Acute and Chronic Exposures to Nitrogen Dioxide

A teaching method using an epidemiologic approach to diagnosis has been devised as the basic approach for helping third-year medical students learn the practical concepts of clinical epidemiology. Small groups of students, with the guidance of an instructor, use information about the distribution of diseases among subgroups of the population and knowledge of the circumstances under which a patient sought medical care to make a disease diagnosis for that patient. The student groups make the correct diagnosis at least five out of seven times without any additional clinical information. The short-term effectiveness of the method has been demonstrated by improved attitude of the students toward the relevance of epidemiology to patient-care problems.     

Towards the identification of student learning problems: the development of a diagnostic inventory

An understanding of how students approach their learning has important implications for medical education. Of particular interest is the fact that the approach students use in their study has a significant impact on both the quality of the learning and their academic success. It would clearly be of value to identify students whose approach to learning was predictive of unsatisfactory performance. This paper describes the initial development of two versions of an inventory (questionnaire) which was designed to aid in the diagnosis of student learning problems. Preliminary information is given on the reliability and validity of these instruments. Factor analyses support the underlying design. Correlation of subscales with academic performance has provided encouraging evidence of the potential of these inventories in identifying students with specific learning or study problems.     

''Condition Diagramming'': a new approach to teaching clinical integration

Integration of clinical material appears to involve three major steps: identification of the pertinent information; organization of that information in some logical sequence; and determination of its meaning to specific applications. The concept of 'Condition Diagramming' has been developed to help students to integrate the large volumes of clinical data that they are expected to learn. It utilizes a defined format to establish what information is needed and where it fits in relation to the patient's current status. Data organized in this manner may be easier to comprehend and use in medical decision-making. Several potential applications of this approach are presented.     

Analysis of case-crossover designs

The case-crossover design provides a means to study the effects of transient exposures on the risk of acute illness, for example, the effects of drinking alcohol on the immediate risk of a heart attack. Only cases are required by the design, since each case is effectively its own control; what a case was doing at the time of an acute event is compared with what the case would have been doing usually. Maclure has described an approach based on the Mantel–Haenszel method of analysis. It is shown here how the analysis of case-crossover designs can be achieved by a method of maximum likelihood. The method is quite general and, in principle, can be used to analyse the joint effects of many transient exposures. For binary exposures the Mantel–Haenszel approach is an approximate solution to the likelihood equations. In practice, case-crossover designs are limited by the information available on each case's ‘usual’ behaviour. Extracting such information requires in-depth questioning, but, in principle, it can be obtained. To do so requires careful questionnaire design. The approach is illustrated by analysis of 24 hour alcohol consumption and the risk of myocardial infarction. The problem with this analysis is how to estimate the probability of what a case would ‘usually’ have been doing from information on drinking frequency.     

Improving nutrition components in medical and dental school curriculums

This article has presented an alternative approach to the traditional, freestanding, concentrated course in nutrition. The integration of nutrition into other courses, with continuous reinforcement throughout the 4-year curriculum, may result in better learning and retention by the student. However, the lack of an accurate curriculum representation presents a problem in selecting topics that integrate with other courses. The unobtrusive approach to nutrition curriculum improvement involves three key points: development of the Nutrition Curriculum Guide, which provides detailed information on what is currently being taught, comparison of what is actually being taught with a set of ideal objectives in order to identify redundancies or omissions, and orchestrating the efforts of faculty in courses throughout the 4-year curriculum to help students integrate nutrition-related topics from the various disciplines. When one makes practical application of the unobtrusive approach, the most difficult problem is defining which interdisciplinary topics are currently being taught. An education specialist and the Tracer Method are important resources for one who is seeking to ameliorate the problem.     

