Showing papers in "Medical Teacher in 1989"
TL;DR: In this article, the authors describe institutional barriers and successful strategies for overcoming these barriers and describe illustrative vignettes, which are generic to medical education institutions all over the world.
Abstract: Successful innovators in medical education accurately diagnose institutional barriers to innovation and employ effective strategies for overcoming these barriers. These institutional barriers and successful strategies are described with illustrative vignettes. They are generic to medical schools all over the world.
50 citations
TL;DR: It is recommended that criterion-referenced testing be the primary method of evaluation, as it best meets the objectives of the medical school by emphasising the achievement of clearly established external standards and, thereby, ensuring a high quality of performance.
Abstract: Any reform of the current medical curriculum requires a reappraisal of the principles and practices of the evaluation system. The norm-referenced test which at this time is the primary method of evaluation was initially designed to rank order students for the purpose of selection. Difficulties arise when it is used, as it currently is for the assessment of competence. The norm-referenced test is often insensitive to instruction and, while it provides information regarding the relative strengths and weaknesses of students in comparison to their peers, it does not provide an estimate of the absolute level of performance achieved. In addition to promoting competition among students, the norm-referenced test is less suitable for programme evaluation. As it is the principal responsibility of a medical school to produce competent physicians and not to rank order them, it is more reasonable to compare student achievement to an external standard of performance or criterion. Criterion-referenced testing, then, is more suitable for the assessment of competence and, within this setting, percentage competency scores can be utilised when there is a need for the rank ordering of student achievement for the purposes of selection. It is recommended that criterion-referenced testing be the primary method of evaluation, as it best meets the objectives of the medical school by emphasising the achievement of clearly established external standards and, thereby, ensuring a high quality of performance.
48 citations
TL;DR: Both self- and tutor ratings increased from Year 1 to Year 2 but self-ratings were independent of achievement while tutor ratings were related to achievement.
Abstract: Medical students in a tutorial program rated themselves in Year 1 and again in Year 2 on Knowledge, Reasoning, Communication and Interpersonal Skills. Student and tutor ratings were similar in Year 1 but different in Year 2. Both self and tutor ratings increased from Year 1 to Year 2 but self-ratings were independent of achievement while tutor ratings were related to achievement. Possible reasons for these results were discussed with reference to the learning goals of the tutorials.
35 citations
TL;DR: Data about the format's perceived benefits were collected and all of the faculty involved in the examination who responded to a questionnaire reported that it was worth the time they had volunteered to evaluate students by observation and that the format should be used in the future.
Abstract: For the past two years, the Bowman Gray School of Medicine has used an Objective Structured Clinical Exam (OSCE) to measure the performance of 117 first- and second-year medical students at the end of introductory courses on differential and physical diagnosis. Given the surprisingly high costs of conducting the OSCE ($1300 for supplies and 527 person-hours of donated time), data about the format's perceived benefits were collected. All of the faculty involved in the examination who responded to a questionnaire (80%) reported that it was worth the time they had volunteered to evaluate students by observation and that the format should be used in the future. The majority of student examinees also reported that the OSCE format was appropriate for the course and should continue to be used.
31 citations
29 citations
TL;DR: The structure and operation of a type of session which allows a large number of students in a lecture theatre to obtain some of the benefits of learning in small groups and from peers is described.
Abstract: Using a specific example within clinical biochemistry, I describe the structure and operation of a type of session which allows a large number of students in a lecture theatre to obtain some of the benefits of learning in small groups and from peers. After preparatory reading before the class, the students work in small self-selected groups on a number of problems or cases for 30–35 minutes of a 50-minute session. Each group must record on the blackboard its answers to key questions before the problems are discussed. The method is designed to highlight a small number of important concepts, to let students see the relevance of what they have learned, and to give the students practice at applying biochemistry to the solution of problems. The students have received the sessions well and I have been impressed with how well the students have functioned during their discussions.
25 citations
TL;DR: This study looked at the reading habits of internal medicine students and house-staff to assess whether they were reading about cases and suggested that contrary to what was anticipated, house- staff do indeed read about the cases they see on the wards.
Abstract: As in-training evaluations often comment that house-staff do not read enough about cases, this study looked at the reading habits of internal medicine students and house-staff to assess whether they were reading about cases All 38 trainees at a major teaching hospital were surveyed with a questionnaire Overall, the house-staff read 87 hours/week, of which half is spent reading about cases They read around approximately half of the cases they see The more senior house-staff use journals and one major textbook; the medical students use only textbooks The reading is done mainly at home, except by the senior residents who spent a quarter of their reading time in the library The major reasons why the house-staff read are to prepare for presentations or for rounds with the attending physicians These results suggest that contrary to what we anticipated, house-staff do indeed read about the cases they see on the wards
24 citations
TL;DR: The literature on the efficiency of students' note-taking and the extent to which they actually learn as a direct or an indirect result of taking notes is reviewed.
