Examination performance of medical students. A view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examinations at the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in Medicine between 1975 and 1981, in Obstetrics & Gynaecology between 1982 and 1989 and in Surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in Medicine should be reviewed.     

Final examination performance of medical students from ethnic minorities

Cause of death among 917 of the 959 subjects in a population-based incidence cohort with Alzheimer's disease (AD) during the years 1960 to 1984 was compared to that of an age- and gender-matched control group (n = 703). In general, a summary of the diagnostic codes entered anywhere on a death certificate suggests that control subjects had more cardiovascular disease and neoplasms than did patients, while patients more often had a diagnostic code of bronchitis/pneumonia (P < 0.01). By logistic regression, this difference remained statistically significant after adjusting for age and gender.     

A human-centered approach to medical informatics for medical students, residents, and practicing clinicians

The authors have developed a curriculum in medical informatics that focuses on practical problems in clinical medicine, rather than on the details of informatics technologies. Their development of this human-centered curriculum was guided by the identification of six key clinical challenges that must be addressed by practitioners in the near future and by an examination of the failures of past informatics efforts to make a significant difference in the everyday practice of clinical medicine. Principles of human factors engineering--the body of knowledge about those human abilities, limitations, and characteristics that are relevant to design--are an essential part of this curriculum. Human factors engineering also provides the necessary perspective, as well as the concrete knowledge and methods, that can enable practitioners to properly evaluate their clinical information needs, weight the merits of proposed technology-based solutions, and understand their own inherent performance limitations.     

Leisure-time physical activity of first-year students in 3 health science departments

BACKGROUND: Physical inactivity is a well-known risk factor for many chronic diseases which have high prevalence in developed countries. The aims of this study are to describe leisure-time physical activity levels and to identify preferences for its practice among first grade students in three Health Sciences Faculties at the University of Barcelona. METHODS: During the year 1994-95, a total of 887 first grade students of three Faculties, Pharmacy (n = 573), Medicine (n = 222) and Dentistry (n = 92), were interviewed using a recall of their leisure time physical activity over last 8 months. Physical activity level was classified into four categories: non-active, low, medium and high, based on the number of hours per week. Statistical methods consisted in the estimation of rates, comparisons using the chi-square test, and computing the odds ratio. RESULTS: Women were 75% of students. Fifty per cent of men and 71.5% of women referred to be non-active or having low physical activity level (chi 2 = 36.8; DF = 3; p < 0.0001), being no evidence of association with current smoking or overweight (Body Mass Index > or = 25). Among the rest of students, men's most frequently reported activities were football, swimming and tennis, and those of women's were swimming, aerobic and tennis. CONCLUSIONS: Physical activity level among first grade health sciences university students is poorly exemplary. More physical activity promotion is needed, particularly to female students, as an important primary preventive measure among this group.     

Individual and relational predictors of adjustment in first-year college students.

Assessed the differential predictive utility of home-leaving status, family functioning, separation–individuation issues, cognitive constructions of the home-leaving process, and personality variables for adjustment during the 1st yr of college with a sample of 286 college freshmen (182 women and 104 men). Findings revealed that the separation–individuation, family relations, and personality variables were better predictors of adjustment than were the cognitive indicators or home-leaving status. Results also varied as a function of gender; less well-adjusted men were more disconnected from significant others, whereas less well-adjusted women exhibited higher levels of separation anxiety and enmeshment seeking. Implications for counseling interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maculinity, femininity, Type A behavior, and psychosocial adjustment in medical students.

80 male and 35 female freshmen medical students (mean age 23.6 yrs) completed measures of masculinity and femininity; Type A (coronary prone) behavior; and psychological well-being, adjustment, and interpersonal satisfaction to investigate the relationship between these variables in Ss. Appropriate statistical treatment of the data revealed strong and consistent masculinity effects on neuroticism, depression, self-esteem, confidence, hedonic capacity, locus of control, and relationship satisfaction. Femininity main effects varied in number as a function of the statistical method employed and involved a more diverse group of variables than is typically reported. Additive androgyny formulations of mental health were supported; balance androgyny formulations were not. No evidence for a Type A?×?masculinity effect on adjustment was found. Discussion focuses on the correct interpretation of masculinity and femininity scales, comparability of ANOVA and multiple regression statistical analyses, and the viability of the concept of androgyny. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comprehensive assessment of satisfaction with care for cancer patients

