Pre-athletic training students perform better on written tests with teacher-centered instruction

There are many different methods of instruction used in the academic setting. Little experimental research exists examining which mode is more effective in educating students. The purpose of this study was to compare scores obtained on the written and the practical examinations of students on a single topic taught through either a teacher-centered format or a student-centered format. A 2 x 2 x 6 factorial design was used in this study. Independent variables were teaching style (teacher-centered instruction and student-centered instruction), order (first or second), and learning style (competitive, collaborative, participant, avoidant, dependent, and independent). The dependent variables were the scores obtained on a written and a practical examination of gait and crutch fitting. Forty pre-athletic training students in their first semester of their first year (16 males, 24 females) participated in this study. The Grasha-Reichmann Student Learning Style Scale was used to determine the learning styles of the subjects. The total subject pool was divided randomly into two groups, one taught by teacher-centered instruction and the other by student-centered instruction. Both groups took the same written and practical examinations, and scores were recorded. A 2 x 2 x 6 fixed model multivariate analysis of variance was performed. A difference was observed for teaching style (F2,21 = 5.35, p = 0.01), on the combination of written and practical exam scores. A difference also was observed on the written examination scores with the teacher-centered format producing better results (p < 0.05); but teacher-centered format scores did not differ from student-centered scores on the practical examination (p > 0.05). Teacher-centered instruction improves written test performance compared with student-centered instruction. When initially teaching a skill, direct teacher involvement may help students learn and perform better.     

Learning in a clinical education programme in primary care: the Maastricht Adoption Programme

INTRODUCTION: At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an 'Adoption Programme', where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme. METHOD: Data from the evaluation questionnaires of 188 medical students were used to test a causal model of learning in the programme. A distinction was made between 'action' and 'reflection on action'. We examined the relationships between perceived instructiveness (the programme's value as a learning experience) and the following variables: comprehensibility; feasibility and execution of the assignments; time spent on the assignments, and the direct and indirect influences of the hosting general practitioner (GP) and the practical medical coaching group. RESULTS: Performing the assignments had little effect on perceived instructiveness. Coaching by the hosting GP influenced the execution of assignments mainly by its effect on feasibility. Coaching by the GP and in the practical medical coaching groups barely affected perceived instructiveness. DISCUSSION AND CONCLUSION: The model gives insight into the contribution of aspects of the Adoption Programme to student learning. The results are probably negatively influenced by the insufficient priority given to the Adoption Programme in the practical medical coaching groups and by inadequate instruction given to the GPs for the purposes of their coaching role. More careful planning of patient-related assignments is recommended. Reflection on assignments and feedback on procedures are needed to lift practical experience onto a higher educational level.     

Perceptions of competency attainment in clinical dietetics: academic Plan IV vs. dietetic internships

A national survey of all Plan IV representatives and dietetic internship directors in programs with a general or clinical emphasis was conducted to determine the level of competence in clinical dietetics expected of Plan IV graduates. Dietetic interns were asked to rate themselves on competency attainment at the beginning and near the end of the internship. The ADA's Role Delineation Study for Entry-level Personnel in Clinical Dietetics was used as the basis for the survey questionnaire. Completed questionnaires were returned by 137 Plan IV representatives (54%), 71 dietetic internship directors (75%), and 530 dietetic interns (62%). Highly significant differences were found among the three groups. Plan IV representatives had higher expectations of students than internship directors. Interns consistently rated their competency levels for all responsibilities below those indicated by either group of directors. All three groups indicated that students were better prepared for client-focus responsibilities than for professional or organizational-level responsibilities. Interns' self-ratings suggested that similar amounts of learning occurred in each of the three areas during the internship. Nutrition-related work experience immediately prior to the internship influenced students' perceived competency level at the beginning of the internship, but differences between those students and the ones with other or no work experience were overcome as students neared the end of their internships. For most major responsibilities, the students' perceived levels of competence did not change after the first few months of the internship.     

