首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 15 毫秒
1.
《Medical teacher》2012,34(12):1434-1440
Abstract

Purpose: Patients who have access to information online may feel empowered and also confront their physicians with more detailed questions. Medical students are not well-prepared for dealing with so-called “e-patients.” We created a teaching module to deal with this, and evaluate its effectiveness.

Method: Senior medical students had to manage encounters with standardized patients (SPE) in a cross-over design. They received blended-learning teaching on e-patients and a control intervention according to their randomization group (EI/LI?=?early/late intervention). Each SPE was rated by two blinded video raters, the SP and the student.

Results: N?=?46 students could be included. After the intervention, each group (EI, LI) significantly improved their competency in dealing with e-patients as judged by expert video raters (EI: MT0?=?9.75 (2.51) versus MT1?=?16.60 (2.80); LI: MT0?=?8.70 (2.14) versus MT2?=?15.20 (2.84); both p < 0.001) and SP (EI: MT0?=?24.13 (4.83) versus MT1?=?26.52 (3.06); LI: MT0?=?23.37 (3.10) versus MT2?=?27.47 (4.38); both p < 0.001). Students’ rating showed a similar non-significant trend.

Conclusions: Students, SP and expert video raters determined that blended-learning teaching can improve students’ competencies when dealing with e-patients. Within the study period, this effect was lasting; however, further studies should look at long-term outcomes.  相似文献   

2.
Background: Multiple mini-interviews (MMI) are commonly used for medical school admission. This study aimed to assess if sociodemographic characteristics are associated with MMI performance, and how they may act as barriers or enablers to communication in MMI.

Methods: This mixed-method study combined data from a sociodemographic questionnaire, MMI scores, semi-structured interviews and focus groups with applicants and assessors. Quantitative and qualitative data were analyzed using multiple linear regression and a thematic framework analysis.

Results: 1099 applicants responded to the questionnaire. A regression model (R2?=?0.086) demonstrated that being age 25–29 (β?=?0.11, p?=?0.001), female and a French-speaker (β?=?0.22, p?=?0.003) were associated with better MMI scores. Having an Asian-born parent was associated with a lower score (β?=??0.12, p?Conclusion: Age, gender, ethnicity, socioeconomic status and language seem to be associated with applicants’ MMI scores because of perceived differences in communications skills and life experiences. Monitoring this association may provide guidance to improve fairness of MMI stations.  相似文献   

3.
Introduction: Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities.

Aim: To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location.

Methods: Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum.

Results: SHS-Palo graduates had significantly (p?p?p?=?0.032) or in rural government health services (p?p?p?=?0.028) and their current position (p?Conclusions: SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.  相似文献   

4.
Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p?=?0.002), came from lower socioeconomic strata (p?=?0.001) and had significantly (p?p?p?p?=?0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p?=?0.033 and p?=?0.040, respectively) and be surgical or medical specialists (p?=?0.010 and p?相似文献   

5.
IRB Becomes E&HR     
In January 2019, under the new name Ethics & Human Research, The Hastings Center relaunched its forty‐year‐old journal that focuses on the ethical, regulatory, and policy issues related to research with humans. Formerly called IRB: Ethics & Human Research, E&HR has the same editorial team, led by the Hastings scholar Karen Maschke, and is meant to continue the work of IRB but will also feature a greater range of scholarship on issues in science and health care that have implications for research with humans. While E&HR is formally a continuation of IRB, it feels like a new journal. It is similar in design and format to its sister journal, the Hastings Center Report, and it has a closely linked channel for publication and distribution. Like HCR, it is published through John Wiley & Sons in both paper and electronic formats. Its home on the Wiley Online Library is https://onlinelibrary.wiley.com/journal/25782363 .  相似文献   

6.
Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed whether feedback was provided on the intended roles and explored differences in quality of written feedback.

Methods: In the feedback system, CanMEDS roles were assigned to five authentic situations: Patient Encounter, Morning Report, On-call, CAT, and Oral Presentation. Quality of feedback was operationalized as specificity and inclusion of strengths and improvement points. Differences in specificity between roles were tested with Mann–Whitney U tests with a Bonferroni correction (α?=?0.003).

