Showing papers in "Medical Teacher in 1996"
TL;DR: This article reports on educational experiences with an assessment method to assess knowledge in a problem-based learning context, a comprehensive test sampling knowledge across all content areas of medicine reflecting the end objectives of the curriculum.
Abstract: This article reports on educational experiences with an assessment method to assess knowledge in a problem-based learning context. This so-called progress test is a comprehensive test sampling knowledge across all content areas of medicine reflecting the end objectives of the curriculum. The test is periodically given to all medical students in the curriculum regardless of their year of training. The format precludes the possibility for students to prepare themselves specifically, therefore preventing the often reported undesirable effects of objective tests such as memorization of facts and interference with tutorial group functioning. The many years of experience indicate that this testing format works effectively. After the introduction of progress tests a number of other, to some extent unexpected, educational advantages became apparent, as well as a few disadvantages. The additional advantages make progress testing also useful in non-problem-based curricula.
269 citations
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TL;DR: In this article, the benefits of recognizing and employing a broader, richer conception of competence are discussed, and the logic of the concept of competence is found to support a broader view about competency standards rather than the narrow one that is so often taken for granted.
Abstract: There has been a tendency for people to think about competence in a narrow way that undermines any possible benefits to be gained from adopting competency standards. This paper will attempt to clarify exactly what competence is. It will be found that the logic of the concept of competence is itself such as to support a broader view about competency standards rather than the narrow one that is so often taken for granted. Second, the benefits of recognizing and employing a broader, richer conception of competence will be outlined and discussed.
182 citations
TL;DR: Task-based learning ensures that learning objectives are achieved, while taking advantage of the rich opportunities and experiences to which a student or doctor can be exposed in a real or simulated clinical setting.
Abstract: Task-based learning (TBL) is an educationally sound, effective and efficient strategy for delivering relevant education. In TBL, the tasks of the healthcare professional provide the context and the focus for learning—but are not the objective of the student's learning. Students gain a basic understanding of the principles of health and disease, and of how to apply these in a range of contexts. Within the specific context of healthcare, students develop generic competences, such as communication and management skills. TBL ensures that learning objectives are achieved, while taking advantage of the rich opportunities and experiences to which a student or doctor can be exposed in a real or simulated clinical setting.
84 citations
TL;DR: In this article, the authors explore the rational arguments that support the movement towards small group learning, the many benefits from small-group activities and the many types of small group methods and provide practical guidance on why to adopt small group work and how to do it effectively.
Abstract: There is a recent trend towards small-group work in undergraduate medical courses. Current understanding of educational strategies supports the use of small groups as an effective method of learning. Small-group work recognizes a movement towards learner-centred, problem-based and self-directed learning. The exploration of knowledge, learning through curiosity, the critical evaluation of evidence and a capacity for self-education are all fostered in small-group interactions. This article explores the rational arguments that support the movement towards small-group learning, the many benefits from small-group activities and the many types of small-group methods. Small groups interact in a variety of ways and the teacher has an important role. Barriers, more often perceived than real, may impede the adoption of small-group teaching. Practical guidance is offered on why to adopt small-group work and how to do it effectively. The teacher is provided with a framework for running small-group sessions and is giv...
68 citations
TL;DR: Content analysis is a research method which allows the qualitative data collected in research to be analyzed systematically and reliably so that generalizations can be made from them in relation to generalizations.
Abstract: Content analysis is a research method which allows the qualitative data collected in research to be analysed systematically and reliably so that generalizations can be made from them in relation to...
57 citations
TL;DR: The characteristic identified as 'most important' by the students and the faculty relates to 'willingness to help students' and other qualities rated highly were 'knowledge of subject-matter', 'ability to present information in a logical sequence', 'attention given to essentials of in...
Abstract: This study sought to identify: (1) the characteristics of an ideal teacher deemed most important by students and faculty in a classroom setting; (2) the relationship between students and faculty pe...
52 citations
TL;DR: The goal of this article is to outline ways in which small-group teaching can become more effective and more enjoyable, and to recommend strategies for enhancing small- group teaching, whether you are working with the same group over time orWhether you are meeting with a particular group only once.
Abstract: (1996). Twelve tips for effective small-group teaching in the health professions. Medical Teacher: Vol. 18, No. 3, pp. 203-207.