Students’ experiences and perceptions of the use of portfolios in UK preregistration dietetic placements: a questionnaire‐based study

Background: Reflective portfolios were introduced to dietetic practice placements in 2005, providing evidence for learning outcomes achieved and acting as a summative assessment tool. Portfolios may measure clinical competence more effectively than conventional examinations, but can be time consuming and subjective. The present study investigated current dietetic students’ experiences and perceptions of the use and effectiveness of portfolio based learning and assessment during practice placements. Methods: Current UK dietetic students, who had completed a B or B and C placement, were invited to participate, via University course leaders, in an online questionnaire exploring opinions and experiences of portfolio preparation, generation, assessment, and personal and professional development and reflection. Results: One hundred and fourteen students from 11 Universities participated. Seventy‐seven percent would have liked more information about portfolio construction prior to placement. Eighty percent of students believed that reflection helped monitor their strengths and weaknesses. Perceived reflective skills were significantly positively correlated with students’ perceived writing skills (P < 0.0005) and academic ability (P = 0.002). Of the respondents, 92% agreed the portfolio was a valuable learning experience; however, 76% agreed that the amount of paperwork involved was excessive and 67% felt there were inconsistencies in portfolio assessment by different supervisors. Conclusions: Portfolio weaknesses identified are not specific to dietetics but are inherent to portfolio assessment across many professions. The introduction of national standardised assessment processes, practices, tools and training for assessors may help improve inter‐departmental and inter‐rater reliability, respectively.     

Minority interns' experiences during their dietetics education and their recommendations for increasing diversity in dietetics: findings from structured interviews

Diversity among racial minorities and males has remained limited in the dietetics field. Structured interviews with eleven minority interns were conducted to assess their experiences throughout their dietetics education and to examine their perceptions of the dietetics profession. General themes were reported. Dietetics was not the first career choice for six interns. Work and volunteer experience were perceived as the most influential factors in their selection for a dietetic internship. Some perceived being the only minority in an internship program and the lack of minorities on internship selection committees as problems. Increasing minority dietitians' visibility at career days and early recruitment of students were suggested as ways to increase diversity within the profession. Resources such as the Building Our Future Mentor Program Tool Kit should be utilized to establish mentoring programs for students and to enhance diversity efforts in dietetics.     

Educational impact of in-training assessment (ITA) in postgraduate medical education: a qualitative study of an ITA programme in actual practice

Objectives To investigate the experiences and opinions of programme directors, clinical supervisors and trainees on an in‐training assessment (ITA) programme on a broad spectrum of competence for first year training in anaesthesiology. How does the programme work in practice and what are the benefits and barriers? What are the users' experiences and thoughts about its effect on training, teaching and learning? What are their attitudes towards this concept of assessment? Methods Semistructured interviews were conducted with programme directors, supervisors and trainees from 3 departments. Interviews were audiotaped and transcribed. The content of the interviews was analysed in a consensus process among the authors. Results The programme was of benefit in making goals and objectives clear, in structuring training, teaching and learning, and in monitoring progress and managing problem trainees. There was a generally positive attitude towards assessment. Trainees especially appreciated the coupling of theory with practice and, in general, the programme inspired an academic dialogue. Issues of uncertainty regarding standards of performance and conflict with service declined over time and experience with the programme, and departments tended to resolve practical problems through structured planning. Discussion Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end‐of‐training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.     

Measuring the success of an objective structured clinical examination for dietetic students

Background: Growing requirements to train more dietetic students greatly increase the teaching burden on clinical supervisors. This may be reduced if students can develop basic nutrition assessment skills before they commence clinical placement. To test achievement of these skills by Australian dietetic students, a preclinical objective structured clinical examination (OSCE) was developed. Performance at this OSCE was then compared with the performance at first clinical placement. Methods: An OSCE was developed to test preclinical skills during the third year of a 4‐year dietetic degree. Learning outcomes relating to nutritional assessment skills were assessed via a 1‐h preclinical examination. Student application of these skills was then assessed after the first clinical placement, when performance was compared with the results at the preclinical OSCE. Results: One hundred and ninety‐three students completed the preclinical OSCE and first clinical placement during the period 2002–2007. A strong relationship was observed for individual student scores at the OSCE and the score achieved at the end of clinical placement (β = 0.66; 95% confidence interval = 0.46–0.86; P < 0.0001). This relationship was maintained even when outliers were removed. No specific year effect was apparent. Conclusions: A third‐year preclinical dietetic OSCE was found to be a valuable method of formative assessment for assisting dietetic students with the preparation for their first clinical placement. It aided the early identification of those students who are likely to do less well on their first clinical placement.     

Do dietitians feel that they have had adequate training in behaviour change methods?

