University and Community Hospital Medical Student Emergency Medicine Clerkship Experiences

Objective : To determine whether there is a significant difference between educational opportunities for fourth-year medical students rotating at a university hospital (UH) compared with several community hospitals (CHs) during a mandatory emergency medicine (EM) clerkship.
Methods : A self-reported clinical tool was completed in real time by each student rotating for 2 weeks at the UH and 2 weeks at 1 of 4 CHs (3 affiliated and 1 unaffiliated). Students are required to document the number of patients seen and the number of procedures performed on each of 20 six-hour shifts. They rated the EM attending clinical teaching by site using a 5-point scale at the end of the clerkship.
Results : Most (95%) of the 87 students in the 7 clerkship blocks of the 1996–97 academic year rotated at the UH and a CH. Most (71%) students rated both the UH and the CH for the quality of teaching by attendings. There was a significant difference in the mean number of patients evaluated/shift (2.2 ± 0.10 vs 2.8 ± 0.10, UH vs CH; p < 0.001) and the mean number of procedures performed/shift (0.36 ± 0.04 vs 0.56 ± 0.05, UH vs CH; p < 0.001). Attending clinical teaching scores were significantly higher (p = 0.03) at the CHs.
Conclusions : The educational opportunities for students in an EM clerkship to evaluate patients and perform procedures were significantly greater at the community hospitals. Inclusion of community hospital settings in a medical student EM clerkship may optimize the clinical experience.     

Core Practical Objectives: A Means to Standardize the 4th-Year Emergency Medicine Clerkship

Background: Core Practical Objectives (CPOs) are clinical emergency medicine (EM) experiences (including suggested number of patient encounters) that students use to self-direct clerkship progress. Purpose: This study investigates feasibility of implementing EM clerkship CPOs, describes characteristics of students fulfilling CPO guidelines, and relates CPO completion to outcome measures (exam scores and grades). Methods: Cross-sectional research was conducted comparing students completing and not completing CPOs by gender, month of rotation, total patients evaluated, clerkship exam score, and final grade. Results: Over 4 years, 117 students completed an EM clerkship utilizing CPO guidelines. Gender and clerkship month were not associated with fulfilling CPOs. Total CPOs completed correlated positively with percent score on written exam and grade for rotation. Completion of specific CPOs was associated with exam scores and final grade. Conclusions: CPOs were successfully integrated into an EM clerkship. Preliminary data suggest that CPO guidelines can be used to standardize EM clerkships.     

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.     

Emergency Medicine Interest Group Curriculum: Faculty and Preclinical Student Opinions Differ in a Formal Needs Assessment

Background: Medical students and Emergency medicine (EM) faculty may have differing opinions on the ideal curriculum during the preclinical years. Objectives: To assess the perceived needs of preclinical medical students exploring EM and compare them with those of EM faculty regarding appropriate educational interventions. Methods: A survey instrument listing 15 workshops related to EM was administered to preclinical medical students in our Emergency Medicine Interest Group (EMIG), and to EM faculty. Respondents graded the perceived utility of each workshop offered at our medical school and those identified via a web search for EMIG. No recommendations for EMIG curriculum were identified through PubMed. Fisher's exact tests were computed using SPSS (SPSS Inc., Chicago, IL) with α = 0.05. Results: There were 48 medical students and 15 faculty members who completed the survey. Students strongly desired workshops in suturing (48/48; 100%), splinting (47/48; 97.9%), and basic electrocardiogram (ECG) interpretation (47/48; 97.9%). Least desired topics were history of EM (16/48; 33.3%), getting involved in EM organizations (20/48; 41.7%), and wellness (21/48; 43.8%). Women chose the domestic violence workshop more than men (p = 0.036). Faculty strongly supported workshops in conducting focused history and physical examination (14/15; 93.3%), the specialty of EM (14/15; 93.3%), and basic ECG interpretation (12/15; 80.0%). The lowest rated faculty preferences were ultrasound (5/15; 33.3%), history of EM (7/15; 46.7%), and emergency radiology (7/15; 46.7%). Conclusions: Preclinical students and faculty opinions of important educational workshops differed. Faculty favored the approach to the undifferentiated patient and an introduction to the specialty, whereas students preferred hands-on workshops. Both groups agreed that basic ECG interpretation was useful. These data may be useful for designing an educational program that is interesting to preclinical students while still meeting the needs as perceived by medical student educators.     

