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

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

Hemidesmosomes show abnormal association with the keratin filament network in junctional forms of epidermolysis bullosa

Leadership in improving the education of doctors, while impressive, is not happening fast enough. While there are many obstacles, there is no time to waste in restructuring medical education to repair its present deficiencies, for otherwise outside forces could overwhelm today's education leaders with imperatives to make improvements on their own terms. The first step in addressing present shortcomings is to establish measurable objectives for the education of doctors that are aligned with the legitimate expectations of society and the enduring precepts of the medical profession. To provide guidance in establishing these objectives, the AAMC launched the Medical School Objectives Project (MSOP) two years ago. This project is now close to completing its initial phase, which is to define the knowledge, skills, attitudes, and values every medical student must demonstrate before graduating. Phase Two will be concerned with implementation (e.g., establishing assessment methods; improving faculty development; etc.). As for aligning the outcomes of medical education with the precepts of the profession, nothing is more important: if doctors do not have high standards of professionalism--altruism, respect, compassion, honesty, integrity, and others--medicine's very survival is threatened. Medical educators must insist that their graduates demonstrate these attributes, through more careful admission criteria, more attention to medical professionalism in the curriculum and in the evaluation of students, more community service for students, and improved role modeling by faculty. Leadership for the changes that are needed will not come from a once-in-a-lifetime leader of heroic proportions but from everyone within academic medicine leading the profession to its promising future through quality education.     

Teaching medical students about mental handicap

The care and management of mental handicap is a relatively increasing problem, and medical responsibilities for the prevention, detection, treatment and management of mental handicap are undergoing significant changes in emphasis. The present paper examines the current position of undergraduate medical training in this field in medical schools in the United Kingdom and in Eire. Although there are considerable training variations between different schools, the over-all style of presentation is not thought to facilitate appropriate learning in this subject for future doctors. There is a suggestion that medical students themselves would welcome more attention to this field. Greater co-ordination is needed within existing teaching programmes. The appointment of senior academics with multiple departmental attachments and a major commitment to the subject of mental handicap may be a valuable step forward.     

Teaching and Learning: The Critical Balance in Effective Education

This lecture addresses the balance between teaching and learning and explores the notion that “we teach too much and our students learn too little.” Research in the areas of teaching and learning, in addition to personal experience in construction education, are used to show how appropriate teaching styles and a learner centered approach can be combined to improve learning and reinforce the belief that the true goal of education should be to produce self-motivated, independent lifelong learners. Data from an informal study of student perceptions are presented to show that much is achieved when faculty make it possible for students to be independent active learners and accept responsibility for their own learning.     

Involvement of lipid peroxidation in free fatty acid-induced isolated rat pancreatic acinar cell injury

Ophthalmologists play a relatively peripheral role in medical student and resident education. A review of the evolution, funding, and administration of medical education in the United States lends insight into why this is so. The author reviews the current status of education in ophthalmology for medical students and residents; the development of an ophthalmology curriculum; alternatives to the traditional medical school curriculum and how these have been incorporated into ophthalmic education; and the effect of new trends in medical education and pressures created by health care reform on the education of medical students and residents. The role of ophthalmologists in the general practice of medicine and in teaching doctors about the eye is discussed. Finally, the opportunity that the current climate presents for ophthalmologists to define their role in health care through education is considered.     

Specialty choice and understanding of primary care among Japanese medical students

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

Are there cytopathic features associated with cytomegalovirus infection predictive of resistance to antiviral therapy?

