Student evaluation of the clinical 'curriculum in action'

AIM: To examine how students' evaluations of the environment, process and outcome of clinical learning interrelated and correlated with assessment results. METHOD: A post hoc study in the 3rd of 5 years in a student-centred, horizontally integrated, objective-based medical curriculum. In the last week of each module, students evaluated what they had learned and how they had learned it using a previously validated, web-based scale. The interrelationships between scale variables and their relationships with summative assessment results were tested using factor analysis, correlation analysis and stepwise multiple regression analysis. RESULTS: Student evaluation yielded 4 summary measures: 2 reflected learning outcomes ('real patient learning' and 'curriculum coverage'), 1 reflected process ('quality of instruction') and 1 reflected environment ('conditions for learning'). They fitted a causal model according to which instruction, conditions for learning and curriculum coverage favoured real patient learning. Real patient learning was rated higher in women than men, and the measures were associated more strongly in women. Performance in end-of-year summative assessments was predicted strongly by mid-year performance but by no other measure. CONCLUSIONS: Students' evaluations of their learning environment and instructional processes correlated with their assessments of 2 outcomes of the curriculum in action: curriculum coverage and real patient learning. There was little shared variance between those measures and students' performance in summative assessments. Given its formative potential, students' evaluation of their curriculum in action could play a useful part in learner-centred clinical education. There is a possibility, which needs further research, that women's evaluations have greater predictive validity than men's. Assessment performance should be regarded not as a solitary gold standard but as just 1 measure of educational outcome.     

Innovative training for new surgical roles--the place of evaluation

BACKGROUND: This paper describes the central role of 'external' evaluation, provided by an independent researcher, in developing an innovative curriculum for new professional roles with surgery. Workforce changes affecting the National Health Service provided an opportunity to develop 2 new roles and design training programmes to support them. The perioperative specialist practitioner (PSP) role was designed from scratch, while surgical care practitioner (SCP) training built on existing practice. Training programmes combined formal modules at Imperial College London (approximately 48 days over 10 months) with supervised clinical practice in each participant's base hospital. Programmes balanced factual knowledge, clinical and communication skills, professional issues and personal development and used a range of innovative techniques. EVALUATION METHODS: A qualitative approach based on a utilisation-focused model monitored the development and implementation of 4 pilot PSP and SCP training programmes. A total of 124 individual and 48 group interviews were conducted at intervals over 3 years, sampling course participants, the project team clinical supervisors and administrators. An independent researcher collected, analysed and presented data at key stages, feeding back findings to the project team as the programmes evolved. DISCUSSION: Effective training programmes for new roles can be developed, but the process is time-consuming and requires sensitivity. An independent evaluator offers great benefits, modulating the collaborative partnership between participants and project team. Positive responses (relating to content and teaching methods) from our study enabled us to refine a learner-centred programme. Negative responses often demanded immediate action to address important concerns, and evaluation provided early warning. External evaluation provides a vital perspective in the development of curricula supporting new roles.     

Reform and innovation: a repeating pattern during a half century of medical education in the USA

INTRODUCTION: Medical education in the USA today is remarkably varied despite the shared mission of training doctors. SIX MEDICAL SCHOOLS: A brief introduction to 6 institutions illustrates the variety of education available, while providing some specific details of how schools differ and how the mandate of any particular school may differ from that of another. Private schools include Dartmouth Medical School, Duke University School of Medicine, and Mount Sinai School of Medicine. State-supported schools include the University of Arizona College of Medicine, Oregon Health and Science University School of Medicine, and Southern Illinois University School of Medicine. CHANGE: General remarks are made about changes over recent years in three separate areas of influence. NEW SCHOOLS: Forty new medical schools were established between 1960 and 1980; a brief explanation is provided of the reasons for this and how it was achieved. NEW DISCIPLINARY EMPHASES IN TRAINING DOCTORS: A few of the numerous new emphases that have been introduced into the medical school curriculum are discussed briefly. CURRICULUM REFORM: A small sample is given of ways in which particular medical schools have reformed their curricula over the years. What went into the most influential curricular reform is presented, along with mention of what are perhaps the most unusual curricular paths today. CONCLUSION: The paper concludes with an assessment of where reforms have brought US medical education by the beginning of the 21st century and what needs yet to be accomplished.     

Achievement of transsaccadic visual stability using presaccadic and postsaccadic visual information

While saccadic eye movements produce rapid shift of images of objects on the retina, the visual world is perceived as stationary (visual stability), but the precise mechanisms involved in such perception remain unclear. We investigated if visual stimuli existing before and/or after a saccade serve to preserve visual stability. Participants observed a vertical array of light-spots flashing consecutively at the time of horizontal saccades. When total duration of the flashing array was short (38 ms), large distortions of the array were observed. However, as duration increased up to 300 ms, distortion decreased or was completely eliminated. This demonstrated that visual images of a flashing array momentarily perceived before and/or after saccades suppressed illusory distortion of arrays observed when a 38-ms array was used, implying that the same mechanism may be used to achieve transsaccadic visual stability in daily life.     