The effectiveness of computer-assisted instruction in teaching nursing students about congenital heart disease

This study compared the effectiveness of three instructional intervention strategies for teaching nursing students about congenital heart disease (CHD). They are: (1) computer-assisted instruction (CAI), (2) traditional class room lecture (TCL); and (3) the combination of CAI and TCL. The subjects were associate degree nursing (ADN) students enrolled in a pediatric nursing course at the University of Cincinnati Raymond Walters College. Differences between pre- and post-scores on a 20-item multiple choice test were analyzed by analysis of variance. There was a significant improvement in scores for all groups but no significant difference in improvement in scores between the CAI group and the TCL group. The CAI/TCL group showed significant improvement in scores compared with the other two groups. The researcher concluded that when teaching strategies are comparable, CAI is as effective as TCL. Used together, a significant improvement is seen in student performance than when either strategy is used alone.     

A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students

BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum.METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course.RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean pre-course ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3% (P<0.01). The didactic group also showed statistically significant improvement on the physiology exam, improving from 59.3% to 70.0% (P<0.01).CONCLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically significant improvement in physiology learning when compared to standard didactic curriculum.     

医学生选修急诊医学课程对培养急救知识和心肺复苏技能的影响

目的 探讨医学生学习急诊医学课程对培养急救知识和心肺复苏技能的影响.方法 选择暨南大学医学院医学专业2002级和2003级全日制本科四年级学生,按是否选修急诊医学课程分为观察组和对照组,在两组中各随机抽取30名学生进行急救知识和心肺复苏技能的考核.结果 观察组学生的理论考试得分为(78.5±9.1)分,对照组学生得分为(46.7±15.6)分,观察组得分明显高于对照组,两组比较差异有统计学意义(P<0.01).观察组和对照组心肺复苏技能考核得分分别为(7.32±0.83)分和(6.63±0.91)分,观察组得分明显高于对照组(P<0.01).观察组和对照组60次胸外按压失败的次数分别为(5.06±0.58)次和(5.77±0.63)次,4次吹气失败的次数分别为(0.92±0.16)次和(1.10±0.17)次,观察组失败的次数均明显少于对照组,两组比较差异有统计学意义(P均<0.01).结论 医学生选修急诊医学课程对培养其急救知识和心肺复苏技能有重要作用,医学院校有必要将该课程列为必修课程.     

护理本科生急危重症监护课程的改革与实践

目的探讨护理本科生急危重症监护课程改革方法与效果。方法主要课程改革内容为:聘请临床专家进行理论授课,采用VCD、CAI课件等教学手段,采用讲授法与讨论法相结合的教学方法;通过学生去医院急诊科和重症监护病房学习,扩大实践教学环境范围,在实验室教学中设计情景模拟训练;期末对学生进行理论和操作考核,并采用教学过程评价量表对学生进行问卷调查。结果 127名学生考核得分(81.80±5.72)分;教学过程评价量表总体得分(134.12±10.65)分。结论学生成绩较理想,对教学过程总体评价较好,但仍存在临床教学环境不稳定、理论授课临床专家缺乏与学生连续有效的沟通、授课过于强调实用性、对教学目标把握不完全一致等有待改善的问题。     

The Virtual Advisor Program: Linking Students to Mentors via the World Wide Web

BACKGROUND: Emergency medicine (EM) is a popular specialty for medical students choosing a career. Many attend medical schools without an affiliated EM residency and lack both the formal mentorship and informal guidance provided by medical school advisors (or faculty) involved in an accredited EM training program. Others desire specialized advice based on geographic or specific academic interest. OBJECTIVE: The authors describe user characteristics of a Web-based virtual advisor program that paired medical students with EM faculty advisors. METHODS: Prospective users access the system from a link on the Society for Academic Emergency Medicine (SAEM) home page. On the initial visit, demographic information is collected. Faculty and student guidelines are provided. Students desiring individual advice may register for a virtual advisor who can assess career goals and qualifications. Volunteer faculty mentors are assigned on the basis of the student's geographic and demographic preferences and career aspirations. Encounters rely primarily on electronic and/or voice correspondence to suit the needs of the pair. A frequently asked question (FAQ) section provides answers to common questions and does not require registration. RESULTS: Two hundred sixty-four students (183 males, 75 females, 6 unspecified) from North American (87) and international (25) medical schools requested a virtual advisor. One hundred twenty-one faculty advisors from 56 U.S. medical schools participated (86 [71%] males; 35 [29%] females). Students indicated reasons they sought a virtual advisor. Qualitative feedback was generally positive from advisors and advisees. CONCLUSION: The implementation of the virtual advisor program enabled medical students to have access to experienced EM faculty career mentors.     