OBJECTIVE: Determination of the prevalence of arthrogryposis multiplex congenita in Western Australia as well as the causes of the condition. Overseas reports varied considerably and no such survey had been conducted in Western Australia. METHODOLOGY: Case names were obtained from various registers and records as well as from private practitioners covering the 14 years birth cohort between 1980 and 1993. The records, and where possible the patients, were seen by one of the authors. Diagnosis was further established through relevant investigation where possible. RESULTS: Thirty cases were identified, giving a birth prevalence of approximately 1 in 12000. In nine cases there were significant abnormalities of the central nervous system, in seven cases anterior horn cell and/or peripheral nervous involvement was the cause and in three there was primary muscle disease. The remaining 11 had various syndromes for which no definite neuropathological lesions could be demonstrated, but most of these had syndromes such as distal arthrogryposis or amyoplasia. Mortality was 37%. Talipes occurred in 23 of 30 cases. Early intervention and, in more severe cases, radical surgical intervention was the management adopted in most cases. CONCLUSION: The birth prevalence of arthrogryposis in Western Australia is somewhat less than that reported in Canada and Finland but somewhat greater than the Edinburgh figures, which appear to be the extremes quoted in the literature. Prognosis is worse in cases with serious central nervous system involvement and/or chest involvement, and better in cases of localised arthrogryposis (e.g. distal), as well as in the specific syndrome of amyoplasia as described by Hall.     

Personal and family backgrounds of first-year veterinary science students at the University of Queensland

OBJECTIVE: To provide information on changes in the social and educational backgrounds of veterinary students over a 10 year period in an effort to determine the extent to which they are representative of the community. METHODS: Questionnaires were completed by first-year veterinary students at The University of Queensland in 1985 and 1986 (152 students), and 1995 and 1996 (154), and the data were analysed using the SAS System for Windows. RESULTS: The gender ratio of first-year veterinary students was 50:50 (male:female) in 1985 and 1986 but 10 years later it had changed to 38:62. In 1985 and 1986 77% had come directly from school, with 43% of the total coming from government schools, 17% from Catholic schools and 34% from other private (independent) schools. A decade later the percentage coming directly from school had decreased to 40%, that from Independent schools increased to 45% and that from cities increased from 53% to 64%. The educational backgrounds of parents varied widely though a high percentage had university degrees; mothers had received less formal education than fathers, and the educational attainments of both parents were higher at the beginning than at the end of the study. More than half (57% initially; 67% 10 years later) the fathers were in professional or managerial occupations, and a similar number (50% initially; 48% 10 years later) of mothers were teachers, nurses or clerks. The number of males from country areas decreased from 26 to 16 over this period. CONCLUSION: These veterinary students differed from the community generally in that progressively more were female, more were from Independent schools, their parents had more formal education and more of their parents were in professional, managerial or clerical occupations.     

A case-based emergency medicine curriculum for senior medical students

OBJECTIVE: To determine the effects of a case-based, core content-oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students. METHODS: All senior medical students rotating through the Milwaukee County EM elective during the 1992-1993 academic year were assigned specific chapter readings from a case-oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. All students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five-point Likert scale. RESULTS: Seventy-five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 +/- 7.1%; final examination score 76.2 +/- 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of -1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale. CONCLUSIONS: A case-based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

Self-condemnation: A comprehensive framework for assessment and treatment.

Presents an ordinary language framework that encompasses self-condemnation and integrates different psychotherapeutic positions to contrast a rational–emotive approach with an alternative that addresses the purposiveness of perfectionistic tendencies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

医学生自我妨碍与自我效能感、成就目标定向的研究

采用自我妨碍问卷、一般自我效能感量表和成就目标定向量表测查医学生的自我妨碍与成就目标定向、自我效能感之间的关系.结果表明,医学研究生自我妨碍倾向低于本科生,城市医学生自我妨碍倾向明显高于农村和城镇医学生;医学生自我妨碍与自我效能感、成就目标定向均存在显著相关;成就目标定向和自我效能感对医学生的自我妨碍有显著预测作用,其中成绩回避目标定向对医学生自我妨碍有显著的正向预测作用,自我效能感对自我妨碍呈负向预测作用.结合研究结果,相应地提出了在教育方面的建议.     

