Education on-demand: the development of a simulator-based medical education service.

OBJECTIVES: Clinical medical education depends on the availability of instructive patient encounters, or "good teaching cases." While all medical students hope to see enough patients of sufficient scope and variety, exposure to good teaching cases has been traditionally limited by time and chance. Students may graduate from medical school without having seen a number of important cases, each of which may represent a knowledge gap they will carry forward into internship and future patient care. Recently, however, the advent of high-fidelity patient simulators has enabled instructors to recreate realistic patient scenarios in a standardized fashion. Using the simulator, we wanted to create a medical education service-like any other clinical teaching service, but designed exclusively to help students fill in the gaps in their own education, on demand. We hoped to mitigate the inherent variability of standard clinical teaching, and to augment areas of deficiency. DESCRIPTION: Using a Human Patient Simulator(TM) (Medical Education Technologies, Inc.), which is equipped with a transmitted voice and reactive eyes, chest movements and breath sounds, heart tones and palpable pulses, a multidisciplinary group of physicians and educators designed a simulator-based medical education service. The premise was that students should have the ability to realistically practice and discuss medicine with a physician-mentor at any time they wish, with full access to simulator-enabled cardiac monitoring, diagnostic resources, pharmacologic agents, and invasive procedures. Students were informed of the program by e-mail and by course instructors. A dedicated pager was established for the on-call physician-educator, and the number disseminated to students. Physician-educators included faculty members scheduled for dedicated teaching time, and senior residents participating in a medical education elective. On-call physicians were responsible for fielding educational requests, developing appropriate scenarios, and scheduling instructional time. Upon arriving at the skills lab for their appointments, students would proceed to interview, evaluate, and treat the mannequin-simulator as if it were a real patient, using the instructor for assistance as needed. All students participated in an educational debriefing after each session. Instructors could also request formal observation and feedback on their teaching style, in collaboration with an existing faculty development program. DISCUSSION: Students enjoy the opportunity to practice medicine on-demand with dedicated clinical mentoring by a practicing physician. Course directors are interested in scheduling simulator time to help bring to life tutorial-based teaching cases and other course material for their students. By offering a medical education elective for residents, we have bolstered the pool of available instructors, provided a valuable learning experience for residents as teachers, and fostered additional opportunities for collaboration between the medical school and clinical training sites. Customized, realistic clinical correlates are now readily available for students and teachers, allowing reliable access to "the good teaching case."     

《医学免疫学》外训课程的设置及教学体会

《医学免疫学》是现代高等医学教育的重要基础课程,是医学留学生的必修课。结合外训学生自身特点,量身定制免疫学外训课程,分析和总结外训教学的经验和体会,为学校更好地开展留学生培训,进一步提高外训学生的教学质量提供参考依据。     

Unique medical education programs at Nippon Medical School

In an attempt to improve the content of the educational programs offered by Nippon Medical School and to better prepare our students to work in the rapidly changing world of medicine, the school has recently revamped its teaching methodology. Particular emphasis has been placed on 1) simulator-based education involving the evaluation of students and residents in a new clinical simulation laboratory; 2) improving communication skills with the extensive help of simulated patients; 3) improving medical English education; 4) providing early clinical exposure with a one-week clinical nursing program for the first year students to increase student motivation at an early stage in their studies; 5) a new program called Novel Medical Science, which aims to introduce first-year students to the schools fundamental educational philosophy and thereby increase their motivation to become ideal physicians. The programs have been designed in line with 2006 guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology to allow flexibility for students to take part in education outside their own departments and year groups as part of the Ministry's program to encourage distinctive education at Japanese universities.     

Trial to stimulate learning motivation of medical students in the dissection practice "teaching assistant system"

At the Medical School of Chiba University, educational dissection tours have been conducted for intra- and extramural students in other programs, such as students of nursing. In the 2006 school year there were more than 1,500 students. As presented in a previous report, we tested an educational program in which our medical students teach other students parts of splanchnology, neurology, and myology to promote student understanding of human physiology through their own teaching. Since this system, termed the "teaching assistant system," was fairly laborious for many medical students, we attempted to improve it by decreasing the students' load and reducing the frequency of teaching from several times to once during the one-term dissection practice. We assessed the improved method with questionnaires for medical students who had studied at the school in 2006 and 2007 (n = 206) before and after teaching other students. The response rate for the questionnaires was 91.3% (n = 188). The results were as follows. (1) Most medical students (69.7%) realized that the task of teaching had stimulating effects on their own learning motivation. (2) According to most of their evaluations (80.4%), the duties of teaching involved in the previous assistant system were laborious. In contrast, the ratio of medical students who considered teaching to be laborious decreased by about half (55.3%) in the present improved system. (3) Most students (79.8%) were satisfied with the teaching assistant system. We concluded that the improved teaching assistant system was effective for the dissection practice.     

