Self-planned experimentation (SPEX) practical classes in physiology

A new form of undergraduate physiology practical experience is described. Students make their acquaintance with the physiological apparatus in the usual manner. At the end of the afternoon each group of four students is allocated an item of equipment with which to perform a true investigative experiment of their own choice, in their own time, the results of which are to be presented 2 weeks later by a randomly chosen member of the group. Students may investigate any question that can be answered using the resources available to them without endangering themselves or their subjects. Marks are awarded for the planning of the experiment (i.e. choice of controls, etc.), the correctness of graphical presentation of the results, the appropriateness of the statistical analysis, and for the discussion. There are no penalties for negative or unexpected results.     

Anatomical dissection as a teaching method in medical school: a review of the evidence

CONTEXT: Discussions about dissection as a teaching method in gross anatomy are characterised by a lack of objective evidence. METHODS: A search for such evidence in the literature produced 14 relevant papers. These were reviewed for objective data on the effect of cadaver dissection on cognitive learning outcomes. RESULTS: All reviewed studies compared groups of students exposed to different teaching approaches, including active dissection, learning on prosected material, or a combination with computerised teaching aids. Study and course designs varied substantially and student groups compared were not always homogeneous. In all studies, compared learning experiences differed in more than 1 variable, and assessment of anatomical knowledge was not standardised. DISCUSSION: It is difficult to interpret and generalise from the results of the reviewed studies. Considering the bias that must be assumed for teachers who develop new course designs and compare these with traditional ones, the review shows a slight advantage for traditional dissection over prosection. CONCLUSIONS: More sophisticated research designs may be necessary to solve the general problem of the small measurable impact of educational interventions and to come to scientifically sound conclusions about the best way to teach gross anatomy. Such research will have to include sufficient sample sizes, the use of validated assessment instruments, and a discussion of the educational significance of measured differences. More educational research in anatomy is necessary to counterbalance emotional arguments about dissection with scientific evidence. Anatomical knowledge is too important to future doctors to leave its teaching to the educational fashion of the day.     

The effect of practical training in obstetrics among medical students: symphysis–fundal height measurements

In a study to evaluate the repeatability of symphysis-fundal (SF) height measurements by medical students, and the effect of practical training in obstetrics on this repeatability eight medical students and an obstetrician initially measured the SF height three times each in six pregnant women. The students were then split into two groups: a training group and a control group. After a training period at the University Hospital in Trondheim, another series of measurements were taken on another group of pregnant women. For comparison of results analysis of variance was used. Within and between observer variation are presented, and the results showed that the practical training had a positive effect on the repeatability of SF height measurements.     

Training of general practitioners in interpreting chest radiographs

Easily accessible chest and skeleton roentgen examinations are needed in primary health care. In Finland the health centres perform about a third of all roentgen examinations. Many of the films are interpreted by health centre doctors at least in the primary phase. About 40% of them are chest radiographs. In 2640 chest radiographs interpreted by general practitioners the final roentgen diagnosis was pathological in 54%. Pathological conditions were totally overlooked in 13%. Of normal cases 19% were interpreted falsely positive. The greatest need for general practitioners' training is in the common findings in the chest, for example cardiac insufficiency and inflammatory as well as atelectatic changes in the lungs. Pulmonary findings in children proved difficult to interpret and were proposed as a subject for training. The role of poor image quality in interpretation errors must be emphasized when less experienced doctors interpret chest films. If regular radiological consultation is not available, postgraduate training in diagnostics of chest radiographs should be considered in the training of specialists in general practice as well as in their supplementary training.     

The assessment of an examination in pathology consisting of multiple-choice, practical and short essay questions

The rationale for assessing medical students' achievement in pathology with examinations consisting of multiple-choice, practical and short essay items is provided. In addition, these three-part examinations are assessed with reference to their reliabilities and their content, criterion and construct validities.     

