Improving medical student performance in smoking health promotion: effect of a vertically integrated curriculum

The majority of medical schools have curricula that address the health effects of smoking. However, there are many gaps in smoking education, especially in relationship to vertical integration. The authors aimed to determine whether medical students would better address adolescent smoking within a vertically integrated curriculum in comparison with the previous traditional curriculum. They studied two groups of fifth-year students; one group received a specific smoking intervention. Each group consisted of the entire cohort of students within the Child and Adolescent Health rotation of a newly designed medical curriculum. Two groups of students from the previous traditional undergraduate curriculum were available for direct comparison, one of which had received the same teaching on adolescent smoking. An objective structured clinical examination station was used to measure adolescent smoking enquiry. Intervention students in the new curriculum were more likely to enquire about smoking in the objective structured clinical examination than students who did not receive the intervention (p < 0.005). New curriculum students performed better than students from the previous curriculum, whether or not they had received the smoking intervention (p < 0.001). This study suggests that integrated undergraduate teaching can improve student clinical behaviours with regard to opportunistic smoking enquiry in adolescents.     

A sexual history-taking curriculum for second year medical students

The purpose of this study is to describe the evaluation of a sexual history-taking curriculum and correlates of student performance during a Clinical Skills Assessment. Reading assignments, small group discussions, a Saturday Sex workshop and performance on a Clinical Skills Assessment were evaluated. Students most favorably rated the workshop and least favorably rated the reading assignments. Eighty-four percent of students asked at least one sexual history question on the Clinical Skills Assessment. We were unable to identify any independent predictors of sexual history-taking behavior.     

Longitudinal cohort study on medical student retention of anatomical knowledge in an integrated problem-based learning curriculum

Background: When modifying a curriculum to accommodate changes in the methods of subject matter presentation or fit within a shortened time frame, student retention of knowledge remains an important issue.

Aim: This study evaluates medical student retention of anatomical knowledge as they matriculate through an anatomy curriculum where the instruction hours are less than half of the current national average.

Method: Medical students completed an assessment tool developed to evaluate their baseline level of anatomical knowledge at the beginning of the first year. They then completed the instrument at the end of their 1st, 2nd, 3rd, and 4th years to assess their retention of anatomical knowledge during medical school. Data collection began in September 2010 and concluded in June 2015.

Results: Results demonstrate that students began medical school with a low level of anatomical knowledge (baseline), that knowledge increased during their first year (p?<?0.001), continued to increase during their second year (p?<?0.001), but was over 90% maintained through years 3 and 4.

Conclusion: In conclusion, an anatomy course with reduced hours (～60), using active learning methods, contextual learning, cadaver demonstrations, increased exposure to imaging, and longitudinal reinforcement can help students build a strong foundation of anatomical knowledge.     

Medical student beliefs: spirituality's relationship to health and place in the medical school curriculum

The relationship between spirituality and health is receiving increased attention; consequently medical schools have begun asking how and in what manner these issues should be addressed in medical education. Unfortunately, student beliefs concerning spirituality and health have not been adequately assessed. This study examined medical student beliefs regarding the relationship between spirituality and health and the level of instruction spirituality should receive in the curriculum. Questionnaire results from 254 medical students indicated that religiousness and spirituality are important, with spirituality more important than religiousness. Spiritual practices were seen as more helpful for acute and mental health conditions than for chronic or terminal conditions and believed to be more helpful for coping with a health condition than healing tissue. Students believed that patients could benefit from spiritual practices more than they could for their own health conditions. Most students endorsed a lecture or one- to two-week seminar with instruction in the first or second year of medical school. Student spirituality was the only predictor of required level of instruction in the medical school curriculum.     

Community of practice and student interaction at an acute medical ward: An ethnographic study

Background: A deeper understanding is needed of the acute medical care setting as a learning environment for students.

Aim: To explore workplace culture of an acute medical ward and students’ interactions within this community.

Method: An ethnographic design was applied. Medical and nurse students’ interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers’ “Community of practice” theory.

Results: We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

Conclusion: The culture shaped a pattern for, and created prerequisites that challenged students’ adaptation and created a space for learning. Students’ task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.     