Results: Supervisors (n?=?126) provided residents (n?=?120) with feedback (591 times). Feedback was provided on the intended roles, most frequently on Scholar (78%) and Communicator (71%); least on Manager (47%), and Collaborator (56%). Strengths (78%) were mentioned more frequently than improvement points (52%), which were lacking in 40% of the feedback on Manager, Professional, and Collaborator. Feedback on Scholar was more frequently (p?=?0.000) and on Reflective Professional was less frequently (p?=?0.003) specific.

Discussion and conclusion: Assigning roles to authentic situations guides supervisors in providing feedback on different CanMEDS roles. We recommend additional supervisor training on how to observe and evaluate the roles.  相似文献   

7.
Abstract

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.

Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n?=?34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.

Results: Students rated in-class time higher than a lecture-based segment of the same course (p?=?0.028). Assessment of achievement emotions demonstrated increased enjoyment (p?=?0.028) and decreased boredom (p?<?0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2?min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n?=?35), students in the FC curriculum scored significantly higher on clinical vignette questions (p?=?0.019) with equivalent performance on other question formats.

Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.  相似文献   

8.
Background: Delayed study progress in medical school is a challenging issue for the tax paying community, the faculty and the medical students themselves. Reasons for a delay might be different from known risk factors for academic difficulties.

Methods: An online survey regarding delays in the study progress and including a personality test (BFI-10) was presented to medical students from four German medical schools after completion of their 3rd year of study.

Results: Of 617 students, 51.2% reported a mean delay of 2.1?±?1.5 semesters. Frequent risk factors were secondary employment (69.5%, odds ratio (OR) 1.7, p?=?0.004), female gender (69.8%, OR 1.6, p?=?0.007), work or study abroad (35.9%, OR 1.5, p?=?0.02), a late graduation (5.9%, OR 2.4, p?=?0.02), as well as support through scholarship or mentoring (19.9%, OR 1.8, p?=?0.004). “Working on doctoral thesis” (11.3%, OR 1.9, p?=?0.03) and structural curricular issues (36.6%, OR 0.9, p?=?0.7) were frequently identified as obstacles. “Support by friends/family” was considered helpful by 24.1% (OR 1.4, p?=?0.09), as well as a high intrinsic motivation (19.1%, OR 0.5, p?=?0.01). In the BFI-10, students with study delay were more prone to openness and agreeableness.

Conclusions: Risk factors for delay are not identical to those for academic difficulties. To decrease the risk for delays, firm curricular structures should be identified and alleviated. Intrinsic motivation is a strong impetus of study progress and additionally might be strengthened by curricular changes.  相似文献   

9.
Purpose: We investigated the effect of Team-Based Learning (TBL) on long-term retention of knowledge in comparison to a traditional curriculum.

Methods: As TBL was incorporated into our curriculum in the 2008–2009 academic year, students were compared with those who received the traditional curriculum the year prior. Students in both the groups completed multiple-choice knowledge test at four time points spanning two years. Test performance was compared at each time point to assess changes in knowledge retention as a function of time.

Results: Baseline knowledge did not differ significantly between the TBL and control groups [51% versus 46%; t(84)?=?0.91, p?=?0.37, d?=?0.20]. Performance improved after the course for both the groups, but was significantly higher in the TBL group [79% versus 59%; t(84)?=?4.96, p?=?0.000004, d?=?0.95]. However, when assessed prior to the pediatrics clerkship, learning gains from TBL had largely disappeared and the small difference in performance was not significant [57% versus 51%; t(84)?=?1.51, p?=?0.14, d?=?0.32].

Conclusion: Incorporating TBL into the pre-clinical pediatrics curriculum led to large gains in knowledge over the short-term, but these gains did not persist. Further research should focus on extending the impact of TBL on long-term knowledge retention.  相似文献   

10.
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.  相似文献   

11.
Context: Little is known about best practices for teaching and learning leadership through Team-Based learning? (TBL?) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework.

Method: The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n?=?20 teams) and the other received only TBL (n?=?19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions.