Abstract: Note-taking by students is generally seen as an integral and essential part of the process of learning from lectures. Here we review the literature on the efficiency of students' note-taking and the extent to which they actually learn as a direct or an indirect result of taking notes. Attention is also paid to the relevance of research in this area to modern lecturing practice and to the problems of researching in the area.
23 citations
TL;DR: This paper attempts to guide innovators in developing countries, but many of the suggestions are appropriate to all innovators.
Abstract: Medical schools in developing countries are constantly faced with the problem of adapting an inherited style of education to suit local needs and constraints. Often these needs have changed considerably since the curriculum was first established. Yet the difficulty of bringing about curricular changes, especially in conventional medical schools, is well known. This paper attempts to guide innovators in developing countries, but many of the suggestions are appropriate to all innovators. The issue of international standards is closely scrutinised, and their hypothetical nature revealed. The detrimental effect of national licensing examinations on curricular innovation is discussed. The futility of ad hoc changes and the need for a carefully thought out philosophy of change which leads logically to new ways of educating future professionals are stressed. Guidelines for maintaining an innovation and for evaluating its short- and long-term outcomes are developed.
17 citations
TL;DR: The Modified Essay Question was introduced in the late 1960s as one assessment technique more suited to general practice than other traditional assessment methods, and appears to be standing up to the test of time.
Abstract: Medical education is moving to a more problem-orientated basis than was the case formerly. The Modified Essay Question has its origins in this movement, being introduced in the late 1960s as one assessment technique more suited to general practice than other traditional assessment methods. In its original form it is a paper exercise based on an evolving situation presented by a patient in primary care. Experience with the technique in different countries is briefly summarised, and its applications to assessment and to teaching are discussed. Despite shortcomings this method appears to be standing up to the test of time.
14 citations
TL;DR: An experience of the Curriculum Development Group of the College of Family Physicians of Canada is reviewed, proposing the use of a medi-drama or multi-scene script encompassing a broad range of bio-psycho-social-ethical issues as a practical tool to teach the doctor-patient relationship.
Abstract: This paper reviews an experience of the Curriculum Development Group of the College of Family Physicians of Canada in describing the doctor-patient relationship and its value in the clinical process. It proposes the use of a medi-drama or multi-scene script encompassing a broad range of bio-psycho-social-ethical issues as a practical tool to teach the doctor-patient relationship. Principles for conducting a medi-drama are presented, as are the advantages of this experiential teaching modality. An example of a specific script developed along the theme of Adult Children of Ageing Parents is described, and an evaluation of its usefulness in teaching the doctor-patient relationship is presented from feedback from seven different family medicine residency or faculty development groups. Finally, examples of the breadth of topics that can be generated from a single medi-drama are presented.
TL;DR: General internal medicine instruction in an unsuccessful lecture-based course was replaced by a clinical problem-based 'junior clerkship' and hospital and ambulatory-clinic instruction was centered around major common medical problems.
Abstract: General internal medicine instruction in an unsuccessful lecture based course was replaced by a clinical problem based junior clerkship'. Hospital and ambulatory clinic instruction was centered around major common medical problems. Tutors willingly adopted a problem-based teaching approach and participated eagerly in a multi-component evaluation. Students and instructors responded favourably to questionnaires regarding the use of a problem list, the content and face validity of the course and the usefulness of the evaluations as learning experiences.
TL;DR: In-training evaluation can be both informal and formal and embrace a wide variety of methods and fair and forthright evaluation is of special importance when dealing with poor student performance.
Abstract: Effective in-training evaluation can significantly enhance learning for both undergraduate and postgraduate medical students. The importance of ongoing assessment must be understood and supported by clinical teachers, and their involvement in effective evaluation requires time and effort. In-training evaluation can be both informal and formal and embrace a wide variety of methods. Self-evaluation by students should be emphasized as an important part of the in-training evaluation process. Clearly stated educational objectives, understood by both teachers and students, are essential. The use of constructive and supportive feedback adds considerably to clinical learning. Fair and forthright evaluation is of special importance when dealing with poor student performance.