Perceptions, Barriers, and Suggestions for Creation of a Tobacco and Health Website Among American Indian/Alaska Native College Students

Information concerning American Indian/Alaska Native (AI/AN) Internet use and health information needs is dearth. Our research team explored Internet use among AI/AN college students to determine Internet use in relation to health information seeking behaviors. We used a tobacco site example for participants to describe what they desired in a health site designed specifically for AI/AN. Using a community-based participatory research approach, we conducted 14 focus groups with AI/AN college students (N = 108), to better understand their perceptions of and attitudes toward Internet use and health information needs. Daily Internet use was reported across strata yet health topics investigated differed among groups. Participants in all strata desired a health website that was easy to navigate and interactive. Respectful representation of Native culture was a concern, yet no consensus was reached for a multi-tribal audience. Participants felt a website should use caution with cultural depictions due to the possible misinterpretation. Overall, participants agreed that recreational and traditional tobacco use should be differentiated and the variation of traditional use among tribes acknowledged. Data concerning Internet use for health information among AI/AN college students are needed to establish baseline indicators to effectively address disparities.     

Disease prevention and health promotion: a study of medical students and teachers

All students at the Royal Free Hospital School of Medicine (n = 508 ) were surveyed on their self-reported smoking and drinking habits, attitudes to disease prevention and health promotion in general, attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught at the beginning of the 1993–1994 academic year (response rate 75.2%). The teaching staff (n = 271 ) were also surveyed on their attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught (response rate 74.2%). Seventeen per cent of the students reported they were current smokers and 81% drank alcohol. Four factors were extracted from the responses to the items on disease prevention and health promotion in general and these represented the importance of health, a patient-centred approach, patient responsibility and a doctor-centred approach. Clinical students and those who were older were more likely to have a ‘patient-centred’ approach to disease prevention and health promotion. Sixty per cent of clinical and 44% of pre-clinical teachers aimed to teach about disease prevention and health promotion. The topics reported by students as most likely to have been taught in detail are smoking and health, alcohol and health, immunization, and breast and cervical screening. However, all these topics were reported as having been taught in detail by less than 50% of the students. The majority of students and teachers believe that teaching about disease prevention and health promotion should be integrated into all years of the curriculum and all clinical firms. Teachers were significantly less likely than students to believe that students should learn more about disease prevention and health promotion, and that learning about prevention is as important as learning about diagnosis and treatment. We believe that, in order to build on the positive features highlighted in this study, agreed aims and objectives should be developed and teaching about disease prevention and health promotion should be integrated both horizontally and vertically throughout the curriculum.     

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.     

Using a diary to quantify learning activities

BACKGROUND: Diaries of actual learning activities can fill the gap between the planned curriculum and students' opinions and outcomes. We report the development and validity of such a method, estimate sources of variation and model sampling strategies to determine efficient ways to obtain information about a curriculum or about individual students. METHODS: Following development and piloting, the diary was administered to fourth- and fifth-year medical students. Each student was asked to complete a diary on 3 randomly selected days of the academic year. Sources of variance and generalisability were determined using variance components analysis. Validity was explored by comparing activities with what is known about the curriculum, assessment, timetables and the 2 classes of students. RESULTS: Response rate was 83% (287/345). Learning activities varied as expected with timing of assessments, and on weekdays compared with weekends. For most activities, 14 days per student would be needed to obtain generalisable information about an individual student. The variation between days is greater than the variation between students, meaning that sampling for information on a curriculum should include all students and all days of the year but the number of diaries per student could be kept low depending on the desired power to detect any differences. CONCLUSION: Such an evaluation method is feasible and can provide reliable and valid information about study activities. Reasons for good compliance are discussed. Sampling strategies should be tailored to the purpose of the study.     

Revisiting an old strategy: cartoons in medical education

Medical education is an arduous process with widespread study of very complex information across diverse subjects. The use of medical illustrations in schematic or cartoon-like appearances is an old method of conveying intricate information. They are relatively absent in medical classrooms today. The purpose of this study was to survey members of a medical university, students and teachers regarding their opinions of medical cartoons. Most respondents had favourable opinions of cartoons in medical education. More research is required to conclude what parameters make cartoons effective teaching aids. Moreover, many teachers may lack formal training in applying cartoons within their curriculum.     

