Preparing medical students to teach.

OBJECTIVE: Residents do a significant amount of teaching. Therefore, as medical students prepare for the clinical aspects of their residency, it is also important for them to prepare for their role of physician as teacher. With the goal of offering fourth-year students an opportunity to enhance their teaching skills, an elective was designed that presented them with an opportunity to expand their knowledge base in education, and then apply and practice this new set of knowledge. A week-long elective, Physician as Teacher, was designed to encompass core educational information such as needs assessment of learners, establishing goals and objectives, teaching methods, and evaluation and feedback. This core information was then applied and enriched during an end-of-course teaching presentation. Aside from this course, there is no forum during their undergraduate medical training for the students to acquire knowledge and skills about how to be teachers. DESCRIPTION: The course was developed with the appreciation that application of knowledge is a rich source of learning. The course began with interactive classroom teaching sessions designed to facilitate acquisition of core educational knowledge. Sessions topics included assessment of learner needs, methods of teaching, learning styles, microprecepting, and feedback. Also incorporated were sessions on facilitating small groups, and teaching and learning how to use technology. Those classroom sessions were then enhanced by a complement of sessions that asked the students to apply their new knowledge to clinical situations. Those more application-based sessions included observation and follow-up discussion of clinical teaching and small-group teaching sessions with the goal of developing the students' skills with respect to the teaching and learning process. An end-of-course teaching presentation by each student provided them with a capstone experience of applying the knowledge and skills learned throughout the week. The topic of the teaching presentation was of their choosing, and could incorporate technology. Each student's teaching presentation was videotaped, immediately viewed by the student, and discussed using a structured format of facilitated feedback. DISCUSSION: Students reported that the end-of-course teaching presentation was a rich source of their learning, and an important vehicle for helping them apply and synthesize the new knowledge. Fifteen percent of fourth-year students enrolled in and completed the elective. Seventy-one percent of those students "strongly agreed" and 29% "agreed" that the course provided useful knowledge and skills. Seventy-nine percent "strongly agreed" and 21% "agreed" that their teaching would be better because of the course. Based on comments, the students appeared to feel that the experience of presenting a teaching session at the end of the course was a rich source of their learning, and helped them to apply and synthesize the new knowledge. Students noted, "the teaching project was an excellent idea to see how much we have learned; I never realized what a responsibility we have as residents to teach our peers; I have been enlightened this past week and will now consciously make an effort to share what little information I currently have; I will be a better teacher because I have been given the appropriate tools."     

A curriculum to teach medical students to care for people with disabilities: development and initial implementation

Background  

Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire.     

A curriculum to teach medical students to care for people with disabilities: development and initial implementation

Background  

Lack of knowledge and skills, and negative attitudes towards patients with disabilities, may adversely affect the services available to this group and negatively affect their health outcomes. The objective of this paper is to describe the development and initial implementation of a curriculum for teaching medical students to care for patients with disabilities.     

Can specialists and generalists teach clinical skills to second-year medical students with equal effectiveness?

PURPOSE: To compare the effectiveness of specialists and generalists as small-group leaders teaching basic physical examination skills to preclinical medical students. METHOD: Specialists and generalists were randomly assigned to teach physical examination skills to 69 groups of second-year students (n = 288). At the conclusion of the course, the specialist- and generalist-led groups were compared using three measures: students' scores on an objective structured clinical exam (OSCE), students' evaluations of their small-group leaders, and leaders' self-evaluations of confidence in teaching. RESULTS: OSCE scores did not differ between students taught by specialists and generalists (93.5% and 93.8% respectively, p = NS). Students' evaluations of their leaders were similar for nine characteristics rated on a seven-point scale (7 = strongly agree/outstanding; range of results for specialists: 6.20-6.62, for generalists 6.34-6.75, p = NS). Leaders expressed similar levels of confidence (on a seven-point scale; 7 = very confident) in their abilities to teach the neurologic exam (specialists 5.52, generalists 6.19, mean effect size difference 0.44, p = NS) and complete history and physical exam (6.03 and 6.53, mean effect size difference 0.43, p = NS). Specialists were significantly less confident in teaching the cardiovascular exam (5.80 and 6.50, mean effect size difference 0.51, p <.05) and pulmonary exam (5.56 and 6.60, mean effect size difference, 0.80, p <.01). CONCLUSIONS: Specialists and generalists can teach preclinical medical students with equal effectiveness as rated by the students and the students' scores on the OSCE examination, but specialists do not rate themselves as confident as do generalists to teach some skills.     

Using gross anatomy to teach and assess professionalism in the first year of medical school

The public is uneasy about the lack of professionalism in physicians chronicled in the different news media. Since professionalism is a set of values developed over a period of time, it is imperative that the evaluation of medical students in regard to these values begins early in their medical school education. In the Gross Anatomy laboratory there are opportunities for students to display such aspects of professionalism as responsibility/accountability for actions, working with others (teamwork), respect for patients, and social responsibility. Because students spend a significant time in the Gross Anatomy laboratory with the faculty, this setting can provide the forum for faculty to assess the expression of principles of professionalism by the students. This requires faculty who are committed to evaluating the progress of students in this regard. Faculty can monitor work ethic, interpersonal relationships, and overall attitude of these students throughout the course. Thus, aspects of professionalism can be introduced, monitored, and evaluated as early as the first semester of medical school.     

