicians' perspectives and preparedness for computing in medical education and practice

PURPOSE: To examine the University of Kentucky College of Medicine's community-based faculty's (CBF) perspective on computing skills that students should acquire for future medical practice, and if the CBF currently use these skills in their daily practice. METHODS: A survey was mailed to 281 of the institution's CBF in the spring of 1997. The survey listed eight basic computing skills derived from our computing curricular objectives for students and asked respondents (a) if they use the skill, and (b) if students should learn the skill. RESULTS: 200 respondents returned a completed survey. 14 CBF (7.2%) indicated that they have all eight computer skills while 91 CBF (46.4%) indicated that students should learn all eight computer skills. 25 CBF (13%) indicated that they have none of the computer skills, while none of the CBF indicated students need none of the skills. A significant difference between primary care CBF and other specialist CBF was found with respect to self-report of computer use, but not regarding their opinions about students' need to learn computer skills. CONCLUSION: The majority of our CBF report using at least one computer skill in their practices. Regardless of specialty, CBF report that students should possess more computer skills than they themselves have. Medical educators should incorporate computing applications into the curriculum to provide appropriate computer training for future physicians.     

Responsibility of universities in the scientific education of our professionals

The universities have a leading role and responsibility in the scientific education of future professionals. Scientific research training should be considered essential in the teaching of professionals in areas such as biology, chemistry, physics, mathematics and in medicine. During the recent years, Chilean universities seem to have focused their undergraduate curricular activities into pragmatic aspects of professional practice and the relevance of involving undergraduate students in high-level scientific research receives little consideration. While resources provided by the government to scientific and technological research in Chile are slowly but gradually increasing, the participation of undergraduate students in specific research projects conducted by faculty members is minimal. The author proposes that this situation could be modified if the students are stimulated to participate in these research projects by receiving preferential scores when their elective activities are devoted to it.     

Biofeedback: a noninvasive treatment for incontinence after radical prostatectomy

This article describes an innovative transfer of cancer prevention information from a Comprehensive Cancer Center to the community and school setting. A cancer control curriculum, developmentally and culturally appropriate for middle school, African-American children, was taught to seventh grade students in a public middle school in a large, northeastern city. By building partnerships among a university, an academic medical center, a public school district, and a non-profit arts organization, students learned cancer control concepts in the context of their daily lives. Students increased their knowledge of cancer risk and demonstrated a positive attitude about their ability to affect their own health. Experience with this project enabled staff to identify additional education and support needs that exist among students who have family members with cancer.     

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.     

Problem-based learning: measurable outcomes

Problem-based learning (PBL) could potentially contribute to four key objectives in the education of doctors. (1) Motivating learning. Three studies show that students studying PBL problems choose fewer topics to study than those identified by the faculty, but one study of a critical care rotation showed that students were motivated to learn over a wider range of basic science topics than had been included in the basic science curriculum. (2) Developing clinical reasoning. One study compared methods of solving problems in PBL and conventional track curricula and suggested that PBL students work backwards from clinical information to theory, while conventional curriculum students tend to reason forward from theory. One study showed that computer searches provide knowledge for helping solve some PBL problems, and another study showed that specific knowledge in emergency medicine correlated with test scores. (3) Structuring knowledge in clinical contexts. A few studies show that PBL students perform less well on basic science examinations but better on clinical examinations. Educational outcomes, however, have been assessed quantitatively mainly by the U.S. National Boards of Medical Examiners Examinations or by clinical examinations with small samples. Only one study includes a power computation to assess type II error. There are no studies that examine how much variance occurs between PBL programmes in their curricular methods and outcomes. (4) Developing self learning skills. PBL students use a much wider range and number of resources than conventional track students. There is only one study comparing the knowledge of doctors trained by PBL and conventional curricula after the doctors have been in practice for a substantial number of years, and no studies of patient outcomes. Patient outcomes need to be assessed with randomized controlled trials, and sample sizes should be determined by power computations to avoid Type II error. Four possible methods of improving PBL would be to derive national and internationally accepted PBL curricula; to organize internationally accepted and psychometrically validated methods of evaluation; to develop attitudes among students and tutors to facilitate co-operative PBL teamwork; and to teach group process diagnostic skills.     