TL;DR: The method used in the General Practice Unit at the University of Leicester is described and how it feels and what it means to be a simulated patient is explained.
Abstract: This article is written to try and convince the ‘sceptics’ that teaching with simulated patients is the way ahead in medical education. It describes in part, the method used in the General Practice Unit at the University of Leicester and attempts to explain how it feels and what it means to be a simulated patient.The conference “When Doctors and Patients Meet” at Churchill College Cambridge in July, 1988, dealt with Communication in Medicine, with emphasis on teaching with simulated patients. It highlighted two dilemmas facing course tutors1. Should one use ‘real’ or ‘simulated’ patients for teaching?2. If simulated-professional or amateur actors?The following article attempts to find a convincing answer to these dilemmas.
TL;DR: Mercer University School of Medicine was established in response to the shortage of primary care physicians in medically underserved Georgia in 1982 and has retained many of the essential qualities of problem-based learning and those educational experiences that prepare community responsive physicians to practice in medicallyunderserved areas.
Abstract: Mercer University School of Medicine was established in response to the shortage of primary care physicians in medically underserved Georgia. Originally patterned after the McMaster model of medical education, Mercer found it necessary to modify the three academic programs of the first 2 years of a 4-year undergraduate medical education curriculum. Since accepting students in 1982, though, it has retained many of the essential qualities of problem-based learning and those educational experiences that prepare community responsive physicians to practice in medically underserved areas.
TL;DR: Providing simultaneous feedback to students via the use of voice overlays of videotaped history taking and physical examination skills performance formed the basis of a study with third year medical students.
Abstract: As indicated by George Engel (1982) the instructor being present while a student takes a history and performs a physical examination has been notoriously lacking in the clinical years of a medical student's education. Similarly in the pre-clinical Introduction to Clinical Medicine courses when basic instruction in these skills are taught, the incompatibilities of the instructor's and student's schedules make review with the instructor difficult. These incompatibilities make valid assessment of the student's skills difficult and feedback to the student almost non-existent. This study demonstrates the use of simultaneous recorded running commentary to enhance videotape as a means of providing meaningful feedback to the student that aids learning and a valid means of assessing the skills of the student.
TL;DR: A wide ranging involvement of all obstetricians joining the College is called for, to ensure that the final form of the programme would reflect their collective views on the major issues raised by obligatory Continuing Medical Education.
Abstract: A career in medicine should involve a commitment to a lifetime of learning. Rapid advances in medical knowledge, as well as the increasing knowledge and sophistication of consumers, make this commitment more important than ever before. The establishment of a new Specialist College in Australia in 1979 provided the opportunity to frame Articles which made this commitment obligatory for those who wished to continue as Fellows in the new College. The implementation of this philosophy called for a wide ranging involvement of all obstetricians joining the College, to ensure that the final form of the programme would reflect their collective views on the major issues raised by obligatory Continuing Medical Education. The development of this programme could serve as a model for other Specialist Colleges facing this increasingly important issue.
TL;DR: An administration development curriculum for academic physicians is described, which provides the academic physician with guidelines for expanding their professional expertise to include organizational and management skills.
Abstract: To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.
TL;DR: The final day of the Leeds general practice attachment now includes an informal interview during which a member of the academic staff has the opportunity to uncover personal problems in medical students, or to follow up possible difficulties identified by a general practice tutor.
Abstract: The final day of the Leeds general practice attachment now includes an informal interview during which a member of the academic staff has the opportunity to uncover personal problems in medical students, or to follow up possible difficulties identified by a general practice tutor. Of 271 students interviewed in this way, 19 were felt to have problems which could adversely affect their personal life or their career at that time. Three students were referred to the medical school administration for follow-up and support in future attachments.The general practice attachment with its opportunities for intensive and personalized teaching provides a good opportunity to screen students, albeit informally, for personal difficulties and educational problems.
TL;DR: During the past 16 years, the Karolinska Institute has undergone a process of change from traditional forms of teaching and assessing, to more problem-orientated, integrated, and student-centered approaches.
Abstract: Some of the factors facilitating and impeding educational development in an established and research-orientated medical school are briefly described. During the past 16 years, the Karolinska Institute has undergone a process of change from traditional forms of teaching and assessing, to more problem-orientated, integrated, and student-centred approaches. A new curriculum has been implemented with earlier patient contact and the introduction of new subjects of relevance for the health needs of today. These innovations could be regarded as modest, but what has been achieved positively is a climate increasingly in favour of change. Examples are the introduction of criteria for assessing teachers' competence for promotion, the establishment of an academic department for research and development in medical education, and discussions have been initiated on establishing a problem-based parallel track. The author's personal perceptions of events contributing to a climate favouring change constitute an integral pa...
