Showing papers by "Albert J. J. A. Scherpbier published in 2000"

Patient-oriented learning: a review of the role of the patient in the education of medical students

Abstract: Aim To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research. Methods Literature review. Results Direct contact with patients can be seen to play a crucial role in the development of clinical reasoning, communication skills, professional attitudes and empathy. It also motivates through promoting relevance and providing context. Few studies have explored this area, including effects on the patients themselves, although there are examples of good practice in promoting more active participation. Conclusion The Cambridge framework is a tool for evaluating the involvement of patients in the educational process, which could be used by curriculum planners and teachers to review and monitor the extent to which patients are actively involved. Areas for further research include looking at the ‘added value’ of using real, as opposed to simulated, patients; more work on outcomes for patients (other than satisfaction); the role of real patients in assessment; and the strengths and weaknesses of different models of patient involvement.

A Qualitative Analysis of the Transition from Theory to Practice in Undergraduate Training in a PBL-Medical School.

Abstract: In spite of numerous curricular innovations, the problems medical students encounter in making the transition from theoretical training to clinical training remain unresolved and the problem has received scant attention in the literature. We performed a qualitative study to explore students' perceptions and attitudes regarding this transition in undergraduate medical training. Twenty fifth-year students of the Maastricht Medical School participated in focus group discussions about the transition from the preclinical phase to the clinical phase of the curriculum. All focus group discussions were videotaped, literally transcribed and qualitatively analysed using content analysis. The results suggest that students have difficulty in bridging the gap between the theoretical and clinical phase of the curriculum. The problems they experience arise largely from professional socialisation processes. However, students also find it difficult to apply theoretical knowledge in clinical practice. Students find contacts with real patients highly motivating. In the clinical phase their learning changes from passive acquisition of knowledge to more active learning.Since the problem-based learning approach is supposed to enhance application of basic science concepts to clinical problems, it is surprising that students experience difficulties in applying their knowledge in practice. To facilitate the transition from theory to practice in the Maastricht Medical School some curricular changes could be introduced, such as early patient contacts to motivate students and help them learn usable knowledge. Furthermore, the advantages of a problem-based preclinical curriculum to student learning should be fully exploited. Finally, the assessment system must be congruent with the educational programme, because examinations have a powerful effect on student learning.

The Need for Evidence in Education.

Abstract: In this article a plea is made to use evidence in education. A remarkable difference in attitude is noted between university staff in their role as scientists in their discipline and in their role ...

An evaluation study of the didactic quality of clerkships.

Abstract: Context Previous qualitative research at the University of Antwerp revealed dissatisfaction amongst medical students about clinical clerkships. Objective To use quantitative methods to further explore student perceptions of their clinical teaching. Method, sample and setting Monthly questionnaire administered to final-year medical students at the University of Antwerp, Belgium. Results The response rate was 83.9%. Many of the qualitative findings were reproduced. Educational resources were not optimally used. The junior doctor was the most important clinical teacher. Many activities were passive experiences. Coaching, feedback and supervision associated most with general satisfaction of the clerkship, however, these dimensions were often considered suboptimal. Conclusions Clinical clerkships do not automatically provide an ideal learning environment for medical students.

The effect on reliability of adding a separate written assessment component to an objective structured clinical examination.

Abstract: Purpose To determine the effect on test reliability when a separate written assessment component is added to an objective structured clinical examination (OSCE). Method Volunteers (n=38) from Maastricht Medical School were recruited to take a skills-related knowledge test in addition to their regular end-of-year OSCE. The OSCE scores of these volunteers did not differ from those of the other students of their class. Multivariate generalizability theory was used to investigate the combined reliability of the two test formats as well as their respective contributions to overall reliability. Results Combining the two formats has an added value. The loss of reliability due to the use of fewer stations in the OSCE can be fully compensated by lengthening the written test component. Conclusion From the perspective of test reliability, it is possible to economize on the resources needed for performance-based assessment by adding a separate written test component.

Developing case-specific checklists for standardized-patient-based assessments in internal medicine: A review of the literature.

Abstract: PurposeTo review the literature on the methods used in writing case-specific checklists for studies of internal medicine physicians' performances that were assessed by standardized patients.MethodThe authors searched Medline, Embase, Psychlit, and ERIC for articles in English published betwe

Clerkship assessment assessed.

Abstract: This article reviews consistent research findings concerning the assessment of clinical competence during the clerkship phase of the undergraduate medical training programme on issues of reliability, validity, effect on training programme and learning behaviour, acceptability and costs. Subsequently, research findings on the clinical clerkship as a learning environment are discussed demonstrating that the clinical attachment provides a rather unstructured educational framework. Five fundamental questions (why, what, when, how, who) are addressed to generate general suggestions for improving assessment on the basis of the evidence on assessment and clinical training. Good assessment requires a thoughtful compromise between what is achievable and what is ideal. It is argued that educational effects are eminently important in this compromise, particularly in the unstructured clinical setting. Maximizing educational effects can be achieved in combination with improvements of other measurement qualities of the assessment. Two concrete examples are provided to illustrate the recommended assessment strategies.

Residents' perception of their role in teaching undergraduate students in the clinical setting

Abstract: Fifty-one residents from four major clinical specialties were interviewed using a questionnaire to assess how they perceived their teaching responsibilities toward undergraduate medical students. The residents' teacher characteristics, teaching effectiveness and abilities in certain aspects of teaching were examined. The residents perceived themselves as good teachers with adequate teacher characteristics. However, they rated themselves better as clinicians than as teachers. They scored themselves highly on attitude towards medical students (interpersonal skills) and technical skills. Their perception of teaching was significantly influenced by their clinical knowledge and their clinical ability. Communication was the best predictor of overall perceived teaching effectiveness. The residents agreed, however, that their teaching skills could be improved.