Effects of a preventive cardiology curriculum on behavioral cardiovascular risk factors and knowledge of medical students

We evaluated a Preventive Cardiology Academic Award (PCAA) program designed to integrate preventive cardiology concepts into the medical school curriculum. Diet, preventive cardiology knowledge, preventive cardiology attitudes, exercise behavior, and body mass index were compared at entrance to medical school and during the graduation year. Complete data were available on 94 students (65 men and 29 women). Similar data from students who graduated in 1987, prior to the introduction of the PCAA curriculum, served as a control. Women showed a significant enhancement in attitude towards cardiovascular disease (CVD) prevention, while both men and women significantly increased their knowledge about CVD prevention. The frequency of planned physical activity decreased significantly in both sexes and men showed a significant increase in body mass index. Men significantly reduced total calories, percent of calories from fat and saturated fat and dietary cholesterol and increased fiber intake. In women, the only significant reduction was in total calories. In comparison to the control class that did not have the program, men receiving the PCAA curriculum reduced dietary cholesterol, dietary fat, saturated fat and monounsaturated fat. Changes in these dietary parameters were nonsignificant for women in comparison to the control class women. Additional analyses showed no systematic secular trends in dietary or other variables in classes entering from 1986 to 1990. We conclude that the PCAA curriculum changes have favorably affected the preventive cardiology knowledge, attitudes and diet of medical students.     

Perceptions of Parental Involvement and Support as Predictors of College Students' Persistence in a Science Curriculum.

As technological and scientific skills are increasingly needed, finding that science students encounter significant problems in their academic program causes serious concern. The authors examined how perceived parental involvement and support predict college students' persistence in science based on J. P. Connell and J. G. Wellborn's (1991) theoretical model: Perceived parental involvement and support should foster student persistence by promoting students' competence, autonomy, and relatedness. Results suggest that perceived parental autonomy supports predicted scientific persistence partly through students' autonomy. Perceived parental involvement, although unrelated to persistence, was a significant predictor of autonomy and relatedness. Results suggest that perceived parental involvement and support have specific roles in predicting student self-processes and achievement, highlighting the importance of sustaining parents' contribution for college students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of a course in basic physical examination skills

Basic clinical skills of most medical school undergraduates continue unobserved and deficiencies have been detected in a significant number of physicians during residency. Nevertheless, our health care system is calling for competent graduates with solid basic clinical skills and a larger representation of qualified generalists in the increasingly important managed care environment. The need for a better introduction to Clinical Skills course was identified by students and clinical faculty at Ponce School of Medicine. In response to these concerns a new curriculum was developed with clear objectives, effective instructional strategies, and performance-based evaluation, with adult learning principles as its framework. The musculoskeletal examination unit of the curriculum was pilot tested and the course evaluation strategies revealed satisfaction with objectives, instructional and evaluation strategies, as well as improved confidence, and sense of usefulness for the learned skills. A curriculum in basic clinical skills that incorporates adult learning principles with solid instructional strategies can increase the confidence and skills of the learners and should lead to improved outcomes.     

Aims and objectives of medical training at the University of Valparaíso

The Medical School of the University of Valparaíso was founded thirty years ago aiming to produce a physician considering the health needs of the population and with a solid humanitarian training. The epidemiological, demographic and scientific changes of the last decades prompted the introduction of modifications in the curriculum such as using problem oriented active learning, incorporation of new subjects such as geriatrics, labour medicine and trauma and training in communication skills. The curricular mesh will be modified to allow an efficient vertical integration of educational contents, which will be delivered sequentially during the different years of the career. The internship, as a crucial part of the career, has incorporated outpatient clinical practice, has emphasized preventive medicine and has stimulated active learning through research projects and active reviews of specific issues. These changes will require cultural changes of professors and students and more resources that are difficult to obtain.     