Factors in faculty evaluation of medical students' performance

CONTEXT: Faculty members often use global rating scales as a method of assessing various characteristics of medical students' clinical performance. The purpose of this study was to determine if some performance characteristics are more highly associated with the overall faculty grade than others. METHODS: The clinical performance of 211 surgery clerkship students was evaluated by 2 or 3 faculty preceptors. Faculty rated students on 10 specific performance characteristics, using a 5-point scale. Faculty then assigned a numerical grade summarising the faculty's view of the student's performance. Reliability of the ratings was estimated by the intraclass correlation, and 1-way (analysis of variance) anova was used to test for differences among the students' mean ratings. Logistic regression was employed to determine the accuracy of each performance measure in predicting students' grades (A or B). Stepwise logistic regression was used to determine if there was a combination of performance characteristics that best predicted students' grades. RESULTS: The inter-rater reliabilities were low (相似文献   

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

Undergraduate teaching of geriatric medicine in the United Kingdom: changes in the years 1981-1986

A follow-up survey of undergraduate teaching of geriatric medicine was carried out in 1986. All 27 clinical medical schools responded. Geriatric medicine is taught to all medical students in 25 and to only a proportion of students in two. Fifty-nine per cent of schools have academic departments teaching for a mean of 89 hours compared with 33 hours in non-academic departments--an overall mean of 68 hours. The subject is taught by various methods with 70% of teaching time spent on bedside clinical instruction. Other aspects of institutional and community care are often covered. The subject is examined in 18 schools. New academic departments are planned at four schools, and an increase in teaching time planned in five. To meet the needs of the population of the next century, reconsideration of curricula in some of the medical schools is recommended.     

Assessment of laboratory exercises in physiology†

Assessment is an integral part of the teaching-learning process. It contributes to the realization of learning objectives by inculcating habits which are conducive to better scores in the examination. A system of assessing laboratory work which combines the performance of experiments by the student with some short questions based on an instrument, experimental data or tracing has been critically examined. The performance of the student in the two parts of the examination is poorly correlated (r=0.36 to 0.72), suggesting that they test different abilities, and that combining them may improve the objectivity of the examination. The overall practical assessment is better correlated with the overall theory assessment (r=0.71, 0.87). The correlation between different forms of examination also improves when only the top 10% and bottom 10% of the class is considered. Since the results quoted are based on only a few examinations at a single medical school, generalizations are not justified.     

Student perceptions of medico-legal autopsy demonstrations in a student-centred curriculum

Objectives  Teaching autopsies in undergraduate medicine, although traditionally considered valuable by both educators and students, have been marginalised in modern curricula. This study explored medical students' experiences of the medico-legal autopsy demonstrations which formed part of their training in forensic medicine.
Methods  In this phenomenological study, qualitative data obtained by interviewing 10 Year 4 medical students from various socio-cultural backgrounds were interpretively examined. One-to-one, semi-structured interviews were tape-recorded and transcribed. The data were thematically organised and then analysed using a theoretical framework of three dimensions of learning, namely, cognitive, emotional and societal.
Results  Students still perceive autopsies as essential even in the context of self-directed learning. They identified a better understanding of anatomy and traumatology as the main cognitive benefits. At an emotional level students felt they had developed a degree of clinical detachment and would be better equipped to deal with issues surrounding death. Although socialisation influenced students' feelings about the autopsy, it did not detract from their appreciation of the educational value of the experience.
Conclusions  The results support previous findings from both students, prior to curriculum reform, and medical educators who were canvassed for their opinions in relation to a modern curriculum. Besides the obvious cognitive advantages, educators should be mindful of the hidden curriculum that emanates from autopsies because it impacts on the development of professionalism and ethical behaviours of future medical practitioners.     

Medical students' attitudes towards and perception of the basic sciences: a comparison between students in the old and the new curriculum at the University Medical Center Utrecht,The Netherlands

OBJECTIVES: The attitudes towards the basic sciences of medical students enrolled in either of 2 different curricula at the University of Utrecht Medical School in The Netherlands were investigated. The purpose of this study was threefold: first, to compare students (beginning clerks) in a conventional and an innovative curriculum; second, to compare beginning clerks with advanced clerks; and third to compare the present results with those of 2 previous American and Canadian studies in which the same questionnaire was used. SETTING: Beginning clerks in the old and in the innovative curriculum, and advanced clerks in the old curriculum, rated 9 statements on a 5-point (disagree - agree) Likert scale. The statements assessed students' attitudes toward the basic sciences. RESULTS: The results showed that beginning clerks in our innovative curriculum, unlike those in a conventional curriculum, consider the basic sciences as somewhat less important for medical practice and do not think that as many biomedical facts as possible should be learned before entering clinical practice. On the other hand, students in the innovative curriculum are more excited by the faculty's teaching of the basic sciences. This latter result confirms the findings in a previous Canadian study. No significant differences were found between beginning and advanced clerks in the conventional curriculum. CONCLUSION: Students experience teaching of the basic sciences as more exciting when they are integrated in organ system blocks with clinical bearings, though they are somewhat less positive about the actual importance of these sciences.     