Evaluation of computerized simulations in a pediatric clerkship

Computer‐assisted instruction (CAI) using patient simulations was introduced on a pediatric clerkship to teach clinical knowledge and problem‐solving skills. To evaluate the efficacy of this educational tool, 151 students were alternately assigned either to complete two CAI exercises or to review the same information in text format. As part of the clerkship examination, all participants completed a latent‐image simulation and 10 multiple‐choice questions on the specific clinical information presented. After adjusting for prestudy differences in National Board of Medical Examiners Part I scores and cumulative grade point averages, scores on the overall final exam and on the outcome measures were similar for the two groups. In conclusion, CAI simulated patients, when applied in this limited fashion, were as effective but no more effective than text reading in teaching clinical information and problem solving on a pediatric clerkship.     

The Impact of the Demand for Clinical Productivity on Student Teaching in Academic Emergency Departments

OBJECTIVE: Because many emergency medicine (EM) attending physicians believe the time demands of clinical productivity limit their ability to effectively teach medical students in the emergency department (ED), the purpose of this study was to determine if there is an inverse relationship between clinical productivity and teaching evaluations. METHODS: The authors conducted a prospective, observational, double-blind study. They asked senior medical students enrolled in their EM clerkship to evaluate each EM attending physician who precepted them at three academic EDs. After each shift, students anonymously evaluated 10 characteristics of clinical teaching by their supervising attending physician. Each attending physician's clinical productivity was measured by calculating their total relative value units per hour (RVUs/hr) during the nine-month study interval. The authors compared the total RVUs/hr for each attending physician to the medians of their teaching evaluation scores at each ED using a Spearman rank correlation test. RESULTS: Seventy of 92 students returned surveys, evaluating 580 shifts taught by 53 EM attending physicians. Each attending physician received an average of 11 evaluations (median score, 5 of 6) and generated a mean of 5.68 RVUs/hr during the study period. The correlation between evaluation median scores and RVUs/hr was -0.08 (p = 0.44). CONCLUSIONS: The authors found no statistically significant relationship between clinical productivity and teaching evaluations. While many EM attending physicians perceive patient care responsibilities to be too time consuming to allow them to be good teachers, the authors found that a subset of our more productive attending physicians are also highly rated teachers. Determining what characteristics distinguish faculty who are both clinically productive and highly rated teachers should help drive objectives for faculty development programs.     

Free internet access, the digital divide, and health information

BACKGROUND: The Internet has emerged as a valuable tool for health information. Half of the U.S. population lacked Internet access in 2001, creating concerns about those without access. Starting in 1999, a survey firm randomly invited individuals to join their research panel in return for free Internet access. This provides a unique setting to study the ways that people who had not previously obtained Internet access use the Internet when it becomes available to them. METHODS: In 2001-2002, we surveyed 12,878 individuals 21 years of age and older on the research panel regarding use of the Internet for health; 8935 (69%) responded. We analyzed respondents who had no prior Internet access, and then compared this group to those who had prior Internet access. RESULTS: Among those newly provided free Internet access, 24% had used the Internet for health information in the past year, and users reported notable benefits, such as improved knowledge and self-care abilities. Not surprisingly, the no-prior-Internet group reported lower rates of using the Internet (24%) than the group that had obtained Internet access prior to joining the research panel (40%), but the 2 groups reported similar perceptions of the Internet and self-reported effects. CONCLUSIONS: Those who obtained Internet access for the first time by joining the panel used the Internet for health and appeared to benefit from it. Access helps explain the digital divide, although most people given free access do not use the Internet for health information.     

Introducing computer-aided instruction into a traditional histology course: student evaluation of the educational value

Both the World Health Organisation and the World Federation for Medical Education have endorsed integration of computer technology into medical education. In line with this and for more practical reasons, second-year medical students were introduced to commercial and in-house computer-aided instruction (CAI) packages in the traditional histology course. Although CAI was well received, light microscopy was still regarded as a valuable skill in the undergraduate curriculum. Its application was viewed to be important in future medical studies, as well as in general practice. It was also perceived to be a more self-directed form of learning than CAI. Students' use of CAI packages was related to CAI meeting course objectives and the level of interactivity.     

Comparison of Internet versus lecture instructional methods for teaching nursing research.