Impact of educational preparation on medical students in transition from final year to PRHO year: a qualitative evaluation of final-year training following the introduction of a new year 5 curriculum in a London medical school

This study is a qualitative evaluation of PRHOs' perceptions of a new final year of the MB BS programme at Guy's, King's and St Thomas' (GKT) School of Medicine, undertaken in 2001 as a precursor to a prospective study. One-to-one interviews were carried out with 16 PRHOs two to four months after starting. These were independently thematically analysed, cross-referenced and joint agreement on the themes reached. PRHOs felt they were well prepared in clinical skills, history taking and examination. They reported lack of knowledge in pathology and therapeutics. The initial 1-4 weeks were stressful because of new responsibility for patients. Relationship with patients and staff changed through acquisition of a definite professional role. They adopted a number of coping strategies to control demands of the post. The PRHOs perceived the course as relevant and good preparation for their posts, with a better balance than the previous curriculum. Greater appreciation of aspects of professionalization in the final year may help the transition further.     

Work engagement in medical students: An exploratory analysis of the relationship between engagement,burnout, perceived stress,lifestyle factors,and medical student attitudes

Abstract

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.     

Warwick Medical School: A four dimensional curriculum

Abstract

Medical curricula vary hugely across the world. Notions of horizontal and vertical integration and spiral curricula are present in many modern curricula although true integration happens to a varying degree. By seeing the development of a curriculum as fundamentally about integration, rather than as a process of seeking to integrate separate elements, we have developed a program that prepares students well for the complexities and rate of change of practice. The risks inherent in bringing forward the point at which learners need to deal with such substantive and fundamental complexity produces challenges. Such challenges are ones that our students have shown they can not only deal with, they are often better equipped than faculty to provide solutions for themselves, their peers and those who follow them. We present the three dimensions of integration in the Warwick Medical School curriculum and note the fourth dimension provided by our students, being student led teaching and support far beyond what is normally found in medical courses.     

How patient educators help students to learn: An exploratory study

Introduction: Benefits of the active involvement of patients in educating health professionals are well-recognized but little is known about how patient educators facilitate student learning.

Method: This exploratory qualitative study investigated the teaching practices and experiences that prepared patient educators for their roles in a longitudinal interprofessional Health Mentors program. Semi-structured interviews were conducted with eleven experienced health mentors. Responses were coded and analyzed for themes related to teaching goals, methods, and prior experiences.

Results: Mentors used a rich variety of teaching methods to teach patient-centeredness and interprofessionalism, categorized as: telling my story, stimulating reflection, sharing perspectives, and problem-solving. As educators they drew on a variety of prior experiences with teaching, facilitation or public speaking and long-term interactions with the health-care system.

Conclusions: Patient educators use diverse teaching methods, drawing on both individualistic and social perspectives on learning. A peer-support model of training and support would help maintain the authenticity of patients as educators. The study highlights inadequacies of current learning theories to explain how patients help students learn.     

Clinical diagnostic reasoning and the curriculum: a medical student's perspective

This short opinion essay provides views of a senior medical student from Pakistan; regarding what he thinks should be the focus of a comprehensive medical curriculum. He correlates his ideas with the new curricular theme problem-based learning, introduced at his university in recent years.     

Perspectives on management education: an exploratory study of UK and Portuguese medical students

Healthcare management is becoming extremely important and large health organizations face increasing demands for leadership and system change. The role of doctors is pivotal but their relationship with management issues and practice has been a matter of long-lasting debate. The aim of this research was to establish opinions of medical students and other medical educational stakeholders on the value and structure of a management and leadership course in medical school. A survey of undergraduate medical students from two medical schools (n = 268) was carried out, and quantitative and qualitative data were analysed and compared with opinions collected from interviews with hospital managers and clinical professors. Portuguese medical students attributed higher relevance to leadership/management education than their UK counterparts. For both groups, such a course would be best: (1) situated in the clinical years, (2) optional and (3) one term/semester long. Main topics desired were 'Managing people/team management'; 'National Health Service'; 'Doctors and Leadership', 'Costs/prices and resource management'. In conclusion, leadership/management education is perceived as relevant but its inclusion in the medical curriculum as well as its content needs careful consideration. Education in informatics and knowledge management would also provide a positive contribution to professional development but is scarcely appreciated at present.