Aim To investigate dietitians’ perceived adequacy of pre‐ and postregistration training in a range of behaviour change techniques, current main approach to dietary treatment and perceived usefulness of future training in five core behaviour change modalities. Method A questionnaire was designed and distributed to all dietitians registered in the BDA membership base (n = 4202). Results Three hundred and ninety‐four questionnaires were returned. The majority of these respondents had obtained their degree since 1982 (77%), since when courses were more likely to have contained a psychological component. Despite the fact that facilitating dietary behaviour change is a key dietetic role, respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. Training was perceived to be most satisfactory in active listening skills, but this was perceived as barely adequate. Training was perceived as particularly poor in: applying theories of cognitive and behavioural therapy (CBT); motivational techniques; group work skills; and in both theory and skills of relapse prevention. Although 40% of respondents reported receiving explicitly psychologically based training, skills‐based training (mainly counselling) was reported by only 25% and was limited by being mainly short 1‐ or 2‐day courses. Overall, where further training was obtained it was perceived to be more adequate than that reported within preregistration dietetic training. Conclusion Respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. The application of CBT, motivational techniques and relapse prevention was perceived as particularly deficient in training and the majority of respondents felt that future training would be useful or very useful. In the current health service climate, where evidence‐based practice is crucial for all practitioners with the emphasis on improved quality of care with measurable outcomes, research must be funded and undertaken to support attempts to improve dietitians’ effectiveness as behaviour change agents.     

仿真患者教学模式在物诊教学中应用

观察仿真患者（Computer-based simulator,CBS）教学模式教学的效果。方法：将2007年在某部队医院进行物理诊断学习的84名医学生,随机分为甲、乙、丙三组,甲组先实行CBS教学,再进行临床实习;乙组先进行临床实习,再实行CBS教学;丙组安排两次相同体征的临床实习。结果：甲组的临床实习时间显著少于乙组（P〈0．001）,丙组第二次临床实习时间较第一次显著减少（P〈0．001）,这些显著差异来自不同临床实习的身体检查部分所需时间;甲组（vs乙组,P=0．034）和丙组第二次（vs第一次,P=0．001）临床实习时阳性体征检出率显著增加。甲、乙组均有超过90％的同学认为CBS教学有趣或对临床实习有价值;认为可以部分替代实际临床患者实习的学生分别占75％和70％。结论：CBS教学模式应用于部队医学生教育是可行的,可以尝试取代部分临床实习课程.     

Minority Interns’ Experiences During Their Dietetics Education and Their Recommendations for Increasing Diversity in Dietetics: Findings from Structured Interviews

Diversity among racial minorities and males has remained limited in the dietetics field. Structured interviews with eleven minority interns were conducted to assess their experiences throughout their dietetics education and to examine their perceptions of the dietetics profession. General themes were reported. Dietetics was not the first career choice for six interns. Work and volunteer experience were perceived as the most influential factors in their selection for a dietetic internship. Some perceived being the only minority in an internship program and the lack of minorities on internship selection committees as problems. Increasing minority dietitians’ visibility at career days and early recruitment of students were suggested as ways to increase diversity within the profession. Resources such as the Building Our Future Mentor Program Tool Kit should be utilized to establish mentoring programs for students and to enhance diversity efforts in dietetics. J Am Diet Assoc. 2002;102:1674-1677.     

Day surgery: teaching the next generation

The advent of day surgery presents new opportunities and challenges for medical education. The opportunity to see patients pre-operatively and follow them through surgery to discharge on the same day is unique to day surgery. However, with rare exceptions, the development of educational programmes in ambulatory surgical settings is still largely at a rudimentary level. An undergraduate pilot programme was conducted at the University of Adelaide to explore the practicalities, acceptance and educational value of a day surgery programme for final-year medical students. The programme had three components: day surgery patient follow through, practical procedure tutorials and problem-based learning tutorials. It incorporated assessment of practical skills and theoretical knowledge with the use of log books and clinical and practical simulations as important elements in the assessment process. The pilot programme was accepted by all stakeholders and students' perceived significant gains in knowledge and skills. This programme may provide a teaching model that could be adapted for use in other medical schools.     

Promoting and evaluating competence in on-line dietetics education

Professional organizations, such as the American Dietetic Association are challenged to assure competency of their practitioners. Competency includes higher-level skills such as critical-thinking, cooperative work, effective communication, and use of lifelong learning resources. Information literacy via computer technology is a key component of competency, which needs to be included in dietetic education and training. This dietetic internship examined use of online technology to develop competency using the key-feature exam. Seventy-five dietetic interns from three different programs were divided into those with (n = 44) and without (n = 31) online instruction, to which pre- and post- test key feature exams were administered. Those with online instruction had greater improvement (P < 0.05) on key-feature exams in nutrition support and pediatric nutrition. Competency is complex and difficult to assess, thus tools to better assess the comprehensive scope of practitioner competency are needed. The key-feature exam may be a tool to assess and verify practitioner competency in dietetics professionals.     

