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1.
Objectives  Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL.
Methods  Year 2 students were randomly allocated to one of two groups for skills training. Group 1 ( n  = 64) were tutored by volunteer Year 6 students, and Group 2 ( n  = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t -test. Qualitative data, obtained from Year 2 students ( n  = 125) by written questionnaire and Year 6 students ( n  = 11) and SPs ( n  = 3) by focus group interviews, were analysed for themes.
Results  Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval − 3.8 to 2.4). The PAL environment was perceived as 'comfortable' and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching.
Conclusions  With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad.  相似文献   

2.
A computer-assisted, experiential course of instruction on early diagnosis of substance abuse was developed and compared to three existing substance abuse curricula for third-year medical students on family medicine clerkships. The experimental course, requiring 2 hours of teacher contact, consisted of three computer-assisted instruction modules, active discussion, role play, opportunities for applying new knowledge and clinical skills, and modelling of clinical interest by a family doctor. The three comparison educational programmes were a one-week immersion experience on a substance abuse in-patient unit, 1-4 hours of lecture, and no formal teaching. For 6 months, all third-year medical students at Jefferson Medical College were exposed to one of these courses, and to the same required readings on substance abuse, on their required family medicine rotations at different clerkship sites. They completed end-of-rotation questionnaires assessing their knowledge, satisfaction with substance abuse teaching, and motivation for continued learning. Groups were similar with regard to demographic variables, academic performance, and previous curricular and extra-curricular exposure to substance abuse. Despite a possible selection bias favouring the immersion experience, the computer-assisted course resulted in higher levels of knowledge on early diagnosis, but similar attitudes and satisfaction. The computer-assisted and immersion courses produced more favourable outcomes than lecture-based teaching and no formal teaching. Compared to no formal teaching, lecture did not produce measurable effect. The results suggest that a computer-assisted, experiential substance abuse course, based on relevant and practical goals, can efficiently augment knowledge and motivation for further learning of third-year medical students.  相似文献   

3.
As part of the restructured undergraduate medical curriculum at McGill Medical School, a return to basic sciences was introduced in the students' final year. This follows the completion of the formal portion of their undergraduate clinical education. This paper describes this unique return to the basic science programme including the rationale behind the change and the effects of this programme on student learning, and student attitudes towards the programme. Final-year medical students in 1978 and 1981 were tested on educational and attitudinal variables. Data were collected using achievement tests, questionnaires and interviews. The findings of the study indicated that the major objectives of the programme, which were to facilitate student learning in greater depth and to integrate basic sciences with clinical knowledge, were achieved. The programme was enthusiastically received by the students in 1978 and also in 1981, indicating the outcome of the return to the basic science programme to be more than a 'Hawthorne effect' as suspected in 1978. The concept of a return to basic science is recommended for consideration by medical faculties.  相似文献   

4.
BACKGROUND: If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a 'journey' across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues. OBJECTIVES: In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance, define educational need and initiate educational action. METHOD: To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess. CONCLUSIONS: We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.  相似文献   

5.
Harrison C  Hogg W 《Medical education》2003,37(10):884-888
OBJECTIVE: This study aimed to discover what the family doctors who attended an annual refresher course wished to obtain from participating in the event and what their response was to evidence that doctor behaviour is not changed by such programmes. DESIGN: The study used the qualitative method of in-depth interviews. SETTING: Ottawa, Ontario, Canada and the surrounding area. PARTICIPANTS: The informants for the study were a sample of 6 family doctors who attended the 50th Annual Refresher Course for Family Physicians, held in April 2001 in Ottawa, Ontario, Canada. METHOD: In-depth interviews with the participants were conducted before and after they attended the annual refresher course. The doctors had pre-registered for the 3-day course. They were purposely selected to obtain diversity of gender, year of graduation from medical school and practice location. RESULTS: The doctors interviewed had 3 main reasons for attending the refresher course: to obtain information or to be updated; to be reassured that their practice behaviour was within accepted guidelines, and to hear from and interact with the specialists who gave presentations. All the participants in the study were able to name changes they had made as the result of attending a similar type of programme in the past and were sceptical of findings that practice behaviour did not change as a result of traditional continuing medical education (CME). CONCLUSIONS: Despite current support for interactive and practice-linked educational activities, the doctors in this study valued the input of the experts who lectured at the course. These doctors were not prepared to accept the currently held precept that their behaviour did not change as a result of attendance at traditional CME programmes.  相似文献   