Psychopathology and delinquency in adolescents: a descriptive and developmental perspective

The current article presents a review on psychiatric pathology in delinquent adolescents. The putative developmental significance of this co-occurrence is discussed within Moffitt's [Psychol. Rev. 100 (1993) 674] developmental framework on antisocial behavior. Articles on psychopathology in delinquent adolescents were retrieved through search engines (MEDLINE, Psychlit) and by exploration of references in those articles. Substantial evidence is at hand that delinquent adolescents have higher rates of externalizing and internalizing disorders when compared to adolescents in the general population. Although substantial limitations hamper interpretation of the findings, the marked similarities across a diversity of samples from different countries suggest that the findings are fairly generalizable. Evidence was found for differences in prevalence and developmental significance of psychiatric pathology between adolescent limited (AL) offenders and life-course persistent (LCP) offenders. Although psychopathology was more severe in LCP offenders, AL offenders still had significant and potential harmful levels of psychopathology. These findings emphasize the necessity of developing mental health services to delinquent adolescents and the necessity of adequate diagnostic and therapeutic interventions in these adolescents.     

Revision of a Parent-Completed Developmental Screening Tool: Ages and Stages Questionnaires

Examined the Ages and Stages Questionnaires (ASQ), a seriesof 11 developmental questionnaires designed to be completedby parents and caregivers of young children from 4 to 48 monthsof age. The ASQ were recently revised and additional psychometricdata were gathered. Analyses on over 7,000 questionnaires indicatedhigh test-retest reliability, interobserver reliability, andinternal consistency Concurrent validity using standardizedmeasures yielded an overall agreement of 85%, with a range of76–91%. Specificity was high 'across questionnaire intervalswhile sensitivity was lower and varied across intervals. Useof parent-completed screening tools such as the ASQ is attractivein terms of costeffectiveness, parental involvement, and flexibiliryin administration procedures.     

An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis

Background  

Four- or five-option multiple choice questions (MCQs) are the standard in health-science disciplines, both on certification-level examinations and on in-house developed tests. Previous research has shown, however, that few MCQs have three or four functioning distractors. The purpose of this study was to investigate non-functioning distractors in teacher-developed tests in one nursing program in an English-language university in Hong Kong.     

Academic leagues: a Brazilian way to teach about cancer in medical universities

Background

Performance of qualified professionals committed to cancer care on a global scale is critical. Nevertheless there is a deficit in Cancer Education in Brazilian medical schools (MS). Projects called Academic Leagues (AL) have been gaining attention. However, there are few studies on this subject. AL arise from student initiative, arranged into different areas, on focus in general knowledge, universal to any medical field. They are not obligatory and students are responsible for the organizing and planning processes of AL, so participation highlights the motivation to active pursuit of knowledge. The objective of this study was to explore the relevance of AL, especially on the development of important skills and attitudes for medical students.

Methods

A survey was undertaken in order to assess the number of AL Brazilian MS. After nominal list, a grey literature review was conducted to identify those with AL and those with Oncology AL.

Results

One hundred eighty of the 234 MS were included. Only 4 MS selected held no information about AL and 74.4 % of them had AL in Oncology. The majority had records in digital media. The number of AL was proportional to the distribution of MS across the country, which was related to the number of inhabitants.

Conclusions

The real impact and the potential of these projects can be truly understand by a qualitative analysis. AL are able to develop skills and competencies that are rarely stimulated whilst studying in traditional curriculum. This has positive effects on professional training, community approach through prevention strategies, and development on a personal level permitting a dynamic, versatile and attentive outlook to their social role. Besides stimulating fundamental roles to medical practice, students that participate in AL acquire knowledge and develop important skills such as management and leadership, entrepreneurship, innovation, health education, construction of citizenship. Oncology AL encourage more skilled care to patients and more effective policies for cancer control.

     

Research centers and institutes in U.S. medical schools: a descriptive analysis.

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.     

The development and descriptive use of the Lithium Attitudes Questionnaire

Studies of patients' attitudes towards lithium treatment are reviewed. In the present work, a brief questionnaire was developed as a means of identifying and grouping the problems patients commonly have with taking lithium regularly. This 'Lithium Attitudes Questionnaire' was found to yield consistent results which patients later confirmed at interview. It was also evaluated in relation to assessments patients made, prior to its first administration, of the main advantages and disadvantages of lithium treatment. Its subscores were then used to describe patients who expressed opposition to continuing on lithium, and those who missed their hypomanic episodes.     

Using the case-discussion method to teach epidemiology and biostatistics.

Medical students must learn the principles of epidemiology and biostatistics to critically evaluate the medical literature. However, this subject has traditionally been difficult to teach. In 1997 at the Albert Einstein College of Medicine, the required first-year course in epidemiology and biostatistics was revised to use the case-discussion teaching method. In preparation for the course, experienced faculty participated in an intensive, two-day training workshop. The course, taught to 163 first-year medical students, was structured in two parts: (1) three lectures complemented by a detailed syllabus, followed by a multiple-choice midterm exam; and (2) six case-discussion seminars, followed by a short answer/essay final exam. There were seven case-discussion groups with 23-24 students each. The program was evaluated using subjective faculty feedback, examination scores, and student evaluation questionnaires. Faculty noted excellent student preparation and participation. Multiple-choice exam scores were comparable to those from earlier years, and a short answer/essay exam demonstrated good student mastery of the required material. Student evaluation was overwhelmingly positive, and significantly improved from prior years of the course. Positive student evaluations of the course using this teaching method continued over the next four years; National Board of Medical Examiners examination scores indicated success in mastery of the material; and student assessment of the course improved on the AAMC Graduation Questionnaire. This favorable experience suggests that case-discussion teaching can be employed successfully in teaching principles of epidemiology and biostatistics to medical students.