用生化免疫方法诊断肿瘤的探讨

目的探讨生化免疫诊断方法对肿瘤的治疗,同时在这个过程中必须先弄清楚的两个概念：（1）什么叫普查方法。（2）什么叫早期诊断。方法采用回顾分析的方法对近几年年来在我院使用生化免疫诊断方法对肿瘤的诊断过程进行探讨和一系列的分析,对肿瘤疾病的产生进行有效的分析。结果人们了解普查方法和早期诊断的概念。结论生化免疫诊断肿瘤是一种很复杂的方法,诊断肿瘤的过程很多,其中有：早期诊断、测定方法、测定结果等等。     

云南省青少年健康需求及认知评价

目的：针对青少年健康需求，作相关认知及教育背景的调查。为学校健康教育的深入提供依据。方法：用定势问卷法对整群随机抽取的２８所中学３５９５名初高中生作家境及疾病和保健知识的调查。结果：３５９５名青少年对常见传染病传播途径知晓率ＡＩＤＳ为７６．３８％，甲、乙型肝炎为３７．７２％和５９．５５％，结核５７．３９％，对慢性病及贫血预防措施掌握率为６３．７６％和６７．４５％。并且有重点中学学生优于非重点，城市     

Planning and the professional preparation of health educators: implications for teaching, research, and practice

Planning skills are one of the seven essential responsibilities of health educators, according to the National Commission of Health Education Credentialing program; yet little information is available about who provides training in planning, what type of training is offered, and what planning models are taught. A survey of 253 accredited graduate and undergraduate health education programs (response rate = 56%) was undertaken to gather information about planning and the professional preparation of health educators. Results revealed that planning instructors were primarily full-time, experienced, and about one half were CHES certified. Overall, 88% (113/129) of respondents taught the PRECEDE-PROCEED model, and 62% (81/131) taught the planned approach to community health (PATCH) model. Few planning differences were found at the graduate and undergraduate levels. Content analysis of 56 course syllabi revealed that 80% (45/56) required students to complete a program plan proposal or document as the culminating project for the course. Implications for teaching, research, and practice are discussed.     

Approaches to curriculum planning

This booklet describes different ways used to tackle the problem of curriculum planning. By studying these approaches teachers can get an insight into the process in their own school. First they must decide whether there should be a particular focus for curriculum planning and if so what it should be. In the light of this they can modify their school's approach. To what extent do they wish to focus on: aims and objectives (engineering approach), teaching methods (mechanics approach), content (cookbook approach), timetable (railway approach), problems (detective approach), one idea or strategy (religious approach), the regulations (bureaucratic approach), or a curriculum designed to attract sponsorship (public relations approach)? The magician approach, in which it is not clear how a curriculum is developed, is not recommended. Second, what should be the pattern of staff involvement—a representative group or committee (United Nations approach), all the teachers (people's congress approach), one individual (the dictator approach), a collaboration with students, patients and other professional colleagues (consumer approach), or a collaboration with an external consultant (consultant approach)? Whichever approach is adopted, advantages should be maximized and deficiencies minimized.     

Assessing clinical competence at the undergraduate level

This booklet aims to provide relevant background information and guidelines for medical school teachers in clinical departments charged with assessing the clinical competence of undergraduate students. It starts by emphasizing the difference between clinical competence and clinical performance. An approach to defining what should be assessed is outlined. The technical considerations of validity, reliability and practicability are discussed with reference to the ward- or practice-based setting and to the examination setting. The various methods available to assess aspects of competence are described and their strengths and weaknesses reviewed. The paper concludes with a discussion of the important issues of scoring and standard setting. The conclusion is reached that the quality of many current assessments could be improved. To do so will require a multi-format approach using both the practice and examination settings. Some of the traditional methods will have to be abandoned or modified and new methods introduced.     