43 citations
TL;DR: There was wide variation in how relevant the students graded the preclinical and clinical courses to be and the correlation with the subject the students planned to specialize in.
Abstract: Medical students were asked in a questionnaire to evaluate the importance of all their courses and lectures with respect to their relevance to training to become a doctor. This survey was carried out at the end of the undergraduate curriculum. As the response rate was over 90% (n = 323) the data are undoubtedly representative. There was wide variation in how relevant the students graded the preclinical and clinical courses to be. Some interesting aspects were the differences found between female and male students as well as the correlation with the subject the students planned to specialize in. About 50% of the students had spent at least one month of their clinical clerkships abroad, 20% spent at least four months in the final intensive year in another county and 6% a whole academic year abroad. Retrospective surveys provide important additional information to surveys held at the end of the individual courses.
25 citations
TL;DR: A 32-item short version of the Approaches to Studying Inventory (ASI) was administered to all students (years 1-6) at an Australian university medical school (return rate 77% = 806 students).
Abstract: A 32-item short version of the Approaches to Studying Inventory (ASI) was administered to all students (years 1–6) at an Australian university medical school (return rate 77% = 806 students). The aim was to assess the ASI's psychometric characteristics and to examine any differences in scale scores between students in different enrolment years. The analysis of the ASI was based on 806 students; factor analyses were conducted on (1) eight subscales and (2) the 32 ASI items, followed by a second-order analysis of the correlations among the Just-order factors. The analyses confirmed the theoretical distinction between the meaning (deep learning;) and reproducing (surface learning) orientations, with both showing satisfactory internal consistency reliability for group comparisons. The failing students did not show any disintegration in their responses to the ASI. This short-version ASI is recommended as a practical tool for curriculum committees and individual teachers to use as an entry point for discussions...
24 citations
TL;DR: This article investigated the effectiveness of a five-day communication skills training course held during the second year of a six-year medical program and found that all facets were significantly improved after training (t, p < 0.05).
Abstract: The aim of the current study was to investigate the effectiveness of a five-day communication skills training course held during the second year of a six-year medical program. The 26 students (10 male, 16 female) who completed the 1994 course were videotaped interviewing matched simulated patients before and after training. Communication experts blindly rated the film segments in terms of global performance and six specified component interview skills using a 10-point scale (0 ‘skill not used’, 1 ‘poor’, 5 ‘pass’ [skill acceptable for a graduate doctor], 9 ‘excellent’). All facets were significantly improved after training (t, p < 0.05). Judges were more often concordant (rs, p < 0.05) when rating pre-training pegormances. Ability to establish rapport was the best predictor of skill in other components. Neither pre-training pegormance, English grade nor overall academic performance for the year was predictive of post-training performance.
23 citations
TL;DR: Some of the difficulties experienced by patients and their doctors are looked at and how to help correct the communication deficiencies are considered.
Abstract: Poor communication can lead to misunderstandings about the importance of different diagnostic tests, underreporting of key symptoms and side-effects and poor adherence to treatment regimens or will...
TL;DR: An external evaluation of the fourth-year medical student attachment in general practice at the University of Dundee was conducted to determine the strengths and weaknesses of the teaching programmed.
Abstract: An external evaluation [1] of the fourth-year medical student attachment in general practice at the University of Dundee was conducted to determine the strengths and weaknesses of the teaching programmed. Written evaluations of the attachment were obtained from 75 medical students. In addition, interviews were conducted with students and their tutors and a focus group was arranged at the conclusion of the attachment. The overall evaluation by the students was positive. Students liked the opportunity for the hands-on practice of medicine and the collegial reception from their tutors. Major criticisms related to the lack of adequate opportunities for some students to see patients on their own and to learn practical procedures. Many students would like to have a longer attachment. Problem areas which may provide valuable learning experiences, such as dealing with ‘difficult patients’ need to be addressed in advance and during the attachment. Other health professionals need to be adequately prepared for, and ...
TL;DR: Surgical teaching faculty at an urban teaching hospital were studied in terms of the numbers of questions asked of third-year medical students in the classroom to suggest that faculty who involved students in their lectures through the use of questions were perceived more favourably.
