Significance of the role of self‐study and group discussion

The study of anatomy is experiencing a reduction in course duration and content, lecture and dissection hours, and number of lectures and examinations. This necessitates that medical students develop skills for self‐study. Toward that end, a self‐study module in basic anatomy was tested. Fifty‐seven new entrants were given a pretest (Pretest A) containing a questionnaire on basic anatomy. Then, in three groups each of 11 and two groups each of 12, they learned basic anatomy from recommended books in the library by self‐study for 2 hours. They discussed what they had learned among their group members during a practical exercise, followed by a posttest (Posttest A). A control group of 57 new entrants during another year was given the same pretest (Pretest B) and a lecture on basic anatomy. Then, without opportunity for self‐study, they were given a posttest (Posttest B). The answers were scored out of 40. The students' mean mark in Pretest A was poor. All the groups performed well in the practical exercise. In Posttest A, the mean mark increased significantly (P < 0.001), by 9.4. It shows that self‐study and group discussions significantly helped the students in construction of core anatomical knowledge as well as the acquisition, assimilation, and application of anatomical concepts and content. The mean mark in Pretest B was also poor. In Posttest B, the mean mark increased significantly (P < 0.001), by 14.2. This indicates that the traditional teaching session is also useful and serves to advance student knowledge. Thus our innovative study module can create a positive learning environment and can become an alternative to traditional instruction in teaching anatomical terminology and basic anatomy. Clin. Anat. 12:277–280, 1999. © 1999 Wiley‐Liss, Inc.     

Teaching pathology in the 21st century: assessment of required student use of interactive videodiscs designed to teach basic pathology

A series of 11 computer-controlled optical videodisc modules in basic medical pathology was developed to be used as self-study materials. There are approximately 70 medical schools in the United States, Canada, the Philippines, and Europe currently participating in field testing this series. In the fall of 1988, second-year medical students at the University of Arkansas College of Medicine used five of these modules in place of traditional lectures during the pathology course. A pretest was administered to students prior to use of modules. Each student then used the interactive modules for individual study. Each module presented a brief pretest, an interactive study lesson, and a posttest, each of which generated a score for the student. In addition, after completion of all five modules, students were given a posttest which was included in their first scheduled course examination. At the end of the course, questions concerning the videodisc material were presented on the final exam to test long-term retention. Students also completed attitudinal questionnaires about their experience using the videodisc modules. Results of the data collected indicate significant improvement in knowledge base by students using these interactive videodisc modules. Analysis of student attitudinal reactions was also positive. Optical videodisc computer-directed learning appears to be well-suited for medical student instruction in pathology.     

Effectiveness of education for gastric cancer patients: A controlled prospective trial comparing interactive vs. lecture-based programs

Objective

Although patient education may enhance knowledge, coping with illness, and quality of life among cancer patients, it is uncertain which didactic method is most effective. We compared the impact of an interactive, patient-oriented group program to a lecture-based, information-only program in gastric cancer patients.

Methods

In this prospective, controlled trial, 121 gastric cancer patients attending inpatient rehabilitation after surgical treatment received either the interactive intervention or lectures providing information. The outcomes were patients’ disease-related knowledge, active coping with illness, and quality of life (QoL) at the end of their stay and 6 and 12 months thereafter.

Results

Both groups improved their knowledge and QoL during rehabilitation; however, knowledge was significantly higher in the interactive group compared to the lecture group. This difference was maintained at the 6- and 12-months follow-ups. In addition, the interactive group proved superior to the lecture group regarding active coping with illness and QoL at the end of rehabilitation, but not during follow-up.

Conclusions

A structured, interactive patient education program proved superior to lecture-based provision of information in regards to short-term and long-term knowledge as well as short-term coping and QoL.

Practice implications

In gastric cancer patients, interactive patient education seems preferable over lectures.     

