A web exercise in evidence-based medicine using cognitive theory

Our aim was to improve clinical reasoning skills by applying an established theory of memory, cognition, and decision making (fuzzy-trace theory) to instruction in evidence-based medicine. Decision-making tasks concerning chest pain evaluation in women were developed for medical students and internal medicine residents. The fuzzy-trace theory guided the selection of online sources (e.g., target articles) and decision-making tasks. Twelve students and 22 internal medicine residents attended didactic conferences emphasizing search, evaluation, and clinical application of relevant evidence. A 17-item Likert scale questionnaire assessed participants' evaluation of the instruction. Ratings for each of the 17 items differed significantly from chance in favor of this alternative approach to instruction. We concluded that fuzzy-trace theory may be a useful guide for developing learning exercises in evidence-based medicine.     

The role of emergency physicians in the care of the child in school

Emergency physicians may contribute significantly to the health of children in the school setting. Because children spend the majority of their waking hours in school, they and their adult caretakers experience medical and surgical emergencies on a regular basis. These emergencies include a wide range of problems, such as asthma, seizures, firearms violence, and mass disasters. Additionally, many children in school have limited access to primary care, which increases their risk for medical emergencies. Recent reports from the National Academy of Sciences Institute of Medicine and the Maternal and Child Health Bureau's Emergency Medical Services for Children Program have described the challenges in improving the medical care of children in both the emergency and school settings. The prevalence of school health emergencies provides an opportunity for use of the expertise of emergency physicians. Emergency physicians have an important role in ensuring the proper treatment of emergency medical problems that occur in school. They need to be integrally involved in the development and organization of systems for prevention, initial stabilization, definitive management, and responsible follow-up of medical problems and injuries.     

Effect of a mandatory geriatric medicine clerkship on third-year students

A nationwide push has increased geriatric medicine instruction within medical school curricula. Some institutions have proceeded with an integrated 4-year curriculum while others have constructed discrete courses in the third or fourth year of medical school. This paper describes the impact of a new mandatory 4-week geriatric medicine clerkship on third-year students developed by the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center. In the first year of implementation, 135 students took the course on both the Oklahoma City and Tulsa campuses. Clinical sites included inpatient, VA extended care unit, outpatient clinics, dementia clinics, home care, long-term care settings, and hospice. Didactic instruction used formal lectures and problem-based learning. The impact of the clerkship on students was assessed in three areas: knowledge, skills, and attitude using a pre- and postknowledge test, student satisfaction survey, and written comments. This article discusses how the clerkship resulted in increased knowledge of geriatric medicine. Student self-report indicates that the clerkship enhanced clinical evaluation and patient assessment skills. Students indicated that the experience was positive and recognized the importance of geriatric medicine in their development as doctors.     

Age differences in memory as a function of depth of processing

It has been proposed that the old do not process information as deeply as the young and therefore show poorer memory. This study manipulated level of processing via type of instructions given to subjects prior to the memory tasks (recall followed by recognition). Five types of instructions were employed: non-semantic, non-semantic + intentional, intentional, semantic, and semantic + intentional. Type of instruction affected the two age groups differentially on recall memory but not on recognition memory. The young and old recalled at the same level following a non-semantic (shallow) instruction, but parted ways thereafter; the young became disproportionately superior with semantic instructions. The addition of an intentional component lo the non-semantic instruction benefited the recall performance of the young to a greater extent than the old. The addition of an intentional component to a semantic component benefited the recall performance of the young, but not the old. It was concluded that the old have more difficulty than the young in dealing with two instructional components simultaneously when recall performance is under consideration.     

Conceptual knowledge increases infants' memory capacity

Adults can expand their limited working memory capacity by using stored conceptual knowledge to chunk items into interrelated units. For example, adults are better at remembering the letter string PBSBBCCNN after parsing it into three smaller units: the television acronyms PBS, BBC, and CNN. Is this chunking a learned strategy acquired through instruction? We explored the origins of this ability by asking whether untrained infants can use conceptual knowledge to increase memory. In the absence of any grouping cues, 14-month-old infants can track only three hidden objects at once, demonstrating the standard limit of working memory. In four experiments we show that infants can surpass this limit when given perceptual, conceptual, linguistic, or spatial cues to parse larger arrays into smaller units that are more efficiently stored in memory. This work offers evidence of memory expansion based on conceptual knowledge in untrained, preverbal subjects. Our findings demonstrate that without instruction, and in the absence of robust language, a fundamental memory computation is available throughout the lifespan, years before the development of explicit metamemorial strategies.     

Medical exemptions to school immunization requirements in the United States--association of state policies with medical exemption rates (2004-2011)

All 50 US states allow medical exemptions from school entry immunization requirements. The extent to which medical exemptions are granted and the relationship with ease of obtaining these exemptions has not previously been examined in detail. We evaluated counts and rates of state-level medical exemptions to kindergarten entry requirements over 7 school years (2004-2005 through 2010-2011). During this period, 0.26%-0.41% of enrolled children received medical exemptions. In states with easier medical exemption criteria, medical exemption rates were significantly higher (adjusted incidence rate ratio: 6.4 [95% confidence interval: 2.7-15.6]). Routine evaluation of medical exemption rates is needed to ensure their appropriate use.     