Using early clinical experiences to integrate quality-improvement learning into medical education.

Health care providers are delivering care in an increasingly complex environment; this requires that providers develop new competencies to better understand their work and to design changes that can help them succeed. Recognizing these new educational requirements, Dartmouth Medical School created a model two-pronged program for teaching quality improvement to its medical students. The goal of the program is to provide students with an active learning experience as well as an education in the theory and application of continuous quality improvement. The program includes two educational experiences: one curriculum is for all medical students and the other is for selected, highly motivated students. The first curriculum is incorporated in Dartmouth's required "On Doctoring" course, in which students spend time with community-based physician preceptors. The quality-improvement curriculum is designed around an improvement project developed at the students' preceptor sites. The second curriculum for students with a special interest in quality improvement is offered as an elective summer program between the first and second years of medical school. Working in groups of two, students identify an area for improvement within a preceptor's practice, assist the practice in articulating an improvement plan, help implement that plan, and write up their experiences. The authors describe the two curricula, factors associated with their successful implementation, and lessons learned.     

医学影像学专业《医学影像电子学》教学改革探讨

目的：医学影像学专业的《医学影像电子学》是从电子电路的分析、设计、仿真与调试出发,面向医学影像设备操作、安装与维修,开发与设计而设置的。文章针对这门课程实践性高的特点,鉴于目前的教学现状,提出了理论教学和实验教学的改革方法。方法：课程设置了理论教学,实验教学,课程设计,电子技术实训四个教学环节。应用计算机多媒体技术、网络技术、计算机辅助教学,自主开发研制了与教材相配套的多媒体教学课件实现《医学影像电子学》理论教学,增加了课程综合设计这一考核方式。将传统的硬件电子学实验与利用计算机软件进行的仿真实验有机地结合起来方法进行《医学影像电子学》实验教学。结果：实验教学采用软件与硬件相结合的的实验方式,精心设计了针对性和实用性较强的10个学习情境,3个综合实训项目,保证了实验教学质量充实了课程教学资源,激发了学生学习兴趣和创造性思维能力,提高了教学质量。结论：实践证明,《医学影像电子学》教学方法的改革得到了学生的认可,减轻了实验课时少、实验室条件紧张等困难,为实验过程延伸到理论课堂和课后创造了有利的条件。这种教学改革值得在其它院校《医学影像电子学》教学中进行推广。     

Managed medical education?

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managed medical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the temple of those who clamor, 'I can name that tune in four notes.'"     

Diseño y validación de un simulador híbrido de paracentesis

Medical education by simulation is an effective method for learning; It improves competence acquisition, repetitive practice and eliminates risks for the patient. Existing paracentesis simulators have a high cost and low level of realism, so a low cost simulator was designed and developed. A representative video of a suitable clinical scenario was demonstrated, demonstrating the complete paracentesis technique. 20 medical specialists observed the video and performed the procedure in the simulator, later applied a questionnaire on the realism of the simulator, the utility of the video, and the importance of the procedure in medical education. The results show that 85% of the participants consider the simulator favored the learning experience. 90% considered the clinical appearance to be adequate. 100% believe that the acquisition of paracentesis ability is relevant in undergraduate students.     

Clinical academies: innovative school-health services partnerships to deliver clinical education.

During the past five years (2001-2006), the University of Bristol Medical School has developed and implemented a new model for delivering clinical education: the clinical academy. The principal features of the model are (1) having both in-Bristol and out-of-Bristol campuses for clinical education, (2) innovative partnerships with local health care providers, (3) local leadership of educational delivery, and (4) the recruitment and training of new cadres of clinical teachers.The seven clinical academies consist of two academies based in traditional acute-care teaching hospitals in the city of Bristol and five academies in the surrounding counties. The same Bristol curriculum is delivered in every clinical academy by locally recruited hospital specialists and family physicians. Each academy is led by an academy medical dean, who has local responsibility for program delivery, quality assurance, academic and personal support for students, and finances on behalf of the university.Medical students rotate between clinical academies every half academic year, alternately based in and outside of Bristol. They learn clinical medicine and develop clinical competence as apprentice members of a local multiprofessional learning community. The medical school now has enough high-quality clinical placements to accommodate increasing numbers of medical students whilst keeping a "human-scale" educational environment.Clinical academies are thus the key components of a decentralized system of curriculum delivery; they differ in concept and purpose from the new academies of medical educators in the United States that offer a centralized focus for the educational mission.     