Although many higher education programs are using the Internet to teach classes, there are few published reports on the effectiveness of this method on test scores or student satisfaction. The purpose of this study was to compare test and student satisfaction scores of graduate nursing students who take a nursing research course via the Internet with those of students who take the same course via traditional lecture instruction. In addition, student technical support use and Internet student lecture attendance also were examined. A total of 97 students (Internet, 44; lectures, 53) participated. There were no significant differences in test scores and overall course student satisfaction (P > .05). However, the Internet students reported significantly higher (P = .04) stimulation of learning compared with the traditional lecture students. Technical support use by the Internet students was high initially and was related to software problems. Of interest were the large proportion of Internet students (73 percent) who attended at least 3 of the 10 lectures. Use of the Internet to teach graduate-level nursing research can provide comparable learning and student satisfaction to traditional lecture instructional methods.     

Book reviews

Background: As medical schools continue to strive to deliver high quality education with diminishing resources, the need to evaluate long-standing teaching techniques becomes imperative. The use of gynecological teaching associates to teach pelvic exam skills to medical students is an example of an education intervention that deserves thorough evaluation. Purpose: The objective was to evaluate effects of two pelvic examination training methods on OB/GYN clerkship students with respect to costs, students’ performance, and perception. Method: During the academic year 2007–08, 106 medical students were randomized to receive either pelvic examination training by a gynecological teaching associate (GTA) alone or a standardized patient (SP) accompanied by an obstetrics and gynecology faculty member. Students participated in an objective structured clinical exam (OSCE) and completed questionnaires regarding the educational intervention at the end of the clerkship. Results: The two training methods produced comparable OSCE scores, and students in both groups felt more confident after training and found the training sessions to be valuable. There was a significant cost-savings associated with using GTAs for pelvic exam training. Conclusions: Faculty time and effort need not be utilized for pelvic exam training exercises, since using GTAs for pelvic exam training produces comparable results.     

考试应激与唾液免疫功能的变化

背景:近年来临床和流行病学相关研究都证实部分口腔疾病的发生与心理应激因素相关.目的:分析学生考试前后唾液分泌型IgA及皮质醇的变化与心理应激状况的关系.设计:横断面调查. 单位:浙江大学口腔系.对象:调查对象为2003-05/11福州二中高二年级在校学生60人,57人完成调查,均为男性,年龄17～19岁,身体健康,无口腔疾病及免疫系统疾病家庭史,无烟酒嗜好,均参加为期3d的期末考试.方法:考试前应用症状自评量表(共90题,包括躯体化、强迫、人际关系敏感、忧郁、焦虑、敌对、恐惧、偏执、精神病性、其他等10个因素,总均分是将总分除以90),将完成调查的57人分为为低症状组(症状自评量表总分＜2.0)和高症状组(症状自评量表总分＞2.0).于考试前5周召集学生填写一般情况调查表;考试前4周和考试当天早晨7:30完成第一、二次唾液标本采集,测定其考试应激前后唾液分泌型IgA、皮质醇值;考试后3 d召集学生填写心理健康问卷,评定其心理健康状况.主要观察指标:①症状自评表得分.②应激前后唾液分泌型IgA及皮质醇水平.结果:采用意向处理分析,进入结果分析57人.①学生症状自评表评定结果与中国常模比较:考试后强迫、焦虑、敌对、偏执4个因子分高于中国常模[(1.98±0.72,1.69±0.61)分;(1.79±0.31,1.42±0.43)分;(1.77±0.68,1.50±0.57)分;(2.00±0.71,1.52±0.60)分,(P＜0.01)],其他因子比较未见明显差异(P＞0.05).②应激后的唾液分泌型IgA分泌量比较:考试前低症状组明显高于高症状组[(236.6±82.29,194.55±66.29)mg/L,(P＜0.05)];考试后低症状组学生唾液分泌型IgA分泌量高于高症状组[(182.21±55.92,132.89±41.16)mg/L,(P＜0.01)];③应激后的唾液皮质醇浓度比较:低症状组考试后明显高于考试前[(5.96±2.46,3.68±2.26)μg/L,(P＜0.01)].④两组分泌型IgA变化率及皮质醇变化率逐步回归分析结果:分泌型IgA下降率(0.012±0.197)、皮质醇上升率(0.199±0.654)和偏执、强迫等心理因素有关.结论:学生考试后症状自评表评定结果中焦虑、强迫、敌对、偏执等因子分高于中国常模,显示考试应激造成学生焦虑水平的上升和心理行为方面变异.高、低症状组学生在考试应激前后唾液分泌型IgA下降率之间存在差异,表明心理症状较多的学生对考试应激耐受力低.