Mathematics education and students with learning disabilities: introduction to the special series

The prevalence of students with mathematics learning disabilities has triggered an interest among special education researchers and practitioners in developing an understanding of the needs of this group of students, and in identifying effective instructional programming to foster their mathematical performance during the school years and into adulthood. Research into the characteristics of students with mathematics learning disabilities is being approached from different perspectives, including developmental, neurological and neuropsychological, and educational. This diversity helps us develop a broader understanding of students' learning needs and difficulties. Special education assessment practices encompass a variety of approaches, including norm-referenced, criterion-referenced, and nonstandardized procedures, depending on the specific assessment questions professionals seek to answer. Students' mathematical knowledge and conceptual understanding must be examined to determine their strengths and weaknesses, curriculum-based progress, and use of cognitive strategies to arrive at mathematical solutions. Research findings have identified empirically validated interventions for teaching mathematics curricula to students with mathematics learning disabilities. Research studies have been grounded in behavioral theory and cognitive psychology, with an emergent interest in the constructivist approach. Although research studies have focused primarily on computational performance, more work is being conducted in the areas of story-problem solving and technology. These areas as well as other math curricular skills require further study. Additionally, the needs of adults with math LD have spurred educators to examine the elementary and secondary math curricula and determine ways to infuse them with life skills instruction accordingly. As the field of mathematics special education continues to evolve, special educators must remain cognizant of the developments in and influences on the field of mathematics education. Reform efforts have shaped the field significantly since the 1950s, contributing to the curriculum offered in mathematics textbooks and the pedagogical practices taught in higher education courses. Mathematics educators continue to search for a better understanding of how children learn mathematics; this process is shaped by the prevailing theoretical orientations and research methodologies. This special series in mathematics special education provides readers with information about the characteristics of students with mathematics learning disabilities, assessment procedures, mathematics programming, teacher preparation, and future directions for the field. The series originated as a result of discussions with Dr. Lee Wiederholt and Dr. Judith K. Voress, who saw a need for the compilation of recent research and best practices in mathematics special education. I thank them for their support of and thoughtful insights about the development of this series. I also appreciate the support of Dr. George Hynd and his editorial assistant, Kathryn Black, in finalizing the details for publication. Finally, I am most appreciative of the authors' contributions to this series; their work continues to significantly influence the development of the field of mathematics special education and programming for students with mathematics learning disabilities.     

Dynein inner arm heavy chain identification in cAMP-activated flagella using class-specific polyclonal antibodies

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.     

Stress in medical students

The object of this study was to examine the main stressors experienced by students in an Irish medical school and their effects on the attitude of the students towards their training. It also determined the students' knowledge of how they could receive help and their attitudes towards seeking such help. Data was collected by an anonymous self-report questionnaire distributed to a fifth year medical school class in the Hilary Term of the academic year. These 63 students had chosen medicine as a career mainly because of vocational and academic factors and almost two thirds of them had always wanted to do medicine. However four were no longer happy with that choice. Fifty-four percent of them had felt like making a complaint on at least one occasion, but did not do so. The perceived problems were mainly verbal in nature. 41% said that this had affected their attendance. The main source of perceived mistreatment was consultant staff. Rates of perceived racial and sexual discrimination were low. Other stressors included examinations, financial issues and family issues. 52% of students did not know the process by which they could make a complaint and 30% felt that seeking help or advice from staff would be damaging to their future career. This study analyses these issues and suggests ways of addressing them.     

A 9-year longitudinal study of reported oral problems and dental and periodontal status in 70- and 79-year-old city cohorts in northern Sweden

BACKGROUND: From 1991 to 1994, a special projects grant to teach nurses cancer prevention/screening theory and clinical skills was developed, implemented, and evaluated. Approximately 60 nurses in Colorado rural settings attended five two-day training sessions over a 20-month period. Attitudes, constructive or destructive, regarding specific behaviors lead to intentions to perform those behaviors and have an important impact on cancer-related nursing practice. METHODS: Two cancer-related attitude scales, Cancer Prevention/Early Detection Attitude Inventory and Fanslow Cancer Attitudes Scale, were administered prior to the first training session, following the final session, and at six-month follow-up. Data reflecting program impact on nursing practice were obtained from follow-up self-assessment of confidence in implementing new knowledge and skills. RESULTS: Significant differences in pre- and post-training attitude scores and fairly high-level confidence ratings suggest that these nurses will continue to use their cancer prevention and detection skills in practice. CONCLUSION: Documentation of practice activities to date has been impressive.     

