Teaching methodologies: knowledge acquisition and retention

In studying the curriculum of a nursing program, knowledge acquisition and retention by nursing students is a primary concern of nursing instructors. The purpose of this study was to determine if a lecture which stimulated several senses would significantly increase knowledge acquisition and retention compared to lectures that stimulate only the auditory sense. Forty-three, junior year, diploma nursing students who had essentially the same clinical experience were the subjects randomly assigned to either Group A or B for this study. Group A (control group) attended a formal lecture on "Spinal Cord Injuries" which stimulated only the auditory sense. Group B (experimental group) attended a lecture on the same subject which stimulated the auditory, visual, and tactile senses. A pretest was given to evaluate the knowledge base prior to the lecture, a posttest was given immediately after the lecture to evaluate initial knowledge acquisition, and a retention test was given three weeks later to evaluate amount of knowledge retained. Students attending the multimodal lecture demonstrated a significantly higher retention test score at the .05 level although they did not demonstrate a significantly higher gain score from pretest to posttest.     

A Case–based Emergency Medicine Curriculum for Senior Medical Students

Objective: To determine the effects of a case–based, core content–oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students.
Methods: All senior medical students rotating through the Milwaukee County EM elective during the 1992–1993 academic year were assigned specific chapter readings from a case–oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. AH students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five–point Likert scale.
Results: Seventy–five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 ± 7.1%; final examination score 76.2 ± 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of –1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale.
Conclusions: A case–based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

The influence of curriculum format on learning preference and learning style

Undergraduate occupational therapy students were given the Rezler-French Learning Preference and the Kolb Learning Style Inventories at the introduction of professional course work (pretest) and upon completion of junior year course work and Level 1 fieldwork (posttest) 1 year later. The students' course work was a guided-study, modified competency-based program that included guided independent study, laboratory work, small group study, and one-to-one tutorials in preference to, but not excluding, the more traditional lecture method. After experiencing different modes of instruction, the students indicated no significant difference in their preferences for ways of learning or in processing information. Implications of these findings for the teaching-learning process are discussed.     

Teaching biostatistics at the Kuwait University health science centre

This study focused on undergraduate, postgraduate, and continuing biostatistical instruction in the Health Science Centre, University of Kuwait. For the past 11 years, 14 hr of lecture have been allocated to biostatistics in the third‐year medical curriculum as a component of the three‐semester 120‐hr Behavioral Sciences lecture course. This course is taught under the aegis of the Community Medicine and Behavioural Sciences Department. A compulsory 45‐hr biostatistics lecture course is also offered to all first‐year students of the Faculty of Allied Health Sciences and Nursing. On the postgraduate level, a 30‐hr lecture course on biostatistics and computers is made compulsory to all enrolled MSc students. The content ranges from introductory concepts to research design. Workshops on biostatistics and computer applications are also organized for practicing physicians and health workers as community continuing education programs. The enthusiasm of medical students as well as those in the medical profession in Kuwait toward learning biostatistics and computing is promising. In view of some problems in the undergraduate course, it is recommended to move the course nearer clinical years and expand the allotted time.     

The Development and Evaluation of a Geriatric Emergency Medicine Curriculum

Objective : To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course.
Methods : A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done.
Results : Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop.
Conclusions : The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.     

The effect of teaching method on objective test scores: problem-based learning versus lecture

This study investigated the effect of teaching method on objective test scores of students in a school of nursing. The hypothesis stated there was a difference between objective test scores of students who were taught content on diabetes using problem-based learning (PBL) and students taught the same content using the traditional lecture method. Junior nursing students enrolled in the Adult Health I nursing course in the fall of 2001 were taught the diabetes content using lecture as the teaching method, while students enrolled in the same course in the spring of 2002 were taught the same content using PBL. A pretest and posttest were administered to both groups of students. Both the pretest and posttest scores of the two groups were compared using an independent t test, and no statistically significant difference was found in the scores of the two groups. The results of this study support the null hypothesis: that there is no difference in objective test scores based on teaching method (lecture versus PBL).     