Abstract: Surgical teaching faculty at an urban teaching hospital were studied in terms of the numbers of questions asked of third-year medical students in the classroom. Forty lectures were studied. The number of questions addressed to students by the teachers were counted, Following the lectures, students were asked to record their opinion. Student achievement on multiple-choice questions on topics of faculty who asked many versus no questions were compared in a post hoe analysis of the surgery final examination. The number of questions asked per lecture ranged from 0 to 72 (mean = 20, SD = 21). Ten faculty (26%) did not ask questions. Students rated faculty who asked questions to be more stimulating than those who did not. No significant differences in achievement were found on test items of faculty who asked a high frequency of questions when compared with those who did not question. Our data suggest that faculty who involved students in their lectures through the use of questions were perceived more favourably...
TL;DR: An assessment system that has been developed to focus on application of knowledge and its two major features are case-based testing and the use of multimedia and computer tools are described.
Abstract: This article describes an assessment system that has been developed to focus on application of knowledge. Its two major features are case-based testing and the use of multimedia and computer tools. The case material for this testing type is based on the key-features concept, reporting the most relevant characteristics of a case and asking a limited number of questions, each aimed at essential decisions. These cases are produced in daily practice using real patients. Subsequently an extensive review process is used to check for flaws in description, phrasing or answer keys. Cases are stored in an item-bank out of which an automated random stratified selection can be drawn, according to a pre-specified blueprint. Cases are then presented to the students by way of a specially developed interface using multimedia when indicated. The article further describes advantages, disadvantages and experiences.
TL;DR: The data taken together indicate that the students were very satisfied with the programme run in each of these two years, and with the changes made in 1994 none of the categories of students was disadvantaged on the case-based component relative to the essay component in the examination.
Abstract: This paper reports on the re-adoption of a case-based learning programme in anatomy for second-year medical students in which initial discussions of the cases were held using a local, cabled videoconferencing system. Staff and students' views on this method as well as students' performance in the case-based component (on abdomen and pelvis) of the written examination in 1993 and 1994 are presented. The data taken together indicate that the students were very satisfied with the programme run in each of these two years, and with the changes made in 1994 none of the categories of students was disadvantaged on the case-based component relative to the essay component in the examination. In addition the programmes encouraged the students to work together in small groups.
TL;DR: A short pharmacotherapy package based on a WHO manual on good prescribing was introduced for second-year undergraduate medical students at the Institute of Medicine in Kathmandu and it was recommended for future students.
Abstract: A short pharmacotherapy package based on a WHO manual on good prescribing was introduced for the second-year undergraduate medical students at the Institute of Medicine in Kathmandu. The method used was interactive discussions between students and teacher coupled with role-plays by students in solving therapeutic problems. All the students felt that the package was useful and interesting and it was recommended for future students. This preliminary experience shows that a short problem-orientated pharmacotherapy package can be integrated easily and successfully into teacher-centred and discipline-based pharmacology teaching.
TL;DR: An innovative teaching unit developed by staff at Monash University, Australia was designed to give first-year medical students insight into the impact of a developmental disability on an individual and his/her family.
Abstract: This paper describes an innovative teaching unit developed by staff at Monash University, Australia. The unit was designed to give first-year medical students insight into the impact of a developmental disability on an individual and his/her family. The students were given opportunities to learn directly from people with disabilities, their families and professionals working with them in the community about their health, educational and social needs. The teaching unit was well received by the students and pre- and post-course questionnaires revealed that considerable attitudinal development had occurred over the 12 weeks of the course.
TL;DR: This study developed a system for the formative assessment of 'core' areas within the physiology curriculum and revealed considerable lacunae in the transfer of ' core' knowledge despite what the faculty considered to be an effective teaching programme.
Abstract: Assessment within the medical system in India is largely summative. There is, however, an increasing awareness of the need for formative assessment. In this study we developed a system for the form...
TL;DR: It is concluded that undergraduate students are an excellent source of MCQs for use in evaluation and that students benefit from involvement in the evaluation process.
Abstract: Multiple-choice questions (MCQs), the predominant evaluation vehicle in North America, are a reliable and valid measure of knowledge but have many detractors. We use MCQs widely in evaluating undergraduate students in a junior Internal Medicine clerkship but find it difficult to maintain a suitable secure bank of questions. We therefore involved our students in generation of new questions. After one year of this practice we compared the accumulated student-generated questions with those from our faculty. The average facility index and the validity of student-generated questions were comparable to those of the faculty-generated questions. The students' questions were less frequently based on a clinical case scenario than were the faculty-generated questions. We conclude that undergraduate students are an excellent source of MCQs for use in evaluation and that students benefit from involvement in the evaluation process.
