基础医学专业课的英语教学初探

针对中国教师进行专业英语教学普遍存在的心理及其他方面的一些困难，本提出了一些解决措施，包括不怕困难的心理准备、苦练发音、印发讲义、启发式教学及英汉对照式多媒体的应用等，同时给建议专业英语的教学应循序渐进，不宜一哄而上。     

Integrating nursing history into the curriculum

Understanding nursing history helps us to comprehend current issues in nursing and anticipate future trends in the profession. Faculty need strategies that will assist them in making history meaningful in the crammed, packed undergraduate and graduate curricula. This article examines how nursing history has been taught in the curriculum since the National League of Nursing Education first introduced a standardized curriculum in 1917 until the present. It explores the teaching strategies used in the past and expands on some of these methods and strategies in order to include them in nursing curricula today.     

Multiple-choice testing in anatomy

An analysis of 596 multiple-choice questions (MCQs) on human anatomy given at three First Professional Examinations for medical students is reported. The MCQ paper at each examination was 200 items long and consisted of three item-types: A, K and T/F. Each A-type item comprised a stem and five options, only one of the latter being the correct or best answer. Items of the K-type consisted of a stem and four responses, any number of which may be correct. The T/F items were of the three-response kind, the available options being 'true', 'false' and 'don't know'. Test reliability was computed by internal analysis, using the Kuder-Richardson 20 formula. Measures of concurrent validity were obtained by correlating the scores in the MCQ papers with the overall outcome of the First Professional Examination. Indices of item facility, discrimination and abstention were calculated. The effects of item-type and the availability of the 'don't know' option on examinee performance were also determined. Reliability (alpha) and concurrent validity (Pearson r) coefficients in the ranges of 0.71-0.85 and 0.80-0.93 (P less than 0.05) respectively were recorded. Regression analysis revealed the MCQ papers to be less sensitive predictors of the aggregate performance than the essay papers. The proportion of highly discriminatory and excessively difficult items was highest for the K-type. When the same K-type questions were re-exhibited in the indeterminate format, the examinees performed significantly better. Higher scores were also recorded when candidates were required to respond to all the questions than when they were offered the 'don't know' option and the percentage gain was higher for the low-scoring examinees. The appropriateness of multiple-choice testing as a tool for assessing student achievement in human anatomy is discussed.     

An investigation of the difficulty of computer-based case simulations

This study investigated the characteristics of computer-based case simulations (CCS) that may be associated with case difficulty. Difficulty was defined as the average rating by physicians of examinee performance on a nine-point scale or the passing rate on the cases. Two data sets were used, one from an administration of 18 cases, the other from an administration of 22 cases with 13 cases used on both occasions. Stepwise regression procedures were used separately for case properties and for analytic scoring of key variables to identify the best sets of predictors of case difficulty. Because of the small number of cases, regression results were evaluated for consistency across both data sets and both difficulty measures. For key variables, the best set of predictors included the number of different serious errors of commission, risk items, and benefit items. In general, cases were more difficult for higher values of these variables. For case variables, the only consistent variable was the length of the paragraph that provided patient history, with longer paragraphs associated with more difficult cases. Other variables were less consistent, but were often related to the structure of the simulation or the severity of the patient condition. Although the findings for case variables were limited, the analyses were very helpful in illuminating the interconnections among the variables within cases.     

An evaluation of the `short form' course experience questionnaire with medical students

In this study we have validated the Course Evaluation Questionnaire (CEQ) as an instrument for use with undergraduate medical students. We have demonstrated satisfactory construct validity and reliability for the inventory. The CEQ is an appropriate instrument for course evaluation in medical education.     