Medical Student Knowledge of Morphine for the Management of Cancer Pain

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean ± SEM) that morphine should be given on a regular schedule for cancer pain (3.41 ± 0.08), that cancer pain management frequently requires co-analgesics (3.36 ± 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 ± 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.     

Medical student education in emergency medicine: new model from South Africa

Emergency medicine is a new specialty in South Africa. Postgraduate training, degrees and diplomas have been introduced and this should make a significant difference, in due course, to emergency care in the country. The University of the Witwatersrand, Johannesburg, South Africa, like many universities in Australia, embarked upon a Graduate Entry Medical Programme. This implied significant curriculum change and gave opportunity for the development of formal emergency medicine training for students, for the first time. After considerable debate over the needs of the graduate in South Africa a new block was developed, called the Acute and Perioperative Care block. This encompasses forensic medicine, emergency medicine, trauma and anaesthetics. The training is integrated and progressive. No similar programme has been detected elsewhere. At the end of the first year there is considerable satisfaction on the part of both teachers and students and many of the students, finding the module exciting, have indicated a wish to become involved in emergency medicine in the future. The structure of the course is laid out and might be of relevance to colleagues with an interest in medical education.     

Political and Budget Issues Associated with Educating Medical Students

The senior year provides an excellent opportunity for medical students to experience the specialty of emergency medicine for career exploration and skill development. This educational experience can provide the medical school with the means to meet the Liaison Committee on Medical Education recommendation that all graduating students should be capable of handling emergencies. The senior rotation may be a mandatory or elective experience. It is in the emergency department that students can gain experience in evaluating the undifferentiated patient and may refine their history and physical examination skills. They have the chance to become adept at rapid decision making in the diagnosis and stabilization of patients. This paper outlines the components of a typical four‐week rotation, such as the orientation session, the didactic program, the clinical experience, the evaluation of students, the faculty, and the educational experience. Strategies for implementing both didactic and clinical components of the curriculum are provided. The managerial role of the clerkship director is introduced. Suggestions for assuming administrative and educational responsibility for an existing course are made. A guide to the development and implementation of a new course is described, in which the course objectives and prerequisites must be set, the core didactic curriculum formulated, the clinical experience defined, and a system of evaluation and feedback developed. Students generally enjoy their emergency medicine experience as it is often their first opportunity to assume primary responsibility for patient care. Clerkship directors can develop their leadership skills in managing a major educational component of the senior year that may prove beneficial in developing a career in the field of medical education.     

Evaluation of an Emergency-procedure Teaching Laboratory for the Development of Proficiency in Tube Thoracostomy

Objective : Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy.
Methods : A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20–25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest.
Results : The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002).
Conclusions : This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.     

Supporting faculty proposal development and publication

The Hispanic Health Disparities Research Center, a collaborative venture between the University of Texas at El Paso and the University of Texas at Houston Health Sciences Center, supports the research capabilities of junior faculty through a variety of programs. Novice researchers often need practical help in conducting literature reviews, extracting data, evaluating the evidence, and formulating a research question of significant importance to be funded yet narrow enough to fit within the scope of the proposal. The authors discuss a successful proposal development program that includes mentoring by more senior faculty and structured sessions with a medical writer and editor.     

Spinal cord injury computer-assisted instruction for medical students

OBJECTIVE: To determine if a computer-assisted instruction program would improve fourth-year medical students' knowledge base related to spinal cord injury, as determined by pretest and posttest scores. DESIGN: A multimedia computer-assisted instruction program was developed and offered on a volunteer basis to an entire class of fourth-year medical students (n = 168). Effectiveness of the instructional content was evaluated with pretests and posttests, and overall user satisfaction with the module was assessed with the courseware evaluation. RESULTS: The responses yielded 83 sets of completed pretest and posttest pairs and 80 sets of fully completed courseware evaluations. Mean posttest score was significantly higher than the mean pretest score (pretest, 6.65 +/- 1.44, vs. posttest, 7.36 +/- 1.38; df = 82, t = -4.74, P < 0.001). Courseware evaluations yielded positive ratings in all areas, including applicability and usability. CONCLUSIONS: The significantly increased posttest scores suggest that the students left the program with an expanded knowledge base in the content areas of spinal cord injury medicine covered in the computer-assisted instruction program.     