TL;DR: In this paper, twelve tips on teaching and learning how to break bad news are given for dealing with bad news in medical teachers, with emphasis on the negative aspect of the news.
Abstract: (1996). Twelve tips on teaching and learning how to break bad news. Medical Teacher: Vol. 18, No. 4, pp. 275-278.
TL;DR: Using the Worksheet for Ambulatory Medicine was feasible and educationally valuable for many third- and fourth-year medical students and their preceptor in a required ambulatory internal medicine clerkship.
Abstract: The Worksheet for Ambulatory Medicine (WAM) was designed to enhance teaching and learning outpatient general internal medicine. It contains a set of explicit learning objectives, promotes important teaching strategies, and carefully structures educational and patient care activities. WAM may help students by: (1) demonstrating methods for more focused history-taking, physical examination, and case-presentation; (2) increasing preceptor feedback; (3) making performance expectations explicit; (4) facilitating and encouraging self-directed learning and reflective, evidence-based, practice; (5) promoting autonomous evaluation and management of outpatient problems; and (6) demonstrating an approach to evaluating undifferentiated clinical problems. WAM may help teachers by: (1) identifying student learning needs; (2) increasing structure and control of teaching sessions; and (3) helping demonstrate steps in the clinical reasoning process. WAM has been pilot-tested with third- and fourth-year medical students. I...
TL;DR: The matrix shows that there are many similarities in the clinical skills required of medical and nursing students, particularly communication skills, and highlights opportunities for joint teaching.
Abstract: This paper describes the development of the Clinical Skills Matrix, a consensus document designed to underpin clinical skills teaching in the Skills Centre at St Bartholomew's Hospital in London. It provides a framework for students, teachers and clinical staff, identifying the skills needed and the level of competence expected in each skill. The matrix shows that there are many similarities in the clinical skills required of medical and nursing students, particularly communication skills, and highlights opportunities for joint teaching. Interestingly, development of the matrix has shown that nurses do not have a monopoly on caring skills, neither do doctors on technical skills.
TL;DR: The question of the degree to which physicians' personal beliefs about abortion may affect women's access to abortion as a therapeutic option is raised, which is especially important in an era of increased limitation of physician choice.
Abstract: To assess whether preclinical medical students hold liberal or conservative attitudes regarding abortion, we administered a standardized questionnaire to 72 second-year medical students at a large urban university. We enquired whether they considered abortion murder, or a legitimate personal choice, and under which circumstances they would perform abortions or refer patients for abortions. In general, students held more liberal attitudes toward abortion if they had had previous sexual experience, if they had been HIV tested, and if they were Jewish. Some 14% of students responded they would never perform or refer a patient for abortion under any circumstances. These findings raise the question of the degree to which physicians' personal beliefs about abortion may affect women's access to abortion as a therapeutic option, which is especially important in an era of increased limitation of physician choice.
TL;DR: Testing the face validity of criteria of teaching competence, developed for the Leicester package for the assessment of teaching skills (L-PAST) for tutor-led, task-orientated small-group teaching, involved a postal questionnaire sent to a sample of medical members of the Association of University Departments of General Practice.
Abstract: Testing the face validity of criteria of teaching competence, developed for the Leicester package for the assessment of teaching skills (L-PAST) for tutor-led, task-orientated small-group teaching, involved a postal questionnaire sent to a sample of medical members of the Association of University Departments of General Practice. Their views on the six categories and 39 components of competence contained in L-PAST were sought on a six-point Likert scale. The survey population was given the opportunity to reject or suggest new categories or components or to reallocate components to other categories. There was minimal support for excluding any Categories or components or for moving any components to different categories. The components which failed to reach the 70% approval threshold came predominantly from the category 'structuring teaching'. The L-PAST has been modified accordingly. Student opinion was also sought on the suggested L-PAST categories and their component competences. In general, students and...
TL;DR: In the Department of Pharmacology at McGill University, a multidimensional evaluation system which includes MCQs, short essay questions, small-group performance assessments, an essay project and oral exams is developed.