Development of a teaching program in clinical medical ethics at the University of Chicago

The University of Chicago Pritzker School of Medicine has developed and evaluated an extensive teaching program in clinical ethics coordinated primarily through the Center for Clinical Medical Ethics. The program provides medical students with a foundation in medical ethics during the four years of medical school and augments the clinical ethics knowledge and teaching skills of the housestaff and clinical faculty at the University of Chicago. Together, medical student teaching and clinical faculty development have made clinical ethics an integral part of medical education at the University of Chicago. Through these efforts, the teaching program aims to incorporate clinical ethics considerations into medical decisions and in this way contribute to improving patient care. (A detailed overview of all clinical ethics instruction at the school is provided.)     

Criteria of the "educators' pyramid" fulfilled by medical school faculty promoted on a teaching pathway.

PURPOSE: To compare the results of academic promotion to associate professor and professor via the teaching pathway at the Wake Forest University School of Medicine (WFUSM) with the criteria of the "educators' pyramid" of Sachdeva et al. METHOD: Data on all candidates promoted to associate professor and professor in the academic years 1995-2000 at WFUSM were collected from candidates' portfolios and compared with the criteria for educator (level three) and master educator (level four) from a modified version of the educators' pyramid. RESULTS: Of 186 faculty promoted, 38 were on the teaching pathway. Everyone promoted on the pathway fulfilled all teacher and master teacher criteria. All educator criteria were found among the associate professors, and all but one of the master educator criteria were found among professors. More than 75% of associate professors demonstrated "sustained participation in significant amounts of effective teaching in more than one modality" and "service as a medical student clerkship, course, or residency director." Less than 30% demonstrated "service as assistant dean of education or student affairs" or "service as the chair of departmental education committees." Most associate professors had not regularly participated in national education meetings. For professors, more than 50% demonstrated "achievement of leadership positions in national organizations, committees, and medical school education"; "recognition as a national leader in specialty education"; and "mentorship of other faculty members locally and nationally." Less than 30% demonstrated "pursuit of further training in education through workshops, faculty development programs, or educational fellowship programs" or "development and implementation of nationally-recognized (in education) innovative curricula or teaching programs." No one promoted to professor on the teaching pathway had made what was considered to be a landmark contribution to educational research and development. CONCLUSION: The findings suggest that the educators' pyramid is generalizable to medical faculty being promoted on a teaching pathway at WFUSM. Documentation of achievement in teaching criteria is essential and faculty should be encouraged to maintain records of accomplishment before becoming candidates for promotion.     

探索基于成果导向教育理念的医学代谢生物化学教学改革

成果导向教育(OBE)作为一种先进的教育理念,正成为医学教育改革的主流理念。医学整合课程"代谢生物化学"课时数少,如何在较少课时条件下提高教学质量,激发医学生的学习兴趣是一个巨大挑战。基于OBE教育理念,本文总结了从学习目标、教学内容及教学策略等方面的改革,以期增强医学生学习的积极性和主动性,提高教学效果,为使医学生成为符合"卓越拔尖人才教育培养计划2.0"要求的卓越医学人才夯实基础。     

Resuscitating the teaching of anatomical pathology in undergraduate medical education: Web-based innovative clinicopathological cases

AIMS: Medical education has undergone substantial change in recent years, resulting in shorter, more compact courses that often contain much less pathology than previously. There has also been a concurrent decrease in the academic pathologist workforce in Australia, such that medical schools struggle to deliver even this reduced pathology curriculum. This paper reports the development and evaluation of an innovative approach in an undergraduate medical school to supporting pathology lectures, through integrating pathology with clinical medicine. METHODS: A series of 32 clinical pathological cases (CPCs) was developed to replicate clinicopathological conferences in a small group format. The CPCs were based on the pathology lectures, developed by a multidisciplinary clinical team and delivered to the students by clinical tutors. Students had access to learning support resources on the School's Intranet in both the main campus and rural teaching sites. Digitised pathology images, Web-based delivery and semi-guided learning issues are the main characteristics of the pathology module. The module was evaluated by a ranking system by the medical students for two consecutive years. RESULTS: In both years, the CPC module achieved a high score when compared with other components of the pathology curriculum. Positive feedback and frequent inquiries were also received about the module. CONCLUSION: The Web-based CPC modules provide an important resource that can facilitate teaching of pathology to medical students in the main campus and rural teaching sites. The module provides an opportunity to improve the profile of pathology in the medical school, in a manner that is sustainable with only one academic pathologist. It has the potential to be used nationally and internationally because of its multidisciplinary nature and the flexibility in its mode of delivery.     