Clinical laboratory science: A profession with honors.

Texas Tech University Health Science Center (TTUHSC) supports a strong undergraduate honors program. Students are required to enter the Honors College as freshmen and enroll in at least 24 hours of honors-designated classes. Some of the clinical core courses in the clinical laboratory science (CLS) program are designated as honors courses so students can continue their contract agreement with the Honors College to enroll in at least six hours of honors credit at the junior and senior level. By providing further educational experiences out of class, these honors students are able to meet the requirements needed to graduate with highest honors. A CLS honors program not only benefits the student but also the faculty involved and the program curriculum.     

A spiritual education course to enhance nursing students’ spiritual competencies

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students’ spiritual competencies, individual spiritual growth, and the ability to care for patients.     

Teaching and evaluation of physical examination skills on the surgical clerkship

It is presumed that graduating medical students possess adequate physical examination skills, although they are rarely evaluated during the clinical years. In this study we assessed the physical examination skills of third‐year medical students at the beginning and end of a surgical clerkship and investigated the effect of clerkship experiences and formal feedback on maturation of these skills. Sixty‐seven third‐year students completed a course on physical examination during their second year of medical school and achieved a 90% performance level on a physical examination performed on a patient instructor. This group subsequently performed a focused physical examination (chest, abdomen, groin [hernia], and external genitalia) during Week 1 and Week 6 of a 6‐week third‐year surgical clerkship. The physical examination was observed and evaluated using a 38‐item checklist; feedback was provided immediately after the first examination. Pretest performance was significantly poorer than that achieved in the second‐year course. Statistically significant improvement was noted from pretest to posttest for all areas except the external genitalia examination. Students in later rotations in the academic year did not perform significantly better than students in early rotations. We concluded that deterioration of learned physical examination skills occurs from the preclinical to the clinical years and that this deficiency is not corrected by clerkship experiences. Evaluation and feedback during the clerkship resulted in improvements in skills back to the levels demonstrated during the second year.     

Effect of basic life support training on the knowledge and skills of first aid of first year medical students

Objective: To determine the timing of first aid training in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine.Method: The study was conducted prospectively with 168 first year medical students at Faculty of Medicine, Maltepe University in October 2019. An 8-hour course plan consisting of theoretical and practical applications was prepared. Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques, basic life support scenarios, Heimlich's Maneuver and the coma position. Students were sent a link consisting of 17 questions created with Google forms at the beginning and the end of the course. Learned knowledge was measured with the posttest, and pre-and post-training results were compared. Results: A significant increase was found in the rate of correct answers compared to the pre-training period. Even the rate of correct post-test answers increased significantly in all questions; the increase in the questions related to the subjects supported by practical applications was more remarkable. It was found that more incorrect answers were given to questions about environmental injuries. Conclusions: It is possible to improve the public recognition of first aid, even with one day of theoretical and practical training. Thus, adding first aid practical courses to the first-year medical school curriculum and raising awareness at an earlier age will play an essential role in medical education.     

Ultrasound Training for Emergency Physicians— A Prospective Study

OBJECTIVES: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. METHODS: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. RESULTS: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean +/- SD pretest score was 15.6 +/- 4.2, 95% CI = 14. 7 to 16.5 (65% of a maximum score of 24), and the mean +/- SD posttest score was 20.2 +/- 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0. 05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 +/- 1.2, 95% CI = 20.0 to 21.4). CONCLUSIONS: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.