Perceptions of competency attainment in community dietetics: academic Plan IV vs. dietetic internship

A national survey of Plan IV representatives, internship directors, and dietetic interns was conducted to determine the perceived level of competence in community dietetics upon completion of academic coursework. Interns also rated their perceived competence in community dietetics near the end of internships. All major and specific responsibilities from the ADA Role Delineation and Verification for Entry-Level Positions in Community Dietetics were included in the survey questionnaire. Completed questionnaires were received from 447 dietetic interns (60%), 47 internship directors (57%), and 59 Plan IV representatives (39%). Highly significant differences were found among the three groups, with Plan IV representatives' expectations highest and students' lowest. Work experience prior to internship affected mean ratings on selected responsibilities. Unlike the results of the previous studies in clinical dietetics and foodservice systems management, the ratings in community dietetics did not reach their highest until the last month of the internship. Findings from all three areas of dietetic practice suggest that students' perceived competence is considerably lower upon completion of Plan IV than after completion of an internship, indicating need for defined work experience. Different teaching techniques, i.e., lecture vs. hands-on, could be related to different ratings of perceived competence within and between practice areas.     

A programme for treating chemically dependent medical students

Summary. The first American programme for chemically dependent medical students at the University of Tennessee, Memphis is described. The goals of the Aid for the Impaired Medical Student (AIMS) Program are to provide confidential treatment for chemically dependent medical students, to assure that recovering students are able to resume their education, and to protect patients and others from the harm that may be caused by impaired students. The Program is administered by the AIMS Council, consisting of medical professionals and elected student representatives. The Council oversees the management of cases, including investigation of students who may be impaired, intervention when chemical dependency is suspected, diagnostic evaluation, treatment and aftercare, and post-recovery advocacy for students. The Program's experience includes 18 cases of suspected chemical dependency, with four self-referrals and 14 students referred by third parties. Eleven students have been diagnosed as chemically dependent and have completed treatment programmes. Nine have maintained recovery and eight have graduated. One student subsequently relapsed and committed suicide. Obstacles in programme implementation have involved absence of perceived need, the view that chemically dependent students should be dismissed from school, and reluctance of students to report classmates. Resources have included highly respected student representatives, a supportive administration, assistance of the impaired physicians programme, and medical insurance and professional courtesy to defray costs. Although the number treated has been modest, the AIMS Program is an important vehicle for training students regarding chemical dependency and their professional obligations toward impaired colleagues.     

Elective modules in the behavioural sciences

An elective modules programme in the behavioural sciences was designed for the undergraduate medical curriculum at The Ohio State University College of Medicine. The programme provides a mechanism by which a broad range of behavioural science content can be introduced into the curriculum without increased allocation of teaching staff or budget. Student preference data indicate some clear differences with the more popular modules being those which focus on skills or behaviours that students perceive to be useful in the immediate practice of medicine. The elective aspect of the programme was part of its initial appeal, both to students and teaching staff. Two years of course evaluation data from the students indicate that most individual modules and the programmes as a total have been successful in achieving their intentions. The programme has now been included as a permanent component of the curricula.     

Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians

BACKGROUND: Interprofessional education (IPE) is a novel teaching and learning initiative where students of more than one health profession learn interactively together. However, despite its potential for improving interprofessional relationships, there is little information regarding the participation of student dietitians in IPE. The aim of this paper was to consider the reaction of student dietitians to an IPE course in order to stimulate debate between dietitians regarding the issues relating to IPE. METHODS: Student dietitians participated in an IPE course consisting of seven sessions on communication and ethics in health care together with students of medicine and nursing. Student dietitians completed an evaluation questionnaire following each session that surveyed their reaction to the session using both a Likert scale and free-text comments. RESULTS: Twenty-six student dietitians completed the IPE course. All sessions were rated positively for interest value (P < or = 0.14), learning experience (P < or = 0.036) and value for clinical practice (P < or = 0.05). The limited number of free-text comments indicated some positive experiences regarding interprofessional learning, teaching content and teaching strategy. CONCLUSIONS: This is one of very few evaluations to describe the reaction of student dietitians to IPE. Student dietitians had largely positive reactions to the IPE course. Further research is required to evaluate whether these positive reactions were a direct consequence of the inclusion of students from other health professions and whether these translate into positive effects on learning, behaviour and results. The opportunities for the dietetic profession posed by students' involvement in IPE are discussed.     

