How strong is the case for the adoption of problem-based learning in physiotherapy education in the United Kingdom?

Despite its use in medical and health education in several countries, problem-based learning (PBL) has to date not been adopted in undergraduate physiotherapy education in the UK. Most of these physiotherapy curricula incorporate many of the educationally desirable features found in PBL. The question is whether the evidence for PBL is strong enough to justify the costs involved in adopting it on such programmes. The strength of the evidence for PBL was reviewed in relation to required graduate attributes and several aspects of learning theory. Overall the findings were equivocal. The evidence suggests that PBL is preferential to traditional curricular design, but does not seem to meet all the requirements of medical and health education. Adoption of PBL would be positive, but its processes and outcomes may be no more successful than those of other curricular designs that incorporate the same sound educational design features. Comparative research in this area is needed.     

Can a dedicated teaching and learning environment in ambulatory care improve the acquisition of learning outcomes?

Current trends in undergraduate medical education are moving away from traditional ward based learning to ambulatory care teaching. We wanted to know whether students gain more learning outcomes from a dedicated ambulatory teaching environment than a conventional outpatient clinic. A comparative evaluation study using a semi-structured student questionnaire and a structured patient questionnaire was performed. Results indicated the learning environment and organization of the teaching in the Ambulatory Care Teaching Centre (ACTC) rated higher. Surprisingly, however, more learning outcomes were achieved in the conventional outpatient clinic setting, but each venue demonstrated particular strengths with regard to individual outcomes. The level of patient satisfaction in the ACTC was high implying patient care was not adversely affected utilizing this setting. This information will inform practice for the content of future teaching sessions in the outpatient setting.     

Can achievement emotions be used to better understand motivation, learning, and performance in medical education?

In this article, we consider an emergent theory of human emotion. The overarching purpose of the article is to introduce medical education researchers to the notion of achievement emotions and provide a brief overview of how this work can inform the theory, research, and practice of medical education. First, we define achievement emotions and describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun R. 2006. The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 18:315-341.). Next, we distinguish between different types of achievement emotions, their proximal causes, and their consequences for motivation, learning, and performance, and we discuss several implications for educational practice. Finally, we end with a call for more research on achievement emotions in medical education to facilitate our understanding of emotions and their impact on important educational outcomes.     

Do they teach what they need to? An analysis of the impact of curriculum mapping on the learning objectives taught in a lecture series in surgery

Abstract

Introduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series.

Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly.

Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p?<?0.001). The increase was found in all surgical disciplines and in all levels of competences without any changes in the average duration of the lectures.

Conclusions: The presented method for mapping a curriculum effectively increased the number of taught learning objectives without requiring longer lecture durations.     

See one, do one, teach one--is this still how it works? A comparison of the medical and nursing professions in the teaching of practical procedures

A survey of 80 junior doctors and nurses was performed to compare the methods of teaching medical and nursing students in eight common practical procedures. Nurses were more likely to have received formal teaching and to be supervised when first performing a procedure. Some 42% percent of doctors felt inadequately trained to carry out a practical procedure safely when performing it alone for the first time compared with 7% of nurses. This study confirms that much of the training of doctors in practical procedures is still received on an informal basis, compared with that of nurses. It also reveals that many doctors view this training as insufficient.     

Saving Tibet? An inquiry into modernity, lies, truths, and beliefs

Social theorists have explored the ways in which quantification serves as an instrument of governance in the modern state, whether tied to concerns of population size and quality or to problems of social behavior. Biopolitics are as visible in the modern socialist states as they are in free-market democratic states, and they are perhaps nowhere more visible today than in the new global standards of "evidence-based medicine," wherein it is assumed that only quantifiable evidence can serve to establish policy, procedure, and outcome. When it comes to creating ways to "civilize" and organize their target citizenry through health development, Socialist China as relied on such technologies as much as have health development funding agencies from donor countries. In this article, I look at quantitative methods in relation to assumptions that morality can be severed from truth and that numbers are potentially morally neutral. This idea is tied not only to forms of modern subjectivity but also to the distinct ways in which certain linguistic and theoretical practices relate to provisional notions of "lying," "truth-telling," and ways of "believing." An exploration of the effects of attempts to quantify maternal behavior, morbidity, and morality in rural Tibet highlights the problem of morality within an environment in which numbers are never free-standing but, rather, are always presumed to carry moral messages, and in which domains that cannot be quantified serve as a primary basis for knowing truth. Through an exploration of rural Tibetan encounters with health development programs for safe motherhood, I provide a critique of quantification and return to questions about "belief" as a rubric that interrupts modern dichotomies of lies versus truths.     