临床医学本科留学生《医学免疫学》教学探索

随着我国综合国力和高等教育水平的不断提升,我国留学生教育的国际影响力也日益增强。探索来华医学学历留学生的教育规律、推动可持续发展已成为当前现实而紧迫的问题。 自2005年开始,我校连续招收12届临床医学学士本科生（MBBS）。在教学过程中,我们不断探索适合留学生的多模式教学方法,逐渐形成一套新的教学模式。     

Promoting Physician Diversity through Medical Student Led Outreach and Pipeline Programs

IntroductionCurrent projections anticipate a dramatic shift from historical population demographics in the United States. Racial and ethnic minorities are expected to constitute the majority of the population by 2050. However, racial minorities continue to be underrepresented in medical school admissions and the physician workforce. Creating a medical student and physician workforce that reflects population demographics of their patients will be an important determinant in promoting public health and health equity.MethodsMedical student led educational outreach programming targeting middle and high school students is one way by which current medical students can actively work to systematically address barriers to aspiring URiM medical students.ResultsOpportunities for medical students to implement meaningful educational outreach programming are limited only by personal motivation and institutional support. Implementation of these programs would provide college and medical school candidacy support for aspiring medical students while providing personal development and education benefits to medical students implementing the program.ConclusionThe authors call on medical students across the country to join in pursuit of health equity and a diverse physician workforce that reflects the evolving demographics of the United States. Medical students can impact the health of local communities through implementation of educational outreach programming to facilitate access to medical education for middle and high school students.     

开放式医学图像处理与设计实验平台建设

目的:建设一个开放式的医学图像处理与设计的实验平台,以适应学校现有的教学环境。方法:根据学院的实际课程设置,通过优化配置硬件和软件环境,开发出不同层次的图像处理实验模块,并允许学生自主选择、组合、设计和创作,最终使整个实验平台内容更丰富、更开放,更具有操作性、层次性和趣味性。结果:整个实验平台的内容贴近学生的实际需求,将知识的专业性、操作的趣味性、学生的自主性、实践的快乐感等很好地统一起来,在教学实践中取得了良好效果。结论:通过扩展实验模块,划分不同需求,创新实验平台建设,是能够提高学生的参与积极性的,是能够满足不同专业不同层次的学习要求的,实验效果是能够有所改观的。     

Sixteen years' experience with a required third-year family medicine clerkship at Jefferson Medical College.

Jefferson Medical College has developed a program to successfully meet the goal of teaching ambulatory care to all medical students, by providing each of its 223 third-year students with a required six-week clerkship in family medicine. The structured clerkship takes place at one of seven residency-based family practice centers, is supplemented by a formal curriculum, and is based on the active clinical involvement of caring for patients under full-time family medicine faculty supervision. This clerkship has been in existence for 16 years, and has added over 400,000 student-patient encounters to the clinical education of over 3,500 students. Student evaluations of the clerkship have rated it the highest of the six required core clerkships at Jefferson. In addition, over 16% of Jefferson graduates have entered family medicine residency training programs, a rate higher than that of any other school in the northeastern United States, and significantly higher than the average for all U.S. medical schools (12%). Jefferson's experience suggests that ambulatory care can be taught as a core component of the clinical education of all medical students. To be successful, however, strong institutional support, a structured curriculum, an adequate number of patients, a dedicated faculty, a sufficient number of training sites, an appropriate evaluation process, and significant financial support are all necessary.     

Development of a brief, self-administered instrument for assessing sleep knowledge in medical education: "the ASKME Survey"

STUDY OBJECTIVES: This report describes the construction and validation of a brief self-administered scale to assess sleep knowledge in medical education ("ASKME Survey"). Few measures of this type have been developed previously; none have been validated or widely adopted. The current instrument was designed as a standardized assessment measure for use in medical education in sleep. DESIGN: Instrument was developed in four phases: initial item selection, expert panel review, reliability and construct validity assessment, and final item selection. Content validity was assessed in six general domains: basic sleep principles; circadian sleep/wake regulation; normal sleep architecture; sleep disorders; effects of drugs and alcohol on sleep; and sleep in medical disorders. SETTING: N/A. PARTICIPANTS: Medical students at Robert Wood Johnson Medical School (RWJMS) and University of Kentucky College of Medicine; students in clinical psychology, nursing and other health-related professions at Rutgers University; school nurses at Texas Christian University; practicing physicians; accredited sleep specialists. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Individual item analysis of 30-item survey demonstrated a high degree of discriminant validity. Internal consistency for test items was relatively high (KR-20=0.89). Overall mean percentage correct was highest for accredited sleep specialists (85.3%+/-10.8%) and lowest for school nurses (53.1%+/-13.7%). Significant group differences were observed across all question categories (p < 0.0001). Medical students scored significantly higher than the nurses on questions related to sleep architecture (59.5% vs. 42.5%) and narcolepsy (36.4% vs. 21.3%). CONCLUSIONS: "ASKME" demonstrates a high degree of internal consistency and reliability among survey items. It discriminates between samples with varied levels of education, experience, and specialty training. The survey is currently available via the American Academy of Sleep Medicine website (http://www.aasmnet.org).