Subjective appearance of ambiguous structure-from-motion can be driven by objective switches of a separate less ambiguous context

Two ambiguous transparent structure-from-motion (SFM) stimuli often appear to co-rotate. Grossmann & Dobbins (2003) reported breakdown of such perceptual coupling when one stimulus was made unambiguous (by rendering it opaque), leading them to propose that coupling depends generally on differential stimulus ambiguity. In contrast, we demonstrate robust stimulus-driven coupling even when one SFM stimulus is relatively disambiguated, by using relative-luminance and/or binocular-disparity cues. Such context stimuli could induce stimulus-driven coupling by disambiguating the transparent stimulus, though critically only when the context was clearly non-opaque and coaxial with the ambiguous stimulus. This demonstrates long-range information-sharing between separate stimulus representations, subject to specific constraints.     

Construction and evaluation of a web-based interactive prescribing curriculum for senior medical students

AIMS: To develop and evaluate for the National Prescribing Service (NPS) a web-based interactive prescribing curriculum for Australian senior medical students based on the World Health Organization's Guide to Good Prescribing. METHODS: Teachers of prescribing from all Australian medical schools in 2000 wrote 12 case-based modules which were converted to on-line format. Objective evidence was provided for selecting first-line medicines from available alternatives by comparing efficacy, safety, convenience and cost. The curriculum was made available to final year students in 2001 and was evaluated by measuring use from web statistics and by semistructured interviews with 15 teachers (2003) and on-line surveys of 363 students over 2003 and 2004. RESULTS: By 2004 the curriculum was used by nine of 11 possible medical schools. Uptake increased each year from 2001 and all 12 modules were accessed consistently. Student access was significantly (P < 0.001) greater when prescribing was an assessable part of their course. Teachers' evaluations were uniformly supportive and the curriculum is seen as a valuable resource. Student responses came from a small proportion of those with password access but were also supportive. Over half of student respondents had created their own evidence-based formulary. CONCLUSIONS: A collaborative venture initiated by the NPS with Australian medical schools has been successfully implemented in most courses. Teachers find the resource of high quality. Student respondents find the curriculum valuable in developing their own prescribing skills. It is best delivered by self-directed study followed by tutorial discussion of prescribing decisions.     

Visualization of episomal and integrated Epstein-Barr virus DNA by fiber fluorescence in situ hybridization

For many Epstein-Barr virus (EBV)-associated malignancies, it is still a matter of controversy whether infected cells harbor episomal or chromosomally integrated EBV genomes or both. It is well established that the expression of EBV genes per se carries oncogenic potential, but the discrimination between episomal and integrated forms is of great relevance because integration events can contribute to the oncogenic properties of EBV, whereas host cells that exclusively harbor viral episomes may not carry the risks mediated by chromosomal integration. This notion prompted us to establish a reliable technique that not only allows to unequivocally discriminate episomal from integrated EBV DNA, but also provides detailed insights into the genomic organization of the virus. Here, we show that dynamic molecular combing of host cell DNA combined with fluorescence in situ hybridization (FISH) using EBV-specific DNA probes facilitate unambiguous discrimination of episomal from integrated viral DNA. Furthermore, the detection of highly elongated internal repeat 1 (IR1) sequences provides evidence that this method permits detection of major genomic alterations within the EBV genome. Thus, fiber FISH may also provide valuable insights into the genomic organization of viral genomes other than EBV.     

The travesty of choosing after positive prenatal diagnosis

OBJECTIVE: To integrate the findings of qualitative studies of expectant parents receiving positive prenatal diagnosis. DATA SOURCES: Seventeen published and unpublished reports appearing between 1984 and 2001 and retrieved between December of 2002 and March of 2003. The electronic databases searched include Academic Search Elite, AIDS Information Online (AIDSLINE), Anthropological Index Online, Anthropological Literature, Black Studies, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Digital Dissertations, Dissertation Abstracts Index (DAI), Educational Resource Information Center (ERIC), MEDLINE, PsycInfo, Public Affairs Information Service (PAIS), PubMed, Social Science Abstracts (SocSci Abstracts), Social Science Citation Index, Social Work Abstracts, Sociological Abstracts (Sociofile), Women's Resources International, and Women's Studies. STUDY SELECTION: Qualitative studies involving expectant parents living in the United States of any race, ethnicity, nationality, or class who learned during any time in pregnancy of any fetal impairment by any means of diagnosis were eligible for inclusion. DATA EXTRACTION: Metasummary techniques, including the calculation of frequency effect sizes, were used to aggregate the findings. Metasynthesis techniques, including constant comparison analysis and the reciprocal translation of concepts, were used to interpret the findings. DATA SYNTHESIS: The topical emphasis in the findings is on the termination of pregnancy following positive diagnosis. The thematic emphasis is on the dilemmas of choice and decision making. Positive prenatal diagnosis was for couples an experience of chosen losses and lost choices. Couples managed information to minimize stigmatization and cognitive dissonance. CONCLUSIONS: Existing guidelines for caring for couples after perinatal losses must accommodate the chosen loss experientially defining positive prenatal diagnosis.     

积分法在诊断急性脑血管病上的价值评估

应用积分法对急性脑血管病人１００例进行打分诊断，并与头颅ＣＴ检查相对照，将脑出血与脑梗塞患者比较，发现积分法在部分病例诊断中差异较大（Ｐ〈０．０５），但提示此方法为指导临床治疗控制脑水肿是较好的客观指标，在ＣＴ还没着普及时显得尤为重要。