Effect of a short skills training course on competence and performance in general practice.

Abstract: Objectives Evaluation of the efficacy of a short course of technical clinical skills to change performance in general practice. Design Subjects were self-selected general practitioners (n=59) who were unaware of the study design. They were assigned to the intervention group (n=31) or control group (n=28) according to their preference for course date. The course covered four different technical clinical skills (shoulder injection technique, PAP-smear, laboratory examination of vaginal discharge, ophthalmoscopic control in diabetes mellitus). Main outcome measures used were pre- and post-training scores on a knowledge test of skills (60 multiple choice items), and pre- and post-training performance of procedures in practice using a log-diary covering 20 days. Setting University of Maastricht, The Netherlands. Subjects Self-selected general practitioners. Results Competence, as measured by the knowledge test of skills, improved significantly as a result of the training and skills test scores were satisfactory after training. A significant effect on performance in practice was found for PAP-smear and shoulder injection technique, whereas no effect could be demonstrated for examination of vaginal discharge and ophthalmoscopic control in diabetes mellitus. Conclusions A good degree of competence is a necessary but not always sufficient condition for a physician to change his performance in practice. While some skills training seems adequate to bring about desired changes, for other skills more complex interventions are probably needed.

Vaardigheidsonderwijs nu en in de toekomst

Abstract: Vaardigheidsonderwijs wordt in alle opleidingen voor de gezondheidszorg gegeven. In dit artikelwordt het vaardigheidsonderwijs in Maastricht beschreven. Uit onderzoek naar de effecten van dit onderwijs blijkt dat het vaardige studenten oplevert. De vraag die we ons, als docenten, moeten stellen, is of het niet nog beter kan. De beantwoording van deze vraag leidt tot een toekomstbeeld voor het (vaardigheids)onderwijs. Een belangrijke conclusie is dat de patient een centrale plaats moet krijgen. De patient is als het ware de rode draad door het curriculum.

De overgang van theorie naar praktijk in het medisch curriculum

Abstract: Er is onvoldoende bekend over de overgang in het medisch curriculum van de eerste vier, hoofdzakelijk op theoretische kennis gerichte jaren naar de vooral praktijkgerichte co-assistentschappen. De ervaringen van medisch studenten met deze overgang zijn onderzocht met behulp van focusgroepdiscussies waaraan twintig vijfdejaars studenten geneeskunde in Maastricht deelnamen. De studenten blijken een groot verschil te ervaren tussen de co-assistentschappen en de voorgaande jaren. Dit is deels toe te schrijven aan het proces van professionele socialisatie. Verder ervaren studenten hiaten in hun basiskennis en hebben ze moeite hun theoretische kennis in de praktijk toe te passen, met name bij het redeneren van symptomen naar diagnose. Dit is opmerkelijk, aangezien het probleemgestuurde onderwijs in Maastricht juist de integratie van basisvakken en klinische vakken en het leren denken vanuit symptomen zou moeten stimuleren. Een mogelijke verklaring is dat toetsing en examenreglement niet goed aansluiten bij de doelstellingen van het curriculum. Er worden suggesties gedaan hoe deze situatie verbeterd zou kunnen worden.

De rol van (simulatie)patiënten in het onderwijs

Abstract: Patientencontacten motiveren studenten en leveren een bijdrage aan de vorming van betere kennisnetwerken, die nodig zijn bij het omgaan met problemen van patienten. Patientendemonstraties en bedside teaching zijn al langer toegepaste onderwijsvormen. Van recenter datum zijn de simulatiepatienten, die als patient, docent, examinator en onderzoeker ingezet kunnen worden. Ook echte patienten kunnen in verschillende rollen en onderwijsvormen een bijdrage leveren aan het curriculum. De geschiedenis en huidige stand van zaken van de rol van (simulatie)patienten in het onderwijs passeren in dit artikel de revue. Tot slot wordt betoogd dat een grotere rol van (simulatie)patienten op een vroeger tijdstip in de opleiding de overgang van theorie naar praktijk vergemakkelijkt en het leren van de student ten goede komt.

Een analyse van de kosten in een probleemgestuurd curriculum

Abstract: Probleemgestuurd onderwijs (PGO) heeft het imago duur onderwijs te zijn. Een echte kosten- batenanalyse is niet goed mogelijk omdat de ‘baten’ van een goede arts niet goed meetbaar zijn. Uit een analyse van de verdeling van de middelen in Maastricht blijkt dat de kosten toe te wijzen zijn aan onderdelen van het curriculum en de onderwijsorganisatie, en dus afhankelijk zijn van de invulling van het curriculum. Voor een vergelijking tussen faculteiten zijn nog te weinig betrouwbare gegevens beschikbaar. Uit onderzoek blijkt dat (het Maastrichtse) PGO baten oplevert.Omkosten beheersbaar te houden wordt geadviseerd om — voorzover mogelijk — bij beleidsbesluiten kosten-batenanalyses een rol te laten spelen. Daarnaast is het plannen van te veel onderwijs verspilling van geld, omdat de studenten niet evenredig meer gaan studeren. Aangeraden wordt om te onderzoeken wat studenten leren, zodat ongewenste bijwerkingen van goedbedoelde maatregelen hersteld kunnen worden.