Results: Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p?=?0.6), 2 (p?=?1) or 3 (p?=?1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p?=?0.77), 2 (p?=?0.23), or 3 (p?=?0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T?=??8.55, p?>?0.001 adjusted on baseline; T?=??8.55, p?>?0.001 adjusted on gender).

Discussion and conclusion: We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.  相似文献   

12.
Background: Simulated office orals (SOOs) are used by the College of Family Physicians of Canada as a method to evaluate family medicine resident readiness for clinical practice. The use of SOOs as a progress test would provide residency programs with useful information to determine resident readiness for challenging the certification exam. The data from a progress test could then be easily manipulated to generate a risk assessment plot.

Methods: During a prospective cohort study conducted at the University of Ottawa, the feasibility of using practice SOO sessions, a structured clinical exam, as a progress test was explored. Twenty-three residents participated in all four practice SOO sessions and their results were entered into a risk assessment plot.

Results: Repeated measures analysis of the data using ANOVA demonstrated that the residents’ scores at each time point were statistically different from each other, generating an F(3, 66)?=?27.52, p?<?0.001, η2?=?0.55.and that the relationship over time was linear with an F(1, 22)?=?123.80, p?<?0.001, η2?=?0.85. At the final time point, a risk assessment resulted in no learners mapping to quadrants III or IV.

Conclusions: Our results demonstrate the feasibility of utilizing a SOO exam, a clinical exam, as a progress test. In addition, we propose generating a risk assessment plot, using the data from the Fall 2013 and Spring 2014 practice SOO sessions, as a means of identifying residents at risk. Further studies will be needed to confirm the utility of this analysis. Combined with other measures acquired during in-training evaluation, the utilization of practice SOOs as a progress test will provide program directors with valuable information on resident progression.  相似文献   

13.
Abstract

Purpose: Propose a framework for planning and undertaking an international elective.

Methods: On returning from conducting maternal health and well-being research in several remote communities in India, two undergraduate medical students have reflected on and documented their experiences with the view to assisting other students (and their supervisors) considering undertaking an international elective.

Results: A framework for undertaking clinical or research electives in remote or rural communities is presented. The framework comprises three distinct phases: Pre-departure planning and briefing, in-country experiences and returning from the elective and considers a range of factors to ensure that, as a minimum, visiting students “do no harm” and are themselves not harmed.

Conclusions: Students’ home institutions have a duty of care for preparing them for their international electives by providing pre-departure training, support during the elective and comprehensive de-briefing on their return. These electives should be evaluated (including by host communities) to ensure that exchanges are socially accountable, with no harm to the often-vulnerable communities in which students gain considerable experience. Also important is that future students build on the positive experiences of their predecessors to ensure sustainability of any interventions in host communities.  相似文献   

14.
Abstract

Purpose: Compare time (speed) and product quality goals in a surgical procedural task.

Methods: Secondary school students participating in a medical simulation-based training activity participated in a randomized experiment. Each participant completed eight repetitions of a blood vessel ligation. Once, between repetitions four and five, each participant received a randomly-assigned speed goal or quality goal. Outcomes included time and leak-free ligatures.

Results: 80 students participated. The speed-goal group performed 18% faster on the final repetition than the quality-goal group, with adjusted fold change (FC) 0.82 (95% confidence interval [CI], 0.71, 0.94; p?=?0.01). Conversely, the speed-goal group had fewer high-quality (leak-free) ligatures (odds ratio [OR] 0.36 [95% CI, 0.22, 0.58; p?<?0.001]). For the quality-goal group, leaky ligatures took longer post-intervention than leak-free ligatures (FC 1.09 [95% CI, 1.02, 1.17; p?=?0.01]), whereas average times for leaky and leak-free ligatures were similar for the speed-goal group (FC 0.97 [95% CI, 0.91, 1.04; p?=?0.38]). For a given performance time, the speed-goal group had more leaks post-intervention than the quality-goal group (OR 3.35 [95% CI, 1.58, 7.10; p?=?0.002]).

Conclusions: Speed and quality goals promote different learning processes and outcomes among novices. Use of both speed and quality goals may facilitate more effective and efficient learning.  相似文献   

15.
Background: In an attempt to address severe medical manpower shortages in several medical disciplines, the Israeli Ministry of Health offered grants to residents who chose one of these fields.