Departing from PowerPoint Default Mode: Applying Mayer’s Multimedia Principles for Enhanced Learning of Parasitology

Purpose: PowerPoint (PPT™) presentation has become an integral part of day-to-day teaching in medicine. Most often, PPT™ is used in its default mode which in fact, is known to cause boredom and ineffective learning. Research has shown improved short-term memory by applying multimedia principles for designing and delivering lectures. However, such evidence in medical education is scarce. Therefore, we attempted to evaluate the effect of multimedia principles on enhanced learning of parasitology. Methodology: Second-year medical students received a series of lectures, half of the lectures used traditionally designed PPT™ and the rest used slides designed by Mayer’s multimedia principles. Students answered pre and post-tests at the end of each lecture (test-I) and an essay test after six months (test-II) which assessed their short and long term knowledge retention respectively. Students’ feedback on quality and content of lectures were collected. Results: Statistically significant difference was found between post test scores of traditional and modified lectures (P = 0.019) indicating, improved short-term memory after modified lectures. Similarly, students scored better in test II on the contents learnt through modified lectures indicating, enhanced comprehension and improved long-term memory (P < 0.001). Many students appreciated learning through multimedia designed PPT™ and suggested for their continued use. Conclusions: It is time to depart from default PPT™ and adopt multimedia principles to enhance comprehension and improve short and long term knowledge retention. Further, medical educators may be trained and encouraged to apply multimedia principles for designing and delivering effective lectures.     

Facilitating the acquisition of basic counseling skills by modeling and language

This study investigated the effect of verbalizing a model's performance for the acquisition of counseling skills. Paraphrasing, a counseling skill used in microcounseling, was used as an index of the acquisition of counseling skills. Undergraduate students (N= 56) were randomly assigned to one of the following groups: self-verbalization group (n= 18), experimenter-verbalization group (n = 21), and non-verbalization control group (n = 17). Pretests, posttests, and follow-up tests (one week later) were used to examine paraphrasing scores. Modeling was practiced after the pretest. From the pretest to the posttest, all three groups showed a performance gain, although the self-verbalization group showed a greater performance gain than the other two groups. From the posttest to the follow-up test, the control group showed a performance loss, while the performance of the other two groups remained at the same level. These findings suggest that verbalization of a model's performance in microcounseling improves the acquisition and the maintenance of the counseling skills.     

Use of computer-based instruction in athletic training education

Computer-based instruction is being widely used in the education programs of many allied health professions. However, there has been little, if any, documentation of computer-based instruction use in athletic training education. The primary purpose of this study was to determine what percentage of undergraduate and graduate NATA-approved athletic training education programs are using some form of computer-based instruction (ie, computer-assisted instruction or interactive video). We also addressed the following research questions: 1) What athletic training educational software is currently being used by athletic training students and educators? 2) What factors currently impede the use of computer-based instruction in athletic training education? 3) What instructional methods are commonly used to incorporate computer-based instruction into the athletic training curricula? and 4) What are the attitudes of athletic training program directors toward the use of computer-based instruction in athletic training education? Surveys were mailed to the program directors (n = 97) of all graduate and undergraduate NATA-approved athletic training education programs. Eighty-six (87.7%) usable surveys were returned. Forty-eight (55.8%) of the respondents reported using some form of computer-based instruction in their athletic training education program; 47 (54.7%) used computer-assisted instruction and 9 (10.6%) used interactive video. Respondents also identified the educational software they use and their method for implementing this software. Software was used most often to supplement traditional instructional methods. A lack of funds was reported to be the primary impeding factor for those programs not using computer-based instruction. Respondents reported an overall positive attitude toward computer-based instruction use in athletic training education and indicated the need for increased development of athletic training/sports medicine software.     

Home care training in internal medicine residencies: a national survey.

PURPOSE: To determine the amount and type of training U.S. internal medicine residents receive in providing home care to patients. METHOD: A four-item questionnaire was developed and sent to the program directors of all accredited internal medicine residencies in the United States (n = 397) to assess the amounts and types of training (didactic sessions or lectures, house calls, or both) internal medicine residents receive in providing home care. Demographic information about the residency programs was also collected and analyzed. RESULTS: A total of 312 (78.6%) of the program directors responded. Sixty-eight percent of their programs included instruction in home care consisting of house calls, lectures, or both. Fewer than half of the responding programs offered any lecture in home care in their curricula, and only 25% of them included a mandatory house-call experience for trainees. Residency programs that had primary care tracks were more likely than were other programs to include either of these experiences in their curricula. CONCLUSIONS: Most internal medicine residents receive limited training in home care. As a consequence, future internists may be inadequately prepared to meet the needs of their patients, particularly as the population ages.     