In recent years, identifying the origins of medical errors has been aided by a growing awareness that such errors are frequently the result of flaws in the system. In short, they are "accidents waiting to happen." Despite the value of the systems approach in identifying and preventing errors, it creates a difficult ethical problem for medical educators. Evidence suggests that when physicians ascribe errors to systemic causes, they may be less likely to modify their future behaviors and thus will be more likely to repeat past errors. Therefore, academic medical centers (i.e., teaching hospitals) must achieve a delicate balance that protects patients from the error that a systems approach can identify, yet provides optimal education for house officers by teaching them to focus also on personal reasons for errors. The authors suggest that this balance can be achieved by having residency programs work aggressively to remove the obstacles that house officers predictably encounter when they look for the personal causes of error (e.g., being shamed, feeling fear and inadequacy). Programs must also encourage house staff to disclose their errors and make constructive changes in their own behaviors, encouraged and guided by role models. The article concludes with discussion of these and related strategies to achieve the desired balance between the use of a systems approach and a personal-responsibility approach to managing errors in academic medical centers.     

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude

Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Link?ping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Link?ping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evidence as to whether our present evaluation is correct.     

Structural Surface-Achieving Model in the Teaching and Learning Process for Construction Engineering Students

Education is a systematic teaching-learning process involving four main components (teachers, students, knowledge, and the environment) and three main subprocesses (teaching, learning, and evaluation). Throughout the education process, students’ learning is considered as the core subprocess, though various interactions are involved among the variables in the components. The surface-achieving learning approach (achieving motive and surface strategy) is not generally recommended by educational psychologists, but it is the most popular learning approach used by construction engineering students in Hong Kong. In order to investigate the reasons for this phenomenon, a structural surface-achieving learning model is established that includes key learning factors. In this paper, teaching approach, learning approach (achieving motive and surface strategy), year of study, gender, performance, and satisfaction are all considered as major elements of the teaching-learning process. Using the LISREL program, three optimized structural equation models were established separately for the three teaching approaches (transferring, shaping, and traveling). The study confirmed a partial causal relationship among the hypothetical variables and revealed six interesting points: (1) shaping is an exogenous variable that has the least effect on the surface-achieving learning approach among the three teaching approaches; (2) the traveling teaching approach, like the transferring and shaping teaching approaches, causes students to adopt the surface strategy in the learning process; (3) good performance can be obtained even though the surface strategy is adopted by construction students in Hong Kong; (4) students’ performance is a factor encouraging or discouraging educators to use the traveling teaching approach in construction education; (5) satisfaction is an essential variable that induces students to learn with an achieving motive; and (6) female construction students often perform better than their male counterparts.     

Contract learning, clinical learning and clinicians

Current trends in education and training emphasise that learners, whether they are school children, students or adults, need to acquire generic skills and personal characteristics which will enable them to become independent self-directed learners. This will enable them to continue the process of learning throughout their lives. Recent recommendations for the reform of undergraduate medical education, for training of hospital doctors and general practitioners, and the higher profile now being given to continuing medical education, reflect the strength of this particular educational current sweeping through all levels of medical education. Learning contracts, developed through negotiation between a teacher and a learner, are especially effective educational tools for stimulating independent learning. This paper examines the theoretical basis of contract-learning and its relevance to clinical settings.     

Computer-assisted learning in dentistry. A view from the UK

OBJECTIVES: The objectives of this paper are to review the development and impact of computer assisted learning (CAL) in dentistry with emphasis on the UK. DATA SOURCES: This is a wide ranging review of dental, medical and technical literature. STUDY SELECTION: An attempt has been made to evaluate present knowledge in an objective manner and to make some prediction as to the future development and use of computer-based teaching methods in dentistry. CONCLUSIONS: The introduction of computers as an educational tool in dentistry and the provision of CAL is having an impact not only on how dentists are trained but also on the skills they will need to acquire in the future to keep pace with this new technology. It is suggested that there is a great potential for computer-based continuing professional education for dental practitioners, and that the Internet will provide access to such material.     

The management of dental problems presenting to an accident and emergency department

Patients with dental diagnoses, not necessarily traumatic, often present to accident and emergency departments and general medical practitioners. Few doctors have received much, if any, education in the management of these patients. A 6 month prospective study revealed 107 patients (0.3% of new attenders) attending the accident and emergency department of Glasgow Royal Infirmary. Only 19 of these had suffered trauma. Medical staff in the department were only rarely able to make any diagnosis, and management of these patients took place on an empirical, symptomatic basis. Management could be improved by better education of medical students and doctors. Use of an algorithm may be appropriate.     