TL;DR: It is concluded that microtraining is a promising technique for developing the communicative competence of pharmacists, but may need to be modified to cater for personality differences within trainees.
Abstract: This paper examines the effectiveness of a microtraining programme in developing the communication skills of pharmacists. In particular, it investigates the influence of this programme upon self-reported communication activities in the actual work environment. Inter-relationships are also obtained between the personality of participants, their attitude to the microtraining technique and the degree of self-reported influence on work performance. Overall, participants demonstrated a strongly positive attitude to, and indicated that they had been highly influenced by, the microtraining programme. It was also found that there was a significant and positive correlation between extroversion and attitude to microtraining (p less than 0.005). Furthermore, a positive correlation was also obtained between attitude and influence although this did not reach the 0.5 level of significance. It is concluded that microtraining is a promising technique for developing the communicative competence of pharmacists, but may need to be modified to cater for personality differences within trainees.
TL;DR: Attention is drawn to the prevalence of dermatology problems in clinical practice, the reported state of dermatologists teaching in 16 Canadian schools in the mid-1980s, and goals, objectives, and a core curriculum are tabulated.
Abstract: The Canadian Association of Professors of Dermatology (CAPD) has approved new goals, objectives, and a core curriculum for Canadian undergraduate dermatology teaching. This followed a survey by mailed questionnaire of the 16 Canadian medical schools. The previous core curriculum approved by the Canadian Dermatological Association (CDA) was modified and received additions. This paper draws attention to the prevalence of dermatology problems in clinical practice, shows the reported state of dermatology teaching in 16 Canadian schools in the mid-1980s, and tabulates goals, objectives, and a core curriculum.
TL;DR: A computer conference was developed for use with students, faculty, and staff at a large state-funded medical school to increase communication among these groups which study, work, and train at a variety of locations across the state.
Abstract: A computer conference was developed for use with students, faculty, and staff at a large state funded medical school. The conference was intended to increase communication among these groups which study, work, and train at a variety of locations across the state. To date, 583 participants (91% are students, 6% are faculty, and 2% are staff) have discussed a variety of academic, ethical, social, and administrative issues. Conference use is required during the obstetrics-gynecology third year clerkship, and has also been used to evaluate courses and critique course examinations. The procedures for creating a computer conference, implementing its use in the curriculum, and evaluating its effectiveness are discussed.
TL;DR: A course in objective methods of clinical practice has been set up for medical students in University College, Galway and needs to rely on practical work and demonstrations with preferably clinical examples rather than exhortation.
Abstract: A course in objective methods of clinical practice has been set up for medical students in University College, Galway. Such a course needs to rely on practical work and demonstrations with preferably clinical examples rather than exhortation. The course should be a fairly intensive one and probably best placed in the third year of a 5-year programme. Adequate resources need to be provided to mount the course. The course should be audited and students should be assessed.
TL;DR: The article concludes by encouraging educational institutions, especially in the UK, to assist in the further development of the discipline.
Abstract: In the education of health professionals, the study of the humanities has been generally overlooked in favour of an intensive scientific training. In recent years, however, both the establishment of the medical humanities as an academic discipline and changing medical expectations on the part of health professionals and public alike have renewed the relevance of the humanities to professional education. While sounding a cautious note on the methods of (re)incorporating the humanities into the curriculum, the article concludes by encouraging educational institutions, especially in the UK, to assist in the further development of the discipline.
TL;DR: The accreditation process of the Royal College of Physicians and Surgeons of Canada is based upon a set of nine explicitly stated standards, each amplified by a detailed interpretation.
Abstract: The accreditation process gives assurance to a number of individuals and groups about the quality of approved programmes. It is based on principles that have evolved over time. The process of the Royal College of Physicians and Surgeons of Canada is based upon a set of nine explicitly stated standards, each amplified by a detailed interpretation. On-site surveys conducted at regular intervals by peers, with active involvement of the teachers and students being surveyed and using checks and balances with respect to information obtained and decisions made are major characteristics of the Canadian accreditation process.
TL;DR: In this paper, the authors give twelve tips for chairing a new committee and discuss the importance of committee meetings in medical education, including meeting scheduling and committee selection. But they do not discuss the committee selection process.
Abstract: (1989). Meetings: Twelve tips for chairing a new committee. Medical Teacher: Vol. 11, No. 1, pp. 47-50.