Comparison of computer-based and paper-based imagery strategies in learning anatomy

This study evaluated the use of computer-based interactive imagery on students' achievement scores when compared with paper-based static imagery. It also assessed students' perceptions about the two imagery strategies and their different components. Sixty-four freshmen veterinary students (50 females, 14 males), enrolled in a comparative anatomy course, volunteered to participate in the study. This study used a pretest/posttest comparison group design and data was examined by analysis of covariance (ANCOVA). A close-ended questionnaire was administered to collect students' perceptions about the two imagery strategies. The mean difference in students' perceptions between the two strategies was analyzed using a two-tailed paired t-test. No significant differences were observed between computer-based interactive imagery and paper-based static imagery in the immediate recall of anatomical information. There was a significant difference in students' opinions toward the two strategies: students perceived computer-based interactive imagery as a better strategy in the assimilation of anatomical information than paper-based static imagery.     

Self-instruction to prevent HIV infection among African-American and Hispanic-American adolescents

This study tested the efficacy of self-instruction intervention to reduce avoidable risks for HIV infection associated with drug use and unsafe sexual activity among African-American and Hispanic adolescents (N = 60). After completing pretests, adolescent participants in the study were randomly divided into three conditions. Participants in one condition received a self-instructional guide about AIDS and its transmission along with group instruction in using the guide. Adolescents in another condition received the guide without group instruction. Participants in the third condition received neither the guide nor group instruction. Outcome findings indicate that participants in the two self-instruction conditions improved more between pretest and posttest assessments on measures of HIV infection risk compared with adolescents in the control condition.     

Curricular trends in instruction of pathology: a nationwide longitudinal study from 1993 to present.

Medical schools throughout the United States continue to respond to various external and internal challenges and make modifications in their curricula. Responses obtained from 66% (n = 83) of schools on a longitudinal survey conducted during the year 2000 to study trends in instruction of pathology over a 7-year period (ie, for classes entering 1993 to 1999) indicate the following. There have been steady shifts in instruction of systemic and clinical pathology from discipline-based courses to integrated formats from 1993 to 1999. The degree of integration with other disciplines varies among schools, and may take one or more of the following formats: joint course (pathology and another discipline); multidisciplinary systems course; a combination of pathology course and another integrated course; and completely integrated in the form of problem-based or case-based small group discussion. Presently, at least some degree of integration occurs in 51% of schools for instruction of systemic pathology and 65% for clinical pathology, up from 31% and 48%, respectively, in 1993. Although there has been an increased trend toward integration in instruction of general pathology as well, it is still taught predominantly in a discipline-based manner in the vast majority of schools. Although often difficult to identify with certainty, the best estimates indicate that the overall scheduled length of pathology instruction time has stabilized over the years; the mean total for the entering classes of 1999 was 196 hours versus 201 hours for the classes entering in 1993. However, internal rearrangements of time for various components of delivery of instruction continue. The lecture remains unchanged as an important mode comprising the largest component of pathology curriculum time (53% in 1999, 52.2% in 1993) during the 7-year period examined. The mean traditional laboratory instruction time has decreased slightly from 27% in 1993 to 24% in 1999. This decrease may be accounted for by a shift toward use of laboratory materials in various other formats and venues not included in the traditional laboratory instruction (eg, small group sessions, clinicopathologic correlation conferences, study of kodachrome slides, and computer programs). The use of electronic educational resources has increased remarkably, but for the most part it is not measurable because of the lack of any designated hours. Because pathology instruction occurs exclusively or primarily during year 2 in most schools, the classes entering in 1999 would have studied it during 2000 and 2001, which means the present study provides the most updated curricular trends at this time.     

Adaptations in Anatomy Education during COVID-19

BackgroundThe impact of coronavirus disease 2019 (COVID-19) has profoundly affected education, with most universities changing face-to-face classes to online formats. To adapt to the COVID-19 pandemic situation, we adopted a blended learning approach to anatomy instruction that included online lectures, pre-recorded laboratory dissection videos, and 3D anatomy applications, with condensed offline cadaver dissection.MethodsWe aimed to examine the learning outcomes of a newly adopted anatomy educational approach by 1) comparing academic achievement between the blended learning group (the 2020 class, 108 students) and the traditional classroom learning group (the 2019 class, 104 students), and 2) an online questionnaire survey on student preference on the learning method and reasons of preference.ResultsThe average anatomy examination scores of the 2020 class, who took online lectures and blended dissection laboratories, were significantly higher than those of the 2019 class, who participated in an offline lecture and dissection laboratories. The questionnaire survey revealed that students preferred online lectures over traditional large group lecture-based teaching because it allowed them to acquire increased self-study time, study according to their individual learning styles, and repeatedly review lecture videos.ConclusionThis study suggests that a blended learning approach is an effective method for anatomy learning, and the advantage may result from increased self-directed study through online learning.     

Analysis of covariance (ANCOVA) with difference scores.