Is insight important? Measuring capacity to change performance

BACKGROUND: Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills - that is, maintain their 'currency' of practice - requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self-regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties. OBJECTIVE: This paper presents an exploration into the nature of insight, its relationship to professional performance and its measurement as part of performance, reflecting the combined experiences of a group of experienced education researchers and the results of literature searches on insight and performance. CONCLUSION: There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed.     

The determination of the relevance of basic sciences learning objectives to clinical practice using a questionnaire survey

OBJECTIVES: Facilitating sufficient understanding of the basic sciences to underpin clinical practice is important in producing the good doctor. However, the inclusion of irrelevant material in the curriculum not only wastes valuable learning time, but may also hinder learning. The aim of this study was to determine how relevant staff and students thought respiratory basic science learning objectives were to medical practice. DESIGN: The study involved a survey using an anonymous questionnaire to determine whether the respiratory learning objectives stated in Year 1 were perceived as relevant to clinical practice. Each learning objective was rated as being 'relevant', 'not relevant' or of 'uncertain relevance'. SETTING: Dundee Medical School, UK. SUBJECTS: Junior and senior students and staff. RESULTS: Year 1 students considered the majority of the learning objectives to be relevant to clinical practice. Staff and senior students identified some respiratory learning objectives as not relevant to clinical practice, most of which were related to biochemistry. CONCLUSIONS: The identification of learning objectives with questionable relevance to clinical practice requires careful consideration to determine whether these should be removed from the course. Attention needs to be given to both the presentation and process by which material is delivered to students. Strategies to emphasise the clinical relevance of the basic sciences to students are discussed. Further research needs to be conducted to evaluate what knowledge is essential for producing good doctors.     

Influence of open- and closed-book tests on medical students' learning approaches

Context Two learning approaches are consistently distinguished in the literature: deep and surface learning. The deep learning approach is considered preferable. Open‐book tests are expected to stimulate deep learning and to offer a possible way of handling the substantial growth in medical knowledge. In this study we test the hypothesis that open‐book tests stimulate deep learning more than closed‐book tests. Methods Medical students in Years 2 (n = 423) and 3 (n = 306) participated in this study. They evaluated their preparation for open‐ and closed‐book tests using the test for Deep Information Processing (DIP). This questionnaire consists of 24 items divided into three subscales: Critical Reading; Broaden One's Context, and Structuring. A paired t‐test was used to analyse the data. Results Both cohorts scored significantly higher when preparing for closed‐book tests for the overall DIP score and on the Broaden One’s Context and Structuring scales. Year 3 students also scored significantly higher on the Critical Reading scale when preparing for closed‐book tests. Gender differences were found: women used deeper learning approaches than men. Conclusions Our hypothesis was not supported. In fact, the opposite was found: closed‐book tests stimulated a deep learning approach more than open‐book tests. Three possible explanations are: deep learning is particularly necessary for remembering and recalling knowledge; students feel more confident when preparing for closed‐book tests, and students are more motivated to study for closed‐book tests. The debate on the concept of deep learning in higher education should probably be renewed.     

A survey of clinical teaching fellowships in UK medical schools

CONTEXT: Undergraduate medical education in the UK has changed considerably over the last decade. One development has involved the creation of teaching-specific posts for junior doctors by medical schools. These posts are generally termed 'clinical teaching fellowships', but it is not known how many of them exist, or whether they are similar in terms of educational activities, professional development, and research and clinical experience opportunities. METHODS: Teaching deans in all UK medical schools were sent a questionnaire relating to clinical teaching fellowships, and were asked to distribute a second set of different questionnaires to their clinical teaching fellows, which were to be returned to the authors separately. RESULTS: A total of 28 deans and 46 fellows responded. Fifteen medical schools had clinical teaching fellows and there appeared to be a total of 77 such posts in the UK. There was little uniformity in the activities undertaken within the posts. Deans who employed clinical teaching fellows were unanimously positive regarding the posts. Fellows were generally positive but expressed reservations relating to approval for postgraduate training, career development, deterioration in clinical skills, financial disincentives, credibility within one's own specialty, and provision of training and support. CONCLUSIONS: Clinical teaching fellow posts are generally enjoyed by fellows and valued by deans. Fellows carry out differing duties and their training in medical education is variable. The posts can be unstructured and may lack credibility to doctors outside medical education. Providing specific structured training in medical education, recognised at a national level, would help deal with these concerns.     