6.
This study examined the validity of using physicians' self-assessed needs, relevance and motivation to learn about clinical topics as a means for setting objectives and priorities for continuing medical education (CME) programmes. In an initial survey family doctors were asked to rate their need, relevance and motivation to learn about 120 different clinical topics. Eight months later, the same population was sent a second mail survey asking respondents to indicate if they had learned about a set of sixteen topics taken from the initial survey and, if so, in what kind of learning activities. Eight of the sixteen topics were highly rated and eight were low rated in the initial survey. In terms of actual participation of family doctors, self-assessed motivation to learn exhibited a strong positive relationship with actual participation. Both self-assessed need and relevance were negative to only moderately positive in their association with actual participation. This evidence contributed to the value of using self-assessed motivation as an indicator of future participation of family doctors in CME and questioned the value of using self-assessed need and relevance as indicators of future patterns of participation.  相似文献   

7.
The educational credits obtained by general practitioners for the postgraduate education allowance were examined. With over 3 months of the qualifying period remaining, 68.4% had reached the requirement. The educational day attainments show almost a normal distribution, with 4.2% of doctors completing more than double the requirement.  相似文献   

8.
Community-oriented medical education: what is it?   总被引:2,自引:0,他引:2  
Summary. The pressing need for this communication has emerged from the author's experience in conducting educational workshops, seminars and meetings for the orientation of health professionals in community-oriented medical education. Many questions are raised and many statements made which clearly indicate that the term ‘community-oriented medical education’ (COME) is still misunderstood. It carries a different meaning for different people. Many give it their own meaning and attach to it their own interpretations. This has resulted in wide propagation of the wrong concepts to the detriment of promoting the approach. (It is worth noting that ‘community medicine’ has over the years suffered the same fate. Is it because both terms include the word ‘community’, which often has a poor image for much of the medical profession?) An attempt is made here to clarify the situation by a process of questions and answers, the questions being those frequently asked as such or posed in the form of statements. They are by no means exhaustive. Seven major such questions are addressed with reference to personal experience and the literature.
  • 1 What do we mean by COME, community-based education (CBE) and community-based learning (CBL)?
  • 2 COME is third-grade medical education producing third-grade graduates and ‘barefoot doctors’.
  • 3 COME produces community health doctors/specialists.
  • 4 COME is not scientifically based (based only on soft sciences) and basic sciences are neglected.
  • 5 Graduates from COME programmes are not competent in dealing with patients as they spend most of their time in the community.
  • 6 If it is community-oriented education, then what about the hospital? Is it not part of the community?
  • 7 COME is expensive and requires more resources than traditional approaches?
  相似文献   

9.
PURPOSE: To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education. METHOD: We performed a follow-up study of 118 doctors on a postgraduate occupational health training programme on the management of mental health problems. The following personal and contextual variables were measured as potential predictors of outcome: gender; age; years of experience as a doctor; university of graduation; learning style (Kolb); present employer (occupational health service), and educational format (problem-based or lecture-based). The main outcome measures were: scores on knowledge tests consisting of true/false and open answer questions, and performance in practice based on self-report and performance indicators. To determine the effect of potential predictive factors univariate analyses of variance and repeated measurement analysis of variance was applied. RESULTS: The mean scores of knowledge (P < 0.001) and performance (P = 0.001) of the participants increased after the educational programme. After multivariate analysis female gender was positively related to accruements in both knowledge and performance (both P < 0.05), independently of the influence of other factors. Accommodator learning style showed a relation with knowledge increase (P = 0.05), but had no influence on performance (P = 0.79). The problem-based educational format yielded a better performance outcome (P = 0.05), but had no influence on knowledge tests (P = 0.31). CONCLUSION: Gender and learning style were found to be related to an increase in knowledge. Gender was also found to be related to improvement in performance after a postgraduate medical education programme. We found no interactions with course design (i.e. problem-based or non problem-based learning formats), but further research could reveal other cues, suggesting practical consequences of student characteristics for course design in postgraduate training.  相似文献   

10.
An interactive patient simulation for the study of medical decision-making was developed which is basically a flexible question and answer simulation between a doctor and a simulator conducting the simulation. To insure a thorough insight into the management of cases over time, provisions were made for doctors to interact with the simulated patients as many as five times. The simulation was tested on 16 family doctors and 16 specialist physicians to evaluate its realism and construct validity. The realism scores were highly favourable for both groups. With regard to construct validity, the hypothesis that the two specialty groups would manifest themselves in decision-making as distinct and homogeneous groups was tested. This hypothesis was confirmed in the case of specialist physicians, but not in the case of family doctors.  相似文献   

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