Teaching medical students alcohol intervention skills: results of a controlled trial

OBJECTIVE: To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills. DESIGN: In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experimental students made a 20-min videotape and participated in a 1.5-h small group feedback session. Prior to and after training, all students completed questionnaires and videotaped interviews with simulated patients. SETTING: Faculty of Medicine and Health Sciences of the University of Newcastle, Australia. SUBJECTS: Final-year medical students. RESULTS: Levels of alcohol-related knowledge, attitudes and interactional skills as well as general interactional skills were significantly improved after teaching. Alcohol-related interactional skills that were unsatisfactory at pretest reached satisfactory standards at post-test. An intergroup comparison of the improvement between pre- and post-teaching scores indicated that there was no significant difference in the effectiveness of the two methods. CONCLUSIONS: Training can improve medical student performance in alcohol intervention. Further research is required to examine the relative effectiveness of different teaching methods.     

Epidemiology for medical students: a course relevant to clinical practice

A new course was designed to make epidemiology clinically relevant to medical undergraduates. The objectives were that students should (1) know the epidemiology of common diseases, (2) understand epidemiological concepts useful in diagnosis and treatment, and (3) be able to critically assess published medical evidence. Results of a written examination showed that objectives 1 and 2 had been 'easily' achieved by 80% and 68% of students respectively. Student opinion of the course, assessed by an anonymous questionnaire, showed that the majority of students considered the course to be an important part of medical education. Before the course 19% felt 'reasonably able' or 'very able' to achieve nine specific objectives related to epidemiological concepts in diagnosis and treatment. By the end of the course this had risen to 78%.     

Selection of medical students: a controlled experiment

Objectives  We aimed to discover, through a controlled experiment, whether cognitive and non-cognitive assessment would select higher-achieving applicants to medical school than selection by lottery.
Methods  We carried out a prospective cohort study to compare 389 medical students who had been admitted by selection and 938 students who had been admitted by weighted lottery, between 2001 and 2004. Main outcome measures were dropout rates, study rate (credits per year) and mean grade per first examination attempt per year. Study rates in the 4 pre-clinical years of medical school were used to categorise students' performance as average or optimal.
Results  Pre-admission variables did not differ between the two groups. The main outcome of the selection experiment was that relative risk for dropping out of medical school was 2.6 times lower for selected students than for lottery-admitted controls (95% confidence interval 1.59–4.17). Significant differences between the groups in the percentage of optimally performing students and grade point average for first examination attempts were found only in the 2001 cohort, when results favoured the selected group. The results of the selection process took into account both the assessment procedure involved and the number of students who withdrew voluntarily.
Conclusions  This is the first controlled study to show that assessing applicants' non-cognitive and cognitive abilities makes it possible to select students whose dropout rate will be lower than that of students admitted by lottery. The dropout rate in our overall cohort was 2.6 times lower in the selected group.     

Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial

Purpose Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer‐term memory? We investigated whether ‘spaced education’, consisting of weekly e‐mailed case scenarios and clinical questions, could improve the retention of students' learning. Methods During the 2004–5 surgery clerkships, 3rd‐year students completed a mandatory 1‐week clinical rotation in urology and validated web‐based teaching programme on 4 core urology topics. Spaced educational e‐mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple‐choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e‐mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28‐item test (Cronbach's α = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. Results A total of 95 of 133 students (71%) completed the end‐of‐year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end‐of‐year test scores (P < 0.001, paired t‐test). The impact of the spaced educational e‐mails was largest for those students who completed their urology education 6–8 and 9–11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). Conclusion Spaced education consisting of clinical scenarios and questions distributed weekly via e‐mail can significantly improve students' retention of medical knowledge.     

Health education poster: a teaching model for clinical medical students

Summary. The teaching of health education or health promotion to medical students is often difficult because they have little experience on which to base their learning. They have limited clinical knowledge and in particular their awareness of the value of and the opportunities for health promotion in general practice is limited. The problem-oriented teaching method described here attempts to make the subject interesting and relevant by asking students, while in their practice attachments, to identify areas of need for health promotion or health education and then to prepare a poster, with supportive background and research, to satisfy that need for display in their given practice.     

Self-instructional teaching of biostatistics for medical students

A growing body of literature deals with the use of self-instructional methods for teaching biostatistics to medical students. The University of Tennessee Department of Community Medicine tested the hypothesis that, in controlled, randomized situations, learning of statistical material by self-instruction is equivalent to learning identical material by the lecture method. An analysis of student performance, in terms of the grades obtained on two separate examinations, showed that students learning by self-instruction did as well or better than their colleagues taking lectures. On the basis of these results, self-instructional biostatistics for medical students at the University of Tennessee has been selected as the major teaching method of that subject.Dr. Robinson is Professor and Chief of Biostatistics in the Department of Community Medicine, University of Tennessee College of Medicine, 800 Madison Avenue, Memphis, Tennessee 38163. Mr. Burke is Instructor in the Department of Community Medicine, University of Tennessee, and Director of Statistical Services in the Memphis and Shelby County Health Department. Dr. Stahl was Assistant Professor of Community Health and Medical Practice, Section of Health Care Studies, University of Missouri, Columbia, Missouri, during this study. He is currently Assistant Professor of Sociology, Purdue University, School of Humanities, Social Science and Education, Lafayette, Indiana. Requests for reprints should be addressed to Dr. Robinson. John W. Runyan, Jr., M.D., and Stephen T. Miller, M.D., of the Department of Community Medicine, University of Tennessee, made valuable suggestions during the preparation of this paper.     