Loss of laboratory instruction in American medical schools: erosion of Flexner's view of "scientific medical education."

There has been a steep decline in the number of hours devoted to laboratory instruction in American medical schools. Medical students attending 1 of the 3 Washington DC medical schools now spend less than 10% of their first 2 basic science years in a laboratory. The paucity of laboratory instruction represents a reversal of the gains made in American medical education after the Flexner report and may partly account for our nation's missing physician-scientists. This situation is not expected to improve anytime soon, given the expenses that would be required to divert research-intensive faculty to laboratory instruction. The expenses would be particularly onerous for medical schools under intensive managed care pressures. Because it is unlikely that many American medical schools have either the will or means to make substantive changes in their laboratory-based curricula, novel solutions to restoring laboratory-based medical education may be required.     

A primer on medical education in the United States through the lens of a current resident physician

Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor’s degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship.     

提高成教医学微生物学教学质量的探讨

成教医学微生物学教学质量普遍较低。本文分析学生、教师和学校等3方面的原因,在此基础上,提出了一些应对措施,以提高成教医学微生物学的教学质量。     

来华MBBS留学生医学免疫学英文教学的实践与探索

随着来华MBBS留学生招生规模的不断扩大,提高教学质量、改善教学效果是广大医学院校的重要任务。针对医学留学生医学免疫学教学中的境遇,本院从加强语言的交流和文化的融合、精心选择组织教学内容、采用LBL（传统教学法）＋PBL（基于问题的教学法）＋CBL（案例教学法）相结合的三轨式教学方法、及时反馈评估教学效果等多方面进行改进与探索。实践表明,本院开展的医学免疫学英文教学能引导留学生积极主动参与教学,激发学习兴趣,提高理解能力,重在培养学生分析问题及解决问题的能力,增强了专业教师团队合作意识,有效地提高了教学水平和促进了教学质量,受到留学生好评。     

Performance of U.S. citizen-foreign medical graduates on certifying examinations in internal medicine

Increasing numbers of U.S. citizens are studying medicine abroad and returning for graduate medical education and practice. The numbers and performance of U.S. citizen and all other graduates of foreign medical schools on the certifying examination of the American Board of Internal Medicine were compared with those of graduates of U.S. medical schools for 1975–1980. Numbers of first-taker U.S. citizen foreign medical school graduates increased whereas numbers of all other foreign medical school graduates decreased during this period. In 1980, U.S. citizens represented 19 percent of all first-taker foreign medical school graduates. During the study period, annual examinations were passed by 79 to 82 percent of U.S. medical school graduates, 15 to 38 percent of U.S. citizen foreign medical school graduates, and 27 to 45 percent of all other foreign medical school graduates taking an examination for the first time. On each examination, U.S. citizen foreign medical school graduates did not do as well as all other foreign medical school graduates. Members of all groups met the same postdoctoral training requirements.     

设计性实验在医学微生物学教学中的尝试

以2006级临床医学本科生为研究对象,在医学微生物学教学中开设"医学生浅部真菌感染的调查与分析"设计性实验课,并对实验结果和教学效果进行分析。结果显示,浅部真菌的感染与环境及个人卫生状况相关,男生感染率高于女生,且以足癣最为常见。设计性实验的实施,理论与实践相结合,不但提高了学生运用所学理论知识分析和解决实际问题的能力,同时也增强了学生学习的兴趣和主动性。     

How to select the doctors of the future

Although previous academic performance is acknowledged as the best predictor of achievement in medical school, no one has succeeded in finding a selection method which will choose students who will become doctors with the qualities the community expect. Australian medical schools use various selection methods. It could well be argued that the most important phase in the selection process is informed decision-making by potential applicants. More effort should be made by medical schools to achieve this.     

Educating physician assistants: the past ten years.

During the past ten years of PA education, new methods of instruction have been introduced and tested, and curricula have been expanded. Clinical experience is being provided in a widening range of medical settings. Greater emphasis has been placed on standardization and accreditation of instruction. Most PA programs are now sponsored by four-year colleges, with instruction leading to a bachelor's degree.     