When comparing pretest to posttest changes in non-randomized groups, most researchers are correctly avoiding ANCOVA with posttest as the dependent variable and pretest as the covariate. However, there is a widespread use of ANCOVA in which the difference score (posttest minus pretest) is used as the dependent variable, and pretest as the covariate. A computer simulation study is presented which shows that measurement error causes identical, biased conclusions when comparing changes using either the posttest score or the posttest minus pretest difference score as the dependent variable. The reasons for this bias are explained and illustrated.     

Effectiveness of self-instruction for arthritis patient education.

Self-instruction is one means of providing patient education, allowing the health professional to teach a larger number of persons than with one-to-one or group instruction and at a lower cost. The purpose of this study was to examine the effects of self-instruction on learning, satisfaction with the teaching approach, and health status of persons with rheumatoid arthritis (RA). A control-group pretest-posttest design was used. Thirty subjects receiving care at a rheumatology clinic who met study criteria were randomly assigned to two groups: self-instruction and control. One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pretest as covariate, was used to examine the difference in learning between the self-instruction and control groups. There was a significant difference between the groups (P = 0.01). Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability. t-Test demonstrated no significant difference between the groups in health status. Significant correlations were found between subjects' test scores and selected variables.     

Latin and Greek in gross anatomy

BACKGROUND: Medical students and practitioners learn and use a vocabulary originating almost entirely from classical Latin and Greek languages. Previous generations required Latin or Greek prior to medical school, but the current generation does not have such requirements. Anecdotal evidence suggests that understanding Latin or Greek helps students to learn and practitioners to recall otherwise foreign terminology. This study evaluated students' familiarity with Latin and Greek etymologies before and after a gross anatomy course that incorporated etymologies into its curriculum. METHODS: First-year medical students at Mayo Clinic College of Medicine were taught Latin and Greek etymologies through lectures and handouts during their gross anatomy course. They took a pretest and a posttest before and after the course to assess their understanding of etymologies. In addition, students from all four years of medical school, residents, and staff physicians also took a general etymology quiz to assess their understanding of etymologies. RESULTS: After their gross anatomy course emphasizing etymologies, first-year students scored higher on the posttest than they did on the pretest. First-year students also reported that learning etymologies enhanced anatomy learning, made the experience more enjoyable, and proved to be less difficult than they thought it would be prior to the course. Medical students, residents, and staff physicians scored almost equally on the general etymology quiz and almost equally reported that etymologies enhanced learning and recalling terminology. Medical students, residents, and staff physicians almost equally endorsed incorporating etymologies into medical education. CONCLUSIONS: This study provides novel scientific evidence that a basic understanding of Latin and Greek etymologies enhances performance and comfort when learning and using medical terminology.     

Effects of prior attention training on child dyslexics' response to composition instruction

Twenty children (Grades 4 to 6) who met research criteria for dyslexia were randomly assigned to a treatment (attention training) or contact control (reading fluency training) group during their regular language arts block at a school that had emphasized multisensory, structured language treatment for reading disability. A university team provided either individual attention training (sustained, selective, alternating, and divided attention) or reading fluency training during the first 10 sessions and group composition instruction during the next 10 sessions. Analysis of variance evaluated the significance of Treatment × Session interactions from pretest to midtest (before composition instruction began) and midtest to posttest (when compositon instruction ends). Treatment × Time interactions were not significant between pretest and midtest, but the Treatment × Time interactions were significant from midtest to posttest for Wechsler Individual Achievement Test, Second Edition Written Composition and Delis-Kaplan Executive Function System Verbal Fluency (attention treatment group improved more over time). Individual children showed the same pattern as group results. For child dyslexics in upper elementary school, attention training did not transfer directly to improved composition but prior attention training led to faster improvement in composing and oral verbal fluency once composition instruction was introduced. Effective instruction for dyslexia may depend on the sequencing as well as the nature of instructional components and require specialized instruction for writing as well as reading.     

