Andragogy and medical education: are medical students internally motivated to learn?

Andragogy – the study of adult education – has been endorsed by many medical educators throughout North America. There remains, however, considerable controversy as to the validity and utility of adult education principles as espoused by the field's founder, Malcolm Knowles. Whatever the utility of andragogic doctrine in general education settings, there is reason to doubt its wholesale applicability to the training of medical professionals. Malcolm Knowles' last tenet of andragogy holds that adult learners are more motivated by internal than by external factors. The validity of this hypothesis in medical education is examined, and it is demonstrated that medical students' internal and external motivation are context-dependent, not easily distinguishable, and interrelate with one another in complex ways. Furthermore, the psychological motivation for medical student learning is determined by a variety of factors that range from internal to external, unconscious to conscious, and individual to societal. The andragogic hypothesis of increased internal motivation to learn on the part of adults in general, and medical trainees in particular, is rejected as simplistic, misleading, and counter productive to developing a greater understanding of the forces that drive medical students to learn. This revised version was published online in June 2006 with corrections to the Cover Date.     

Realist methods in medical education research: what are they and what can they contribute?

Medical Education 2012: 46: 89–96 Context Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the ‘how’ and ‘why’ questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts. Methods One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research). Discussion The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.     

Hospitalist programs: are they good for your practice?

With the changes brought about in health care delivery by the growth of Managed Care, the attractions of hospitalist programs are becoming increasingly evident. As the programs have grown in usage, and program models have evolved from mandatory to voluntary, primary care physicians (PCPs) and independent practice organizations (IPAs) have begun to recognize their positive impact on their practices, from both financial and logistic perspectives, as well from those of patient care. This article discusses that effect and reviews the procedures and ramifications of one of the newer program models. Quality of patient care and the provision of successful outcomes via clinical guidelines are addressed as indications of successful hospitalist programs.     

Report cards: how relevant are they for patients?

Two advocates for providing consumers the information they need to make informed choices among HMOs point out that the data being gathered for purchasers and others steeped in health plan analyses have little meaning for the end user. Foundation for Accountability President David Lansky, Ph.D., and PacifiCare's Vice President of Health Services Sam Ho, M.D., discuss the outcomes information consumers need, the style they need it in and the steps being having taken to ensure they get it.     

Cellular phones: are they detrimental?

The issue of possible health effects of cellular phones is very much alive in the public's mind where the rapid increase in the number of the users of cell phones in the last decade has increased the exposure of people to the electromagnetic fields (EMFs). Health consequences of long term use of mobile phones are not known in detail but available data indicates the development of non specific annoying symptoms on acute exposure to mobile phone radiations. In an attempt to determine the prevalence of such cell phones associated health manifestations and the factors affecting their occurrence, a cross sectional study was conducted in five randomly selected faculties of Alexandria University. Where, 300 individuals including teaching staff, students and literate employee were equally allocated and randomly selected among the five faculties. Data about mobile phone's users and their medical history, their pattern of mobile usage and the possible deleterious health manifestations associated with cellular phone use was collected. The results revealed 68% prevalence of mobile phone usage, nearly three quarters of them (72.5%) were complainers of the health manifestations. They suffered from headache (43%), earache (38.3%), sense of fatigue (31.6%), sleep disturbance (29.5%), concentration difficulty (28.5%) and face burning sensation (19.2%). Both univariate and multivariate analysis were consistent in their findings. Symptomatic users were found to have significantly higher frequency of calls/day, longer call duration and longer total duration of mobile phone usage/day than non symptomatic users. For headache both call duration and frequency of calls/day were the significant predicting factors for its occurrence (chi2 = 18.208, p = 0.0001). For earache, in addition to call duration, the longer period of owning the mobile phone were significant predictors (chi2 = 16.996, p = 0.0002). Sense of fatigue was significantly affected by both call duration and age of the user (chi2 = 24.214, p = 0.0000), while burning sensation was only affected by frequency of calls/day (chi2 = 5.360, p = 0.020). According to the 95% confidence interval of frequency and duration of calls, the study recommended not to increase the call duration more than four minutes and limit their frequency to less than seven calls/day with total duration of exposure less than 22 min./day.     

Teaching medical students - what's in it for teachers?

The term 'doctor' comes from the Latin 'docere' meaning 'to teach'. Although few general practitioners have formal teaching skills or qualifications, we are all involved in teaching patients every day. The importance of our role as educators has been recognised for a long time, with the first statements of the Hippocratic Oath dealing with respect for our teachers and our duty to pass our knowledge on to others.