Methods: A total of 220 residents from various disciplines were surveyed on demographic, academic, and professional data, and asked to rank considerations in the choice of their field of residency.

Results: Residents in targeted fields attributed significantly more importance to the grant in their decision-making process (U?=?3704.5, p?p?p?=?0.031) and attribution of significance to the working conditions compared to other residency fields (OR 1.69, 95%CI 1.23–2.32, p?=?0.001) were significantly associated with receptivity toward the grant in a multivariate analysis.

Discussion: Receptivity toward the offered grants correlated with real-life data shows a rise in physician in these fields, and the weak association between such receptivity and most variables tested may suggest that the grants were perceived as a property of the specific choice rather than a special bonus.

Conclusions: Grants may be useful in diverting medical manpower. Further analysis and modeling are required to determine causal relationship and budgetary feasibility.  相似文献   

16.
17.
Introduction: Script concordance testing (SCT) is a method of assessment of clinical reasoning. We developed a new type of SCT case design, the evolving SCT (E-SCT), whereby the patient’s clinical story is “evolving” and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear.

Objectives: We aimed to: (1) determine whether an E-SCT could differentiate clinical reasoning ability among junior residents (JR), senior residents (SR), and pediatricians, (2) evaluate the reliability of an E-SCT, and (3) obtain qualitative feedback from participants to help inform the potential acceptability of the E-SCT.

Methods: A 12-case E-SCT, embedded within a 24-case pediatric SCT (PaedSCT), was administered to 91 pediatric residents (JR: n?=?50; SR: n?=?41). A total of 21 pediatricians served on the panel of experts (POE). A one-way analysis of variance (ANOVA) was conducted across the levels of experience. Participants’ feedback on the E-SCT was obtained with a post-test survey and analyzed using two methods: percentage preference and thematic analysis.

Results: Statistical differences existed across levels of training: F?=?19.31 (df?=?2); p?p?p?p?α) was 0.83. Participants found the E-SCT engaging, easy to follow and true to the daily clinical decision-making process.

Conclusions: The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real-life clinical reasoning and decision-making processes. We suggest that further refinement and utilization of the evolving style case will enhance SCT as a robust, engaging, and relevant method for the assessment of clinical reasoning.  相似文献   

18.
We are pleased to inaugurate a new feature to appear three times annually. “ Capital Report ” is designed to keep readers abreast of bioethics debates in Congress, federal agencies, and other branches of the federal government. Tabitha M. Powledge , a former Center associate, brings to the Report her experience as founding editor of The Scientist and as editor of AAAS Observer. Ms. Powledge is currently a contributing editor to Issues in Science and Technology.  相似文献   

19.
Purpose: Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants’ learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics.

Materials and methods: Cross-sectional study of all participants (n?=?393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data.

Results: A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p?=?0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%).

Conclusions: Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.  相似文献   

20.
Purpose: The purpose of this study was to explore the use of an objective structured clinical examination for Internal Medicine residents (IM-OSCE) as a progress test for clinical skills.

Methods: Data from eight administrations of an IM-OSCE were analyzed retrospectively. Data were scaled to a mean of 500 and standard deviation (SD) of 100. A time-based comparison, treating post-graduate year (PGY) as a repeated-measures factor, was used to determine how residents’ performance progressed over time.

Results: Residents’ total IM-OSCE scores (n?=?244) increased over training from a mean of 445 (SD?=?84) in PGY-1 to 534 (SD?=?71) in PGY-3 (p?<?0.001). In an analysis of sub-scores, including only those who participated in the IM OSCE for all three years of training (n?=?46), mean structured oral scores increased from 464 (SD?=?92) to 533 (SD?=?83) (p?<?0.001), physical examination scores increased from 464 (SD?=?82) to 520 (SD?=?75) (p?<?0.001), and procedural skills increased from 495 (SD?=?99) to 555 (SD?=?67) (p?=?0.033). There was no significant change in communication scores (p?=?0.97).

Conclusions: The IM-OSCE can be used to demonstrate progression of clinical skills throughout residency training. Although most of the clinical skills assessed improved as residents progressed through their training, communication skills did not appear to change.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号