A meaningful health assessment course for baccalaureate nursing students

In response to the challenge of teaching health assessment to large groups of entry-level BSN students with minimal experience in the health professions and a faculty belief that theory and practice are best actualized with small groups, a new health assessment course was implemented. Based on a philosophy of student accountability and self-direction in learning, faculty willingness to try new teaching strategies, and using computer testing, a successful course was developed. Students rotated through specific small group clinical labs while preparing with textbooks, study questions, videotapes, and computer-assisted instruction. Evaluation methods based on case application and the use of computer testing technology were implemented for this course. The result was increased satisfaction for the faculty and the students with enhanced application experiences supportive of the clinical practice.     

The organization of an integrated basic medical science curriculum at a new medical school, Nottingham

The detailed organization of an integrated medical sciences curriculum from its initial planning to the final stage of "automatic" administration are described. Although some reduction in departmental autonomy results, this is outweighed by the advantages of a timetable and curriculum prepared, planned and carried out in a cooperative manner. Flexibility and scope for controlled change and experiment are retained.     

A learning resources centre: its utilization by medical students

The 17 described genomic species (DNA groups) of the genus Acinetobacter, including the type strains of the seven named species, were studied by using a multiplex PCR. The multiplex PCR assay combined two primer sets (rA1 and rA2 for recA gene target; rib1 and rib2 for 16S rDNA sequence) in a single reaction. Restriction analysis with two enzymes (Mbol and Hinfl) of the enzymatically amplified products allowed identification of all genospecies. This technique proved to be a rapid and reliable method for the identification of the Acinetobacter genomic species including the closely related DNA groups (1, 2, 3, 13). The results of this study suggest that the proposed method can be used for the identification of Acinetobacter spp. and as such may help to elucidate the ecology and clinical significance of the different species of this genus.     

Patients as teachers: an integrated approach to teaching medical students about the ambulatory care of HIV infected patients

Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting.     

Attitudes of oncologists, family doctors, medical students and lawyers to euthanasia

OBJECTIVE: To evaluate clearance of the vaccine strain, immunologic responses, and potential shedding of Brucella abortus strain RB51 organisms after vaccination of bison calves. ANIMALS: Fourteen 7-month-old female bison calves. PROCEDURE: 10 bison calves were vaccinated SC with 1.22 x 10(10) colony-forming units of B abortus strain RB51. Four bison calves were vaccinated SC with 0.15M NaCl solution. Rectal, vaginal, nasal, and ocular swab specimens were obtained to evaluate potential shedding by vaccinated bison. The superficial cervical lymph node was biopsied to evaluate clearance of the vaccine strain. Lymphocyte proliferative responses to strain RB51 bacteria were evaluated in lymph node cells obtained from biopsy specimens and also in peripheral blood mononuclear cells. RESULTS: Strain RB51 was recovered from superficial cervical lymph nodes of vaccinates examined 6, 12, and 18 weeks after vaccination (4/4, 3/4, and 1/4, respectively) but not in vaccinates examined at 24 weeks (0/3) after vaccination or nonvaccinates examined at all sample collection times (n = 1 bison/sample period). Serologic, immunologic, and bacterial culture techniques failed to reveal shedding of strain RB51 by vaccinates or infection of nonvaccinated bison. Lymphocyte proliferative responses were evident in lymph node cells and blood mononuclear cells from strain RB51-vaccinated bison beginning 12 weeks after vaccination. CONCLUSION: Strain RB51 was cleared from bison by 18 to 24 weeks after vaccination. Bison vaccinated with strain RB51 did not shed the vaccine strain to nonvaccinated bison housed in close proximity. Strain RB51 did not induce antibody responses in bison that would interfere with brucellosis surveillance tests, but did stimulate cell-mediated immunity.     

A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh

This report assesses the quality of service inputs, service processes and service outcomes (with the exception of coverage and effectiveness) for immunization services in Zone 3 of Dhaka City. The results indicate that in general, the providers of immunization services are knowledgeable, friendly and give technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toxoid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opportunities for the promotion or provision of immunizations; uneven distribution and utilization of immunization sites, and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductive age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numbers of deaths and illnesses from vaccine-preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.