Beyond a shadow of a doubt? Experts, lay knowledge, and the role of radiography in the diagnosis of silicosis in Britain, c. 1919-1945

The history of silicosis provides an important chapter in the history of occupational and environmental health. Recent historical scholarship has drawn attention to the importance of patient attitudes, popular protests, and compensation claims in the formation of a "lay epidemiology" of such a disease, frequently challenging the scientific orthodoxies devised by large corporations and medical specialists. Surprisingly little research has been undertaken on the United Kingdom, which provided much of the early expertise and medical research in respiratory diseases among industrial workers. This article examines the introduction of a particular technique, x-radiography, and its use by radiologists and others in debates on the causes and consequences of silica inhalation by the laboring population in Britain during the early decades of the twentieth century. In contrast to some recent interpretations, and also to the narrative of progress that practitioner historians have developed since the 1940s, this article suggests that the use of this technology was contested for much of this period and the interpretation of X-rays remained disputed and uncertain into the 1950s. The article also questions recent accounts of lay epidemiology as an adequate model for understanding the progress of such innovations in medical history.     

Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping,Sweden

Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Link?ping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Link?ping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Link?ping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.     

Engineered nanomaterials in soils and water: how do they behave and could they pose a risk to human health?

It is inevitable that, during their use, engineered nanoparticles will be released into soils and waters. There is therefore increasing concern over the potential impacts of engineered nanoparticles in the environment on aquatic and terrestrial organisms and on human health. Once released into the environment, engineered nanoparticles will aggregate to some degree; they might also associate with suspended solids, sediment, be accumulated by organisms and enter drinking water sources and food materials. These fate processes are dependent on the characteristics of the particle and the characteristics of the environmental system. A range of ecotoxicological effects have also been reported, including effects on microbes, plants, invertebrates and fish. Although available data indicate that current risks of engineered nanoparticles in the environment to environmental and human health are probably low, our knowledge of the potential impacts of engineered nanoparticles in the environment on human health is still limited. There is therefore a need for continued work to develop an understanding of the exposure levels for engineered nanoparticles in environmental systems and to begin to explore the implications of these levels in terms of the ecosystem and human health. This will require research in a range of areas, including detection and characterization, environmental fate and transport, ecotoxicology and toxicology.     

Can Clinical Empathy Survive? Distress,Burnout, and Malignant Duty in the Age of Covid‐19

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.     

First do no harm? Female hysteria, trauma, and the (bio)logic of violence in Iraq

In Iraq, women are frequently rushed to the hospital in severe anxiety, diagnosed by medical professionals in local hospitals as "hysterical." The treatments proffered are often disturbingly violent in their own right, indicating the normalization of violence in the conflict zone and the rationalizing discourses of biomedicine to this end. Based on fieldwork in the northern Kurdish region, held to be a prosperous beacon of "postconflict" stability in an otherwise war-torn country, I consider the ways in which neoliberal interventionist agendas, medical technologies in the aftermath of war, and gendered narratives of the Kurdish nation coalesce to valorize particular forms of suffering while devaluing others as both inherently "feminine" and devoid of either agency or recuperative value. I argue that the violence of such biomedical beliefs forms a "natural" rationalized corollary of wider logics of violence in the war zone, and that both inscribe non-normative expressions of trauma in gendered terms.     

Undergraduate medical students’ perceptions of their learning experience in pediatric rotation at King Abdulaziz University Medical College in Jeddah,Saudi Arabia

Abstract

Aim: This study aimed to evaluate fifth-year medical students' perception of their learning experience during pediatric rotation at the medical college of King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

Method: This cross-sectional study was conducted by distributing a questionnaire to fifth-year students who attended the pediatric rotation at KAU, during 2013–2014.

Results: Three hundred fifty-six out of 360 students agreed to participate, representing a response rate of 99%. More than 90% were satisfied with the module, and 80% reported the usefulness of the orientation session. The mean scores for the usefulness of morning experience and afternoon activities were 7.20?±?2.40 and 6.40?±?2.70, respectively. A significant difference in the mean scores for supervision was observed between the clerkship sites (p?=?.0001), with the highest score for consultants’ supervision (7.01?±?2.90) and lowest for interns’ supervision (4.81?±?3.30).

Conclusions: Overall, although the program was satisfactory to the majority of participants, areas of concern were identified. Students reported more effective learning and development of clinical skills , during the morning rounds, when supervised by consultants and senior specialists, and in activities that involved examining patients, presenting cases, and participating in discussions.     

Demons, nature, or God? Witchcraft accusations and the French disease in early modern Venice

In early modern Venice, establishing the cause of a disease was critical to determining the appropriate cure: natural remedies for natural illnesses, spiritual solutions for supernatural or demonic ones. One common ailment was the French disease (syphilis), widely distributed throughout Venice's neighborhoods and social hierarchy, and evenly distributed between men and women. The disease was widely regarded as curable by the mid-sixteenth century, and cases that did not respond to natural remedies presented problems of interpretation to physicians and laypeople. Witchcraft was one possible explanation; using expert testimony from physicians, however, the Holy Office ruled out witchcraft as a cause of incurable cases and reinforced perceptions that the disease was of natural origin. Incurable cases were explained as the result of immoral behavior, thereby reinforcing the associated stigma. This article uses archival material from Venice's Inquisition records from 1580 to 1650, as well as mortality data.