Abstract: Evaluation of students is useful to assess knowledge and comprehension while motivating learning and providing feedback. In medical schools the predominant assessment vehicle is the multiple-choice question (MCQ, exam. Such exams, while useful, largely test recall and have low face validity. In the Department of Pharmacology at McGill University we have developed a multidimensional evaluation system which includes MCQs, short essay questions, small-group performance assessments, an essay project and oral exams. We consider that our system stresses the knowledge and skills required to be a successful physician while motivating students and rewarding excellence. Students are enthusiastic about the program while faculty are satisfied with the breadth and completeness of our evaluation system.
TL;DR: A system that allows the faculty unfamiliar with the computer to convert a set of class notes into a multimedia lecture presentation easily and a program template designed to organize lecture materials and easily display relevant text, graphics, video and interactive questions.
Abstract: In recent years computer-assisted education (CAE) has provided exciting new ways to present anatomical ideas. Several multimedia software programs for medical education have recently entered the marketplace. Alternatively, we developed a system that allows the faculty unfamiliar with the computer to convert a set of class notes into a multimedia lecture presentation easily. The program template was designed to organize lecture materials and easily display relevant text, graphics, video and interactive questions. Using Asymetrix Toolbook®, we can use animation, still images or full motion video of prosections to illustrate fundamental ideas. Students had access to the award winning ADAM® program versus our course-individualized multimedia program. Our program correlated with the learning objectives established by the instructors of the class. Results of the student surveys showed that students gave higher ratings for the course-individualized Toolbook® program and laserdisc presentations over the ADAM® pro...
TL;DR: Evaluation showed that most students found the teaching both interesting and useful, and their understanding of cultural factors in health, as well as communication skilk, had increased.
Abstract: Communication teaching should now be an important part of the undergraduate curriculum. Training in cultural issues has been identified as missing by practising doctors. We describe here teaching which addressed both areas. Second-year students visited and interviewed a family from an ethnic minority group. They then presented and discussed their findings in groups of 12. Evaluation showed that most students found the teaching both interesting and useful. Their understanding of cultural factors in health, as well as communication skilk, had increased.
TL;DR: An attempt has been made to provide reliable and valid qualitative and quantative feedback to a group of general practitioner registrars who wished to explore the skills required in the more patient-centred consultation.
Abstract: An attempt has been made to provide reliable and valid qualitative and quantative feedback to a group of general practitioner registrars who wished to explore the skills required in the more patient-centred consultation.
TL;DR: Findings suggest that efforts to improve medical teaching should focus on helping low profile teachers to become more active rather than enhancing the performance of those who already teach.
Abstract: Using a postal questionnaire, comments were invited from recent graduates on the teaching profile and performance of all teachers at an ‘innovative’ medical school which emphasizes problem-based learning. Of the 120 teachers involved in the survey, graduates considered 32 (27%) to have a very high profile, 18 (15%) a high profile, 29 (24% a low profile and 41 (34%) a very low profile. In a follow-up survey involving the teaching performance of 106 teachers, graduates considered 20 (19%) to be of very high quality, 64 (60%) of high quality, 21 (20%) of low quality and 1 (1%) of very low quality. These findings suggest that efforts to improve medical teaching should focus on helping low profile teachers to become more active rather than enhancing the performance of those who already teach.
TL;DR: Students are enthusiastic about the courses and are seen as gaining motivation and direction in their studies, particularly in relation to patient care, and the recorded telephone interview is an effective survey technique where problems with questionnaires are anticipated.
Abstract: This study explores the variety of early patient contact courses available to medical students in their early years in six UK medical schools, their aims and objectives, and the views of medical teachers on student gain, professional satisfactions and course problems. Semi-structured 30-minute themed telephone interviews with selected teachers in Aberdeen, Belfast, Edinburgh, Glasgow, Leicester and Southampton University Departments of General Practice were carried out and a qualitative analysis of data performed. Useful information on the aims and emphasis of courses emerged. The relationship of courses to the General Medical Council guidelines was clarified. The enthusiasms and problems of early patient contact teachers were apparent. Students are enthusiastic about the courses and are seen as gaining motivation and direction in their studies, particularly in relation to patient care. The recorded telephone interview is an effective survey technique where problems with questionnaires are anticipated. Ea...