Teaching nutrition to medical doctors: the potential role of the State Registered Dietitian

Medical doctors ought to have a sound knowledge of nutrition, but it is clear that most do not. Teaching nutrition to medical doctors should start during undergraduate training. Dietitians have a vital role to play—acting as consultants for the course, in formulating learning objectives, teaching, organizing practical sessions, assisting with clinical demonstrations and writing exam questions. Dietitians could also be encouraged to become more involved in the clinical training of medical students by assuming a more active role in the provision of seminars, grand rounds, clinical case presentations and conferences. Finally, dietitians may attract more medical doctors to nutrition conferences and meetings if these are registered for CME (continuing medical education) and PGEA (postgraduate education allowance). The dietitian has a unique role and responsibility for teaching nutrition to medical doctors. The task ahead is a difficult one, but if successful will surely result in improvements to the nutritional status of both patients and the general public.     

The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

BACKGROUND: We investigated whether learning basic science mechanisms may have mnemonic value in helping students remember signs and symptoms, in comparison with learning the relation between symptoms and diagnoses directly. PURPOSE: To compare 2 approaches to learning diagnosis: learning how features of various conditions relate to underlying pathophysiological mechanisms and learning the conditional probabilities of features and diseases. METHODS: Undergraduate students (n = 36) were taught 4 disorders (upper motor neuron lesion, lower motor neuron lesion, neuromuscular junction disease and muscular disease), either using basic science explanations or (symptom x disease) probabilities. They were tested with diagnostic cases immediately after learning and 1 week later. RESULTS: On the immediate test, there was no difference in the results. One week later, the accuracy of the mechanism group remained at 0.52, but the performance of the probability group had dropped to 0.43. CONCLUSIONS: Knowledge of basic science may have value in clinical diagnosis by helping students recall or reconstruct the relationships between features and diagnoses.     

The effect of giving information in advance on the clinical training of medical students

OBJECTIVE: To study whether or not giving written information in advance influences patients' willingness to participate in the clinical training of medical students. SETTING: Dermatology surgery at a university hospital. METHODS AND PARTICIPANTS: Prior to the visit, patients were randomly allocated either to receive a letter about medical education (the experiment group), or not to receive a letter (the control group). MAIN OUTCOME MEASURE: The willingness of patients to participate in clinical training. RESULTS: There was no difference between the 2 groups regarding their willingness to participate. Almost all patients perceived the provided information as good or rather good, but some patients, especially in the control group, did not feel free to refuse to participate. CONCLUSION: The present written-information-in-advance strategy seems to prevent patients from feeling forced to participate, without having any negative influence on their inclination to participate.     

Comparison of directed and self-directed learning in evidence-based medicine: a randomised controlled trial

OBJECTIVES: To compare 2 educational programmes for teaching evidence-based medicine (EBM). DESIGN: Prospective randomised controlled trial accompanied by a qualitative evaluation. SETTING: University of Oslo, Norway, 2002-03. PARTICIPANTS: A total of 175 students entered the study. All tenth semester medical students from 3 semesters were eligible for inclusion if they completed baseline assessment and consent forms and either attended teaching on the first day of the semester or gave reasons for their absence on the first day in advance. Interventions One intervention was based on computer-assisted, self-directed learning (self-directed intervention), whilst the other was organised as workshops based on social learning theory (directed intervention). Both educational interventions consisted of 5 half-day sessions. MAIN OUTCOME MEASURES: The primary outcomes were knowledge about EBM and skills in critical appraisal. A secondary outcome measured attitudes to EBM. Outcomes were compared on an intention-to-treat basis using a stratified Wilcoxon rank-sum test. RESULTS: There were no differences in outcomes for the 2 study groups in terms of EBM knowledge (mean deviation 0.0 [95% confidence interval - 1.0, 1.0], P = 0.8), critical appraisal skills (MD 0.1 [95% CI - 0.9, 1.1], P = 0.5), or attitudes to EBM (MD - 0.3 [95% CI - 1.4, 0.8], P = 0.5). Follow-up rates were 96%, 97% and 63%, respectively. CONCLUSIONS: This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. However, further research is needed to confirm this and investigate alternative educational models.