The behavioral sciences in medical education: A view from psychology.

Argues that a number of unsolved issues confront the behavioral sciences in medical education and that the most pressing problem is the type of core basic science curriculum that should be provided. The behavioral sciences often seem to fail in their teaching mission because they do not provide that information which can be "converted" into specific clinical skills. Recent studies of behavioral science programs at 9 major medical schools underscore the fact that there is no unanimity of opinion about the material that should be taught to all medical students. Although diversity is valuable because it promotes experimentation with curricula, the behavioral sciences, particularly psychology, should develop a model of the doctor's job which contains the basic information required for primary patient care. Some examples of clinically applicable behavioral science content that could be included in all curricula are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical education at Universidad de los Andes, Santiago, Chile

Universidad de los Andes School of Medicine started in 1991 with a new medical curriculum aimed at providing a medical education for its students, that is, it attempts to give, together with technical proficiency in medical matters, formation of character and a strong ethical attitude. The curriculum lasts for seven years: five of basic, pre-clinical and clinical theoretical and practical courses, followed by two years of internships in Internal Medicine, Surgery, Obstetrics and Pediatrics, plus a four month period of an elective internship. The courses have an integrated design, in which each matter is presented from multiple perspectives, e.g. in Internal Medicine together with the clinical aspects of disease, the pathophysiology and the pharmacology of the drugs used are presented. Also the Pathology of each disease is given in coordination in the Pathology course. General educational matters such as Anthropology, Psychology, Origin of Living Beings, Theology and Medical Ethics are interspersed in the curriculum. An important feature is the personal counselling system, in which each student may choose an academic counsellor and discuss with him (her) the subjects of his choosing. Clinical practice is given in a system that includes five hospitals and five private clinics that range from general medical practice to Psychiatry or Ophthalmology.     

Evaluative comparison of PsyD and PhD students by clinical internship supervisors.

Internship supervisors evaluated the preinternship preparation of 67 PsyD students and 228 PhD students in regard to several core clinical skills and general dimensions of professional competence. In contrast with previous studies that suggested serious dissatisfaction among supervisors with the general quality of preinternship training, most interns evaluated individually in this study were considered at least adequately prepared for most kinds of clinical work. Except for slight superiority of PsyD students in "sensitivity" and of PhD students in "scientific attitude," there were no reliable differences between interns from practitioner programs and those from scientist-practitioner programs. For future evaluation research, the need to move beyond ratings to performance-based measures of competence is imperative. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Entrance qualifications and student performance in a hybrid problem based and traditional medical programme

A hybrid problem based learning (PBL) and traditional medical programme was started at the Trinidad campus of the University of the West Indies in 1989. Analyses were carried out to determine the extent to which the entrance qualifications of the students were related to their performances at the examinations in the Phase I (preclinical and paraclinical) and Phase II (clinical) programmes. Students who were admitted on the basis of their results in the secondary school General Certificate of Examination (GCE), 'A' level scored higher at the Phase I, but not at the Phase II, level than those who already had university education. Among the 'A' level students, there was positive correlation between the total 'A' level scores and the examination marks in the medical programme, particularly at the Phase I level. Furthermore, multiple regression analyses indicated that the grades in 'A' level Chemistry and, to a lesser extent in Biology, had the most influence on performances at the Phase I examinations, with much less influence on performances at the Phase II examinations. These results suggest that good grades at 'A' level examinations are significant factors, but not the only important ones, that favour high achievement in the initial stages of this type of PBL/traditional medical programme.