Medical Records for Building Health Management

Medical records provide essential information for evaluating a patient’s health. Without them, it would be difficult for doctors to make accurate diagnoses. Similar to diagnoses in medical science, building health management also requires building medical records for making accurate diagnoses. At later stages of a building’s life cycle, when the budget is limited, organizations responsible for building repairs and maintenance are unable to digitalize building health diagnoses and keep complete medical records of buildings; as a result, maintenance crews usually cannot fully understand buildings’ overall health conditions and their medical histories, which may result in erroneous diagnoses directly or public safety dangers indirectly. Using the problem-oriented medical record adopted for the medical diagnosis of human diseases, this paper designs a building medical record (BMR), which allows simple electronic archiving, and evaluates its practicability with a case study of school buildings. The purpose of a BMR is to enable maintenance engineers (building doctors), building managers, and contractors of school buildings to have low-cost access to required information for making complete evaluations and maintenance suggestions for buildings.     

Teaching Construction Contracts: Mutual Learning Experience

Construction contract modules are delivered to second-year architectural technology and construction/construction management students undertaking foundation and undergraduate degree programs. Feedback and assessment results from recent years showed that students generally found these modules difficult. Studies were conducted to further understand students’ experiences and expectations, to assess quality of teaching, and to evaluate the dissemination of theoretical and practical knowledge during the delivery of construction contract modules. The objective was to review the methods used for teaching, learning, and assessment of construction contract modules and make recommendations to inform and improve future module development and delivery. This paper is based on a first-time experience of teaching a law-related subject to construction students. Reflection on the teaching and assessment methods implemented during the term and on student responses permits conclusions to be drawn on how best to improve students’ learning experience and simultaneously maintain the university’s quality standards.     

Motivation of university surgeons to achieve excellence in teaching

In view of the recent focus on the accountability of their commitment to teaching, university surgeons will have to rearrange their academic priorities to place teaching at the top of the list. Since excellence in medical teaching appears to be directly related not only to the motivation of the educator but to knowledge of the subject, we must retain our superiority as clinical surgeons and continue to pursue new scientific information by investigation. Inasmuch as the major reason for the low priority of teaching in our busy academic schedules is the difficulty of quantifying teaching excellence, I hope that the members of this Society will direct further attention to developing new evaluative approaches. The worthiness of our efforts toward motivating university surgeons of achieve excellence in teaching will be rewarded by the enhanced quality of the students into whose hands we place the future of surgery. I greatly appreciate this opportunity to express some of my concerns about the teaching effectiveness of university surgeons and hope that it may stimulate and challenge you to give a new vitality to teaching and to consider new approaches in surgical education. I believe that we should inspire each other to strive for excellence in education as well as in research and clinical care and to develop a deeper commitment and genuine concern for assuring that our students and residents learn what we have to teach.     

医学英语阅读能力的培养探究

培养医学学生的专业英语阅读能力既是教育部对医学英语的课程要求,又是医学院校英语教学的重要内容。医学科学的迅猛发展和学科特点对医学生应用英语的能力,特别是专业英语阅读能力提出了更高要求。阅读能力是医学生应该具备的最重要的能力之一,培养他们的阅读理解能力对改善当前医学英语阅读状况有着重要意义。     

职业院校与矿山测量行业企业形成命运共同体途径探索

随着我国职业教育体制的不断改革创新,职业院校的教学模式和环境也需要不断的调整。职业院校主要以培养复合式创新型高素质技术技能人才为目标,通过对学生们进行技能性的教学活动,以此来实现教学目标,目前,职业院校的教学工作应该更多的了解产业结构、调研相关行业协会、走访企业,与行业、企业建立命运共同体,由此为学生们提供更加全面的发展空间,以此提高教育教学质量,培养高素质技术技能人才。     

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.     

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.     

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.