Students teaching students: a medical school peer tutorial programme

A peer tutorial programme which is available to all first- and second-year medical students has been in operation at Case Western Reserve University School of Medicine since 1972. A retrospective study of the classes of 1982, 1983 and 1984 was undertaken to assess the participation levels in the tutorial programme and to compare the participation level to available performance parameters. The analysis revealed that 54% of the first-year classes and 22% of the second-year classes participated in the peer tutorial programme. X2 analysis of the data demonstrated that the relationship between participation in the tutorial programme and performance on examinations reached statistical significance. The results suggested that an open peer tutorial programme responded to the needs, both cognitive and affective, of medical students.     

Teaching clinical epidemiology: a controlled trial of two methods

The teaching of clinical epidemiology to second-year students at the Bowman Gray School of Medicine is carried out using journal articles to illustrate concepts. Because of the need for discussion, the instructors believed that the concepts of epidemiology might best be learned by, and that greater satisfaction with the learning process might be derived from, small group discussions rather than large lecture sessions. To test these hypotheses, students were randomized into either one of two discussion groups or a larger lecture group. The course handouts and text were identical, and the three instructors presented the same material successively to each group. In the final examination, all three groups answered approximately 26 of 36 questions correctly. Seventy percent of students responded to a questionnaire at the end of the course. There were no significant differences between the discussion and lecture groups in their ability to read and understand medical articles. However, the discussion group students were more favorable in their assessment of the success of the teaching method and in their perception of the importance and overall quality of the course. While there may be little difference in the short-term retention of epidemiological principles between the two teaching methods, the greater satisfaction reported by the students in the small groups will stimulate us to try to provide that type of learning environment in the future.     

Health care ethics teaching for medical students

This paper describes an innovatory teaching programme in health care ethics for medical undergraduates. The general aims and objectives are outlined and the 1990 course is discussed specifically. The course has several unusual features, including the use of performers and the presentation of ethically based decisionmaking implements, which are highlighted. The course is evaluated. The 1990 results are encouraging.     

Epidemiology course for medical students focuses on proposal writing

Teaching epidemiology to medical students is often seen as a difficult, if not impossible, task. After experimenting with several other approaches, faculty at the West Virginia University School of Medicine have developed a course centered around the production of a research proposal using National Institutes of Health criteria and format. The course content, while comprehensive, emphasizes the clinical uses of epidemiology. Lectures are combined with self-study and individualized teaching to assist the students as they explore their chosen topic. This problem-solving approach to teaching and learning epidemiology in medical school has proved both effective and more acceptable to students, as evidenced by the quality of their research proposals, National Medical Examination Board Scores, student evaluations, and improved faculty-student interaction.     

The use of a questionnaire on medical terms as a teaching tool for medical students

Several authors have administered multiple choice type questionnaires about the definition of some medical terms in order to determine the range of answers given by patients in general ( Seligmann, McGrath & Pratt, 1957 ; Boyle, 1970 ; Cottrill et al. , 1973 ) and by University students of varying disciplines in particular ( Tring & Hayes-Allen, 1973 ). Some have tried to elucidate the influence of such factors as the age, sex, educational level and social class of the patient on the level of knowledge ( Seligmann et al. , 1957 ; Samora, Saunders & Larson, 1961, 1962 ; Boyle, 1970 ; Cottrill et al. , 1973 ). Samora et al. (1961, 1962) asked patients to perform the more difficult task of explaining the terms in their own words. All have clearly indicated the fact that laymen may be aware of, or have misconceptions about, the meaning of medical terms.
This paper illustrates the use of such a questionnaire as a tool to: (a) indicate to both clinical and pre-clinical medical students the range of answers given by patients. The results show clearly the misunderstandings which may occur if such words are used in a clinical interview without ensuring that both participants attach the same meaning to the term; (b) teach survey techniques as a meaningful practical exercise rather than only in theory; (c) produce results in which the students are sufficiently interested that they want to analyse it by using the appropriate statistical techniques; and (d) show students that, even at entry to medical school, there is a gap in understanding between themselves and patients on some, but not all, terms. Hopefully, when these students reach the clinical part of their course they will remember their own ignorance and so be more sympathetic towards patients' lack of knowledge than if they had not completed such a questionnaire.