Valuing height: diagnosis,valuation and the case of idiopathic short stature

This paper proposes a ‘valuographic’ approach to diagnosis, exploring how values and valuation practices are implicated in the contested diagnostic category of idiopathic short stature (ISS). ISS describes children who are ‘abnormally’ short but do not have any other detectable pathology. In the USA growth‐promoting hormone therapy has been approved for ISS children, since 2003. However, no other jurisdiction has approved this treatment and the value of ISS as a diagnostic category remains disputed among healthcare professionals. Drawing on qualitative interviews with paediatric endocrinologists in the UK and the US, this study presents a historical snapshot illustrating how the problematisation of ISS as a diagnosis involved multiple registers of value including epistemic, economic and moral calculations of worth. Contestation of the diagnosis was not just about what counts but about what ought to be counted, as respondents’ accounts of ISS gave differential weight to a range of types of evidence and methods of assessment. Ultimately what was at stake was not just the value of increased height for short patients, but what it meant to properly practice paediatric endocrinology. Consideration is then given to how a valuographic approach can be applied to sociological studies of diagnosis more broadly.     

Visualising the invisible: a network approach to reveal the informal social side of student learning

World-wide, universities in health sciences have transformed their curriculum to include collaborative learning and facilitate the students’ learning process. Interaction has been acknowledged to be the synergistic element in this learning context. However, students spend the majority of their time outside their classroom and interaction does not stop outside the classroom. Therefore we studied how informal social interaction influences student learning. Moreover, to explore what really matters in the students learning process, a model was tested how the generally known important constructs—prior performance, motivation and social integration—relate to informal social interaction and student learning. 301 undergraduate medical students participated in this cross-sectional quantitative study. Informal social interaction was assessed using self-reported surveys following the network approach. Students’ individual motivation, social integration and prior performance were assessed by the Academic Motivation Scale, the College Adaption Questionnaire and students’ GPA respectively. A factual knowledge test represented student’ learning. All social networks were positively associated with student learning significantly: friendships (β?=?0.11), providing information to other students (β?=?0.16), receiving information from other students (β?=?0.25). Structural equation modelling revealed a model in which social networks increased student learning (r?=?0.43), followed by prior performance (r?=?0.31). In contrast to prior literature, students’ academic motivation and social integration were not associated with students’ learning. Students’ informal social interaction is strongly associated with students’ learning. These findings underline the need to change our focus from the formal context (classroom) to the informal context to optimize student learning and deliver modern medics.     

Epidemiological enquiries into a school outbreak of an unusual illness

A total of 65 students and one female teacher were afflicted with an unusual illness following alleged inhalation of a 'gas' in the school. The main symptoms were dizziness, chills, nausea, headache, difficulty in breathing and faintness. Initial investigations revealed elevated carboxyhaemoglobin levels (greater than 5%) of 16 hospitalized students. However, no sources of carbon monoxide emission could be detected despite extensive environmental investigations. The outbreak was characterized by the following features: most victims were adolescent girls; there was a high proportion of recurrences; the illness was self-limiting with inconsistent clinical and epidemiological findings; its mode of transmission was associated with antecedent visual observation or verbal information, and it died down immediately after confidence had been restored. A diagnosis of mass psychogenic illness was made. The high-risk students were Malay girls who were from the normal class (for slow learners), engaged in part-time employment and easily influenced by what they had heard or seen.     

Using Portfolios to Assess Student Performance in School Health Education

ABSTRACT: Outcome-based education is a topic of growing interest in educational circles today. More performance-oriented than traditional learning approaches, outcome-based education requires students to demonstrate what they know and what they can do. Because of this emphasis, outcome-based curricula will require new methods to assess student achievement. One approach is the portfolio, a repository that enables students to document authentic examples of academic work and presentations as well as nonschool accomplishments. The possibility of using portfolio-based assessment as a viable mechanism to promote comprehensive school health education is examined. Practical recommendations concerning portfolio development and evaluation are offered. (J Sch Health. 1993;63(9):377–381)     

Approach to systemic vasculitis.

Systemic vasculitis is a confusing subject which has been difficult to classify and understand. Improvements in therapy increase the importance of early diagnosis. This paper reviews the clinical and pathological differences of the systemic vasculitides, and a working approach to the differential diagnosis of vasculitis is formulated based on the size of the vessel involved. Vessel size and histopathology determine to what group of diseases a particular syndrome belongs, thereby allowing subclassification and a more rational approach to management.