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Journal ArticleDOI

In-Depth Learning: One School's Initiatives to Foster Integration of Ethics, Values, and the Human Dimensions of Medicine

01 Apr 2007-Academic Medicine (Acad Med)-Vol. 82, Iss: 4, pp 405-409

TL;DR: It is proposed that a theme-based, individualized, in-depth learning experience (in which students pursue a focused project comprehensively and in detail)--one that is an integral part of the curriculum--helps students learn to blend values and ethics with medicine in a way that cannot occur during rapid-paced topical survey courses.

AbstractToday's medical student curriculum is a lock-step experience that provides a broad survey of medicine with little opportunity to pursue fully integrated, in-depth learning. To teach students about the human dimensions of health care, many schools simply have added courses that survey general areas such as ethics, values, and patient-doctor relationships. However, a superficial, broad-brush approach does not offer students sufficient opportunity to engage with these topics in substantive and meaningful ways. The authors propose that a theme-based, individualized, in-depth learning experience (in which students pursue a focused project comprehensively and in detail)--one that is an integral part of the curriculum--helps students learn to blend values and ethics with medicine in a way that cannot occur during rapid-paced topical survey courses. Furthermore, it is in the depths of a learning experience that one comes face to face with the realities of uncertainty: the realization that unanswerable questions outnumber answerable ones; the awareness of the difficulty in accumulating sufficient evidence to answer a question that is, in fact, answerable; the recognition that many patients' problems transcend available evidence and must be addressed by the art of medicine; the realization that a patient can have a condition that one cannot diagnose and that may even get better for reasons that one cannot understand. The authors describe three initiatives at the University of Pittsburgh School of Medicine, two of which have been offered for more than 10 years, that illustrate the value of in-depth learning experiences. These in-depth experiences blend situated learning, reflective exercises, faculty mentoring, critical reading of literature, and constructive feedback in a prescribed but individualized curriculum.

Topics: Problem-based learning (58%), Curriculum (55%), Situated learning (55%), Critical reading (51%), Face-to-face (50%)

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Citations
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Journal ArticleDOI
TL;DR: In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors.
Abstract: Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protege, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic.

306 citations


Cites background or methods from "In-Depth Learning: One School's Ini..."

  • ...Mentoring models Six of the programs offer one-to-one mentorships [12,13,15,18,20,24]; in two programs, small groups of students are mentored by a faculty member or a senior phy-...

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  • ...Results Of the 25 papers that met the four inclusion criteria established, 14 papers [5,12-24] describe formal mentoring programs for medical students, provide information about the goal of the program, the mentoring model used, participants, the nature of program evaluation, and the effects of the program (Table 1)....

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  • ...This was mainly due to the integration of medical students into research collaborations [5,13,18]....

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  • ...Goals of the mentoring programs The mentoring programs reported pursued different main goals: (1) to provide career counseling [5,1517,21,24], (2) to develop professionalism and to support students in their personal growth [14,19,22,23], (3) to increase interest in research and to support an academic career [5,13,18], and (4) to foster students' interest in a specialty for which a future shortage is projected [12,20]....

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  • ...In two programs [5,13] in which mentoring forms part of a broader curriculum reform, the mentoring relationship is deliberately not implemented until the fourth year....

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Journal ArticleDOI
TL;DR: Evidence on the positive long-term impacts of integrating humanities into undergraduatemedical education is sparse and may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.
Abstract: PurposeHumanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities i

177 citations


Journal ArticleDOI
TL;DR: The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.
Abstract: Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.

125 citations


Journal ArticleDOI
TL;DR: The authors believe that this type of program has the potential to significantly impact the education of medical students through scholarly, in-depth inquiry and longitudinal faculty mentorship.
Abstract: Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and structure, but they share the goal of producing physicians with improved analytic, creative, and critical-thinking skills. In this article, the authors explore models of both required and elective SC programs. They gathered information through a review of medical school Web sites and direct contact with representatives of individual programs. Additionally, they discuss in-depth the SC programs of the Warren Alpert Medical School of Brown University; the University of South Florida College of Medicine; the University of California, San Francisco; and Stanford University School of Medicine. The authors describe each program's focus, participation, duration, centralization, capstone requirement, faculty involvement, and areas of concentration. Established to address a variety of challenges in the U.S. medical education system, these four programs provide an array of possible models for schools that are considering the establishment of an SC program. Although data on the impact of SC programs are lacking, the authors believe that this type of program has the potential to significantly impact the education of medical students through scholarly, in-depth inquiry and longitudinal faculty mentorship.

93 citations


Journal ArticleDOI
Abstract: PurposeScholarly concentrations (SCs) are elective or required curricular experiences that give students opportunities to study subjects in-depth beyond the conventional medical curriculum and require them to complete an independent scholarly project. This literature review explores the ques

82 citations


References
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Abstract: In the past decade self-regulated learning (SRL) has been studied extensively. It has been defined as a complex interactive process involving not only cognitive self-regulation but also motivational self-regulation. An increasing body of knowledge attests that cognitive self-regulation can be taught and that students who use these self-regulatory skills obtain better grades in the content domain to which these skills apply. However, students who self-regulate on one occasion may not self-regulate their studying on another occasion, despite the acknowledged benefits. It is argued that self-regulated learning can be domain-specific or domain-transcending, and that competent performers in a specific domain rely on different types of prior knowledge related to that domain. In this paper a conceptual review on self-regulated learning is offered on. Four major points will be addressed. First, six types of prior knowledge will be described. Second, it is documented that SRL can be a complex, demanding and deliberate activity, but also a simple, habitual and automatic activity. Third, it will be argued that we have covered some ground demonstrating that cognitive self-regulation can be taught. Fourth, motivational self-regulation will be addressed in an attempt to clarify its position in the six component model of self-regulated learning. Finally, our intervention program will be briefly described in an attempt to demonstrate how the various design recommendations given in the previous sections can be put to the test.

971 citations


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Abstract: Previous research on student learning has established the importance of the constrasting conceptions of learning held by students, and of the distinction between deep and surface approaches to learning. It has also shown that the outcome of learning may be described in terms of qualitatively different levels and that different forms of examination encourage different levels of answer. Within all these studies the nature of the understanding which is developed has been rather taken for granted. In this essentially exploratory study, a detailed examination of the interview transcripts of 13 students, who had just completed their final degree, was supplemented by analyses of written responses from an additional 11 students in their final undergraduate year. In the interviews, the students were asked about the revision strategies they had adopted and their attempts to develop understanding, and aspects of these were explored further through the written responses. Analyses of both interviews and written responses indicated the existence of differing forms of understanding which parallel, to some extent, the conceptions of learning identified previously. Links were also explored between the revision strategies adopted and the forms of understanding reached. Implications of the findings suggest that traditional degree examinations do not consistently test deep, conceptual understanding. It appears that some students gear their revision to question types which can be answered within frameworks provided by the lecturer or a textbook and that the type of questions set has a strong influence on the forms of understanding students seek during their studying and their revision. Some types of question encourage, and test, a restricted form of conceptual understanding. It also seems that the particular types of structure used in a lecture course to provide a framework also has an important influence on the ease with which students can relate it to other courses and also develop their own understanding.

311 citations