Web‐Based Training in Geriatrics for Medical Residents: A Randomized Controlled Trial Using Standardized Patients to Assess Outcomes

Although Web‐based instruction offers an advantageous approach to medical education, few studies have addressed the use of Web‐based education to teach clinical content at the postgraduate level. Even fewer studies have addressed clinical outcomes after the Web‐based instruction, yet postgraduate training requirements now focus on outcomes of training. A randomized trial was conducted to compare knowledge of postgraduate year (PGY) 1 residents after Web‐based with that after paper‐based instruction and to compare residents' clinical application of their instruction using unannounced standardized patients (SPs) and unannounced activated standardized patients (ASPs). PGY 1 residents were assigned to a month‐long ambulatory rotation during which they were randomized as a block to Web‐ or paper‐based instruction covering the same four geriatric syndromes (dementia, depression, falls, and urinary incontinence). Outcome measures were mean change scores for before and after testing and scores from SP and ASP clinical encounter forms (checklist, chart abstraction, and electronic order entry). Residents who completed the Web‐based instruction showed significantly greater improvement on the knowledge tests than those who received paper‐based instruction. There were no significant differences in the scores from the SP and ASP clinical encounters except that the chart abstraction score was better for Web‐based group than the paper‐based group for dementia. Web‐based instruction is an educational tool that medical residents readily accept and can be used to improve knowledge of core geriatrics content as measured using immediate posttesting. More‐intensive educational interventions are needed to improve clinical performance by trainees in the care of older patients.     

Virtual Patients in Geriatric Education

The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators have spurred the development of virtual patient programs to teach geriatrics at the medical undergraduate, graduate, and postgraduate levels. As an instructional tool, the Virtual Patient must be placed in the correct educational context to help educators identify opportunities for its proper use in the curriculum. In this review, the experiences of three medical schools in the development and application of geriatric virtual patients are described as case studies. In each case study, the challenges encountered and solutions developed are presented. Areas of future research in the use of virtual patients in geriatrics education include the determination of the optimal combination of features, the settings of use of virtual patient programs, the underlying pedagogy, and the limitations in its application in clinical instruction.     

Occupational Stress, Psychological Vulnerability and Alcohol-Related Problems over Time in Future Physicians

This paper elaborates the conceptual frameworks and major results to date from an ongoing longitudinal study of alcohol problems in male and female future physicians. A medical student cohort was surveyed at medical school entrance and in the 2nd and 3rd years of training. Relative to life span developmental orientations, a sizable proportion of premedical school problem drinkers "matured out" of their earlier patterns after entrance into occupational training roles. Relative to occupational selection versus stress perspectives, medical school problem drinkers were equally divided between those manifesting onset prior to the initiation of training versus those manifesting onset during medical training. Overall, both male and female problem drinking declined during the preclinical years (in contrast to premedical school levels) but manifested a trend in the direction of a reversal of the previous decline after the initiation of clinical training. The major psychosocial predictor of alcohol abuse during clinical training involved social-relational deficits or narcissistic personality styles. Moreover, this relationship was mediated by social support deficits and patient care-related stressors. This cohort is currently being re-surveyed in the last year of medical school and will be followed again during residency training.     

Current Perception of Nutrition Education in U.S. Medical Schools

Historically, physicians have perceived the quality of nutrition training during medical school as inadequate. A literature review suggests that this perception has not significantly changed since the 1950s. Many schools have worked to create clinical nutrition curricula for use during medical school. Interestingly, data suggest that medical students’ perception of the importance of clinical nutrition can decrease during medical school. Recent data support the importance of targeted nutritional therapy to reduce morbidity and mortality, yet the number of physicians interested in nutrition appears to be declining, and fewer hours of nutrition training are occurring in medical school. One possible solution to improve both training and awareness of the problem is to implement a certification program for both students and preceptors modeled after the Cardiac Life Support training offered by the American Heart Association.     

An adult development study of contextual memory

This study tested the hypothesis that there is a relatively greater decrease in memory for contextual features than in memory for target information with increasing age. Young, middle-aged, and elderly adults were presented with a number of slides, each of which contained a word centered on a background composed of either a landscape/cityscape or a border design. One third of the subjects were told to remember the words, one third were told to remember the backgrounds, and one third were told to remember the word-and-background pairs. Recognition memory for both words, backgrounds, and word-and-background pairings was tested in all subjects. The interaction between age, instruction condition, and type of information tested was not significant. Thus, there was no support for the hypothesis that older adults have a greater deficit in contextual memory than in memory for target information when compared to younger adults.     

A Brief, Intensive, Clinically Focused Geriatrics Course During the Third Year of Medical School

During the next several decades, the aging of the "baby boom" generation in the United States will result in a dramatic increase in the number of patients aged 65 and older seeking medical care, but current projections suggest that the shortage of geriatrics-trained specialists will only worsen during this time period. As a result, the care of elderly patients will largely fall to other types of physicians. Consequently, it is imperative that medical school training include exposure to the basic skills needed to care safely for older adults. This goal is challenging, because the number of geriatric medicine faculty in most academic medical centers is small, and multiple other medical specialties are also vying for time in a busy medical school curriculum. Whether a 3-day course conducted during the third year of medical school could teach basic principles of geriatric medicine in a time- and manpower-effective manner was explored. It was found that even this brief exposure to geriatrics could have meaningful effects on student knowledge of and comfort with geriatrics.