Preparing students for their first fieldwork placement using on-campus practicums

The present study describes and evaluates a programme that aimed to help students make best use of the scarce professional resource of fieldwork placements, in particular the first placement. The placement used a model of self-directed learning as a foundation principle. An on-campus clinical practicum programme was developed following a needs analysis to facilitate attainment of clinical competencies that were a prerequisite to placement commencement. Student self ratings of comfort in doing specific tasks before and after the practicum programme were obtained. Student and supervisor ratings of performance in specific tasks after placement were also made. In addition, supervisors were asked to rate the level of self-directedness of students. Results demonstrate the positive impact of the programme in preparing students for their first placement. Supervisors identified high levels of performance on specified tasks and a view that the students were more self directed than other novice students they had supervised. Recommendations are made for the continuation and further development of the practicum programme.     

The role of senior teachers in students'' achievements

This study points out the significant role of senior teachers in the process of instruction. It also asserts the consistency and reliability of student assessments of instruction, and the correlation between these assessments and the students' achievement. The study was conducted on groups rather than individual students. The assumption was that when teaching is carried out in groups, it is preferable to relate to the evaluation expressed by the whole group, and its correlation with achievement. The data included 51 student groups studying in 15 departments affiliated with the medical school in 12 hospitals: paediatrics (3), psychiatry (5), gynaecology (4) and surgery (3). The results emphasize the role of senior teachers in the process of instruction. It was found that a high positive correlation exists between senior teachers' direct involvement in teaching and students' academic achievements. However, a low correlation was found between students' assessments of the overall departmental teaching and their academic achievements. Thus, it appears that achievement is not directly influenced by the quality of teaching as perceived by the students, but rather by other factors, with the exception of a positive correlation between the contributions of the department heads to instruction and students' achievement.     

Nutrition education and counseling: knowledge and skill levels expected by dietetic internship directors

Development of nutrition education and counseling skills is important in the educational preparation of dietitians. A national survey of dietetic internship directors was conducted to determine competency levels expected of students at the start of an internship, internship training given, and further preparation students need in 32 knowledge/skills areas deemed essential for delivery of nutrition education and counseling services. Completed questionnaires were received from 66 of 102 (65%) internship directors surveyed. The majority of directors expected only basic preparation for group nutrition education and individual counseling knowledge/skills areas. Internship training in nutrition education competencies was "moderate" to "extensive," whereas preparation in nutrition counseling competencies was more likely to be "extensive." Directors perceived the internship to provide adequate preparation in all but the advanced practice skills, such as behavior modification and motivational strategies, for which further preparation was recommended. The majority of internship directors reported that more than 25% of the intern practice experience was in patient counseling, with less experience in group instruction. Implications for undergraduate dietetic education are discussed in relation to internship directors' expectations as well as to present and future trends in the dietetic profession.     

Breastfeeding: The neglected guideline for future Dietitian‐Nutritionists?

The objective of the present study is to determine the knowledge, attitudes and beliefs regarding breastfeeding of final‐year nutrition and dietetic students. A cross‐sectional survey of final‐year nutrition and dietetic students at a leading Australian university was conducted using an emailed questionnaire of 50 multiple‐choice questions on knowledge, attitudes, beliefs and future intentions to support and promote breastfeeding. The frequency of response to all questions was determined. Twenty‐seven of the 38 eligible students completed the survey. Significant deficits were identified relating to breastfeeding knowledge. Ninety‐two per cent of respondents reported a future intention to breastfeed or support their partner to do so; yet 69% felt bottle feeding was more socially acceptable and 23% believed that using artificial formula was easier for the mother. Although 85% of respondents believed they could influence breastfeeding initiation and duration rates, no students perceived that their studies had provided a significant amount of information on this subject, while only 8% of respondents had a strong interest in work relating to breastfeeding in the future. Improvements in the curriculum in this context may be required to ensure new graduates have the appropriate knowledge and are motivated to take positive action so that breastfeeding is properly supported. Further research is needed to determine if this issue applies in other nutrition courses and to assess the need to adopt an industry position paper on breastfeeding and associated competency standards for vocational training.