Item response theory: applications of modern test theory in medical education

CONTEXT: Item response theory (IRT) measurement models are discussed in the context of their potential usefulness in various medical education settings such as assessment of achievement and evaluation of clinical performance. PURPOSE: The purpose of this article is to compare and contrast IRT measurement with the more familiar classical measurement theory (CMT) and to explore the benefits of IRT applications in typical medical education settings. SUMMARY: CMT, the more common measurement model used in medical education, is straightforward and intuitive. Its limitation is that it is sample-dependent, in that all statistics are confounded with the particular sample of examinees who completed the assessment. Examinee scores from IRT are independent of the particular sample of test questions or assessment stimuli. Also, item characteristics, such as item difficulty, are independent of the particular sample of examinees. The IRT characteristic of invariance permits easy equating of examination scores, which places scores on a constant measurement scale and permits the legitimate comparison of student ability change over time. Three common IRT models and their statistical assumptions are discussed. IRT applications in computer-adaptive testing and as a method useful for adjusting rater error in clinical performance assessments are overviewed. CONCLUSIONS: IRT measurement is a powerful tool used to solve a major problem of CMT, that is, the confounding of examinee ability with item characteristics. IRT measurement addresses important issues in medical education, such as eliminating rater error from performance assessments.     

Portfolio learning for foundation doctors: early feedback on its use in the clinical workplace

CONTEXT: A learning portfolio was developed to support the development of trainee doctors piloting Foundation Programme prototypes across the Northern Deanery in 2004 and 2005. Trainee doctors and their educational supervisors were surveyed about their experiences of using the portfolio in the clinical workplace. METHODS: The evaluation consisted of semi-structured interviews with trainee doctors and supervisors, followed by postal questionnaire surveys in 2004 and 2005. Quantitative and qualitative data were triangulated to identify core findings. RESULTS: Questionnaires were returned from 182/305 (60%) trainee doctors and 104 out of 179 (58%) educational supervisors. The portfolio was felt to be a 'good idea' by 55% supervisors and 48% trainees. Trainees' perceptions of the educational value of the portfolio remained consistently low over 2 surveys and they described a sense of 'burden', whereby they identified problems in workload and usability and in gaining feedback on performance. However, positive trainee attitudes towards the portfolio were significantly correlated with greater perceived educational benefits (r = 0.855, P < 0.001). DISCUSSION: Learning portfolios are now an integral part of Foundation Programme training but this evaluation suggests that many trainee doctors and educational supervisors are yet to be convinced of their educational value. Gaining multi-source feedback, a substantial component of trainee doctors' portfolios, impacts on the wider clinical team and presents a significant challenge to trainees. Educational supervisors continued to rely on feedback from clinical colleagues, rather than portfolio evidence, to monitor trainee doctors' development. Such factors may serve to disengage trainees with the portfolio process by overshadowing any perceived educational gains.     

The benefits of flexibility: the pedagogical value of instructions to adopt multifaceted diagnostic reasoning strategies

Objectives Building on the advice of previous research to avoid parsing diagnostic strategies too finely, recent studies have shown that teaching novices to utilise analytic and non‐analytic reasoning strategies yields higher diagnostic accuracy than teaching either in isolation. This study assesses the extent to which students spontaneously adopt a combined approach and compares its benefits with those experienced with a contrastive learning strategy known to enhance analogical transfer. Methods A sample of 48 naïve students were trained to identify features on electrocardiograms (ECGs) and assign diagnoses. Half the participants learned in a standard manner, encountering diagnoses (and their associated features) in sequence. The remaining participants were explicitly instructed to draw comparisons between the diagnostic category being learned and another confusable diagnostic category (contrastive learning). Half the participants in both groups were further instructed to carefully identify all features while trusting guidance provided by feelings of familiarity (a combined reasoning strategy). The remaining participants were given no instructions on how to approach the diagnostic task. Results Greater diagnostic accuracy was achieved following both contrastive learning and instructions to use a combined reasoning strategy relative to the control conditions. These variables did not interact with each other, nor did they interact with novelty of the test case. The effects were observed immediately after learning and following a 1‐week delay. Discussion The results emphasise the importance of explicitly empowering students to utilise multiple diagnostic strategies, including non‐analytic approaches. In addition, this study reveals the benefit that can be gained from contrastive learning in a medical domain.