Effects of Prior Attention Training on Child Dyslexics' Response to Composition Instruction

Twenty children (Grades 4 to 6) who met research criteria for dyslexia were randomly assigned to a treatment (attention training) or contact control (reading fluency training) group during their regular language arts block at a school that had emphasized multisensory, structured language treatment for reading disability. A university team provided either individual attention training (sustained, selective, alternating, and divided attention) or reading fluency training during the first 10 sessions and group composition instruction during the next 10 sessions. Analysis of variance evaluated the significance of Treatment × Session interactions from pretest to midtest (before composition instruction began) and midtest to posttest (when compositon instruction ends). Treatment × Time interactions were not significant between pretest and midtest, but the Treatment × Time interactions were significant from midtest to posttest for Wechsler Individual Achievement Test, Second Edition Written Composition and Delis–Kaplan Executive Function System Verbal Fluency (attention treatment group improved more over time). Individual children showed the same pattern as group results. For child dyslexics in upper elementary school, attention training did not transfer directly to improved composition but prior attention training led to faster improvement in composing and oral verbal fluency once composition instruction was introduced. Effective instruction for dyslexia may depend on the sequencing as well as the nature of instructional components and require specialized instruction for writing as well as reading.     

小组治疗对糖尿病患者生活质量的干预效果

目的：用小组治疗方法对糖尿病患者生活质量进行干预,以36项简式健康调查问卷（SF-36)评定干预效果。方法：以“准实验法”的原则为依据,设置实验组和对照组,对实验组进行小组治疗干预,在实验前后分别对两个组的成员进行SF-36问卷的测试并分别对比前测和后测的分值,观察其变化情况。结果：实验组的前测和后测分值差异有统计学显著性;而对照组的前、后测分值的差异无统计学显著性。结论：小组治疗对于糖尿病患者的生活质量干预有明显效果。     

Learning outcomes in medical informatics: comparison of a WebCT course with ordinary web site learning material

OBJECTIVE: The purpose of this study is to compare whether students' learning outcomes would be better in a designed learning environment (WebCT) than in a conventional web site (WWW) with similar course material but without special learning tools. CONTEXT: Third-year medical students in an introductory course on medical informatics at the University of Helsinki, Finland. METHODS: Students were randomly assigned to a WebCT group (n=39) and a WWW group (n=46). The students in the WebCT group utilized the course material in general discussion groups, special discussions about lectures, quizzes and students' own notes. The WWW group had access only to the course material. The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz. RESULTS: The course grade was significantly higher in the WebCT group as compared to the WWW group. This finding was more prominent among females. The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group. CONCLUSIONS: Based on our results, web-based learning seems to be more effective when students are provided with specially designed learning tools.     

A randomized trial of a problem-based learning approach for teaching epidemiology.

PURPOSE: To conduct a controlled trial of traditional and problem-based learning (PBL) methods of teaching epidemiology. METHOD: All second-year medical students (n = 136) at The University of Western Australia Medical School were offered the chance to participate in a randomized controlled trial of teaching methods for an epidemiology course. Students who consented to participate (n = 80) were randomly assigned to either a PBL or a traditional course. Students who did not consent or did not return the consent form (n = 56) were assigned to the traditional course. Students in both streams took identical quizzes and exams. These scores, a collection of semi-quantitative feedback from all students, and a qualitative analysis of interviews with a convenience sample of six students from each stream were compared. RESULTS: There was no significant difference in performances on quizzes or exams between PBL and traditional students. Students using PBL reported a stronger grasp of epidemiologic principles, enjoyed working with a group, and, at the end of the course, were more enthusiastic about epidemiology and its professional relevance to them than were students in the traditional course. PBL students worked more steadily during the semester but spent only marginally more time on the epidemiology course overall. Interviews corroborated these findings. Non-consenting students were older (p < 0.02) and more likely to come from non-English-speaking backgrounds (p < 0.005). CONCLUSIONS: PBL provides an academically equivalent but personally far richer learning experience. The adoption of PBL approaches to medical education makes it important to study whether PBL presents particular challenges for students whose first language is not the language of instruction.     

A comparison of three covert assertion training procedures

Assessed the effectiveness of covert modification procedures in an assertion training program (N = 52). At pretest, Ss chosen on the basis of high scores on an assertion questionnaire were compared to low scoring Ss in a behavioral role play test. Significant differences between these groups were obtained on behavioral ratings. After the pretest, the nonassertive Ss were assigned randomly to a no-treatment control group or to one of three treatment groups that received covert assertion training procedures. One treatment group received a program that emphasized the generation of alternative responses, while a second group received training directed at restructuring hypothesized negative self-statements. The third treatment group received a social skills treatment program that employed covert rehearsal procedures. All the treatment groups were superior to the control in behavioral ratings of assertiveness during the posttest in those situations that had been employed previously in treatment; two were superior in those that had not been used and thereby provided evidence of transfer of training. Results are discussed with regard to assessment issues in assertion training programs and the use of cognitively oriented procedures in producing behavioral changes.