Determining geriatric content in a medical school curriculum

Geriatric content in a medical school curriculum was assayed by surveying faculty course directors and students about course content, by conducting an independent review of course content, and by analyzing the content of course examinations. The students' assessments of geriatric content were found to be not valid. Considerable variability was found in the amount of geriatric content within courses, and review of course examinations was found to be the most valid review method. Pharmacology and second-year psychiatry courses were shown to have the most coverage of geriatrics, while microbiology, biochemistry, and neuroanatomy courses were shown to have the least coverage of geriatric items. The geriatric items in the course examinations correlated strongly (r = .71) with the National Board of Medical Examiners Part I and Part II examinations; because of this correlation, the investigators felt the study findings may be generalizable outside the one medical school. It would appear that geriatric content within the medical school curriculum is low; however, the results of the review methods indicate that disagreement exists over the degree of deficiency. The authors conclude that examination review offers an expeditious method to determine the relative emphasis placed upon geriatrics material within specific courses.     

用因子分析法研究医学生学业考核的结构效度

本研究选择某校2002、2003、2004届临床医学专业学生的组织胚胎学、生理学、生物化学、病理学、药理学、儿科学、内科学7门课程全体考生的成绩，用因子分析程序进行分析，研究考试的结构效度。按累计贡献率达60％，提出公共因子，每个因素各自解释的方差百分比较低，考试结果表明，预期测量学生“记忆”、“理解”、“应用”三层次的能力，没有达到理想效果。作者认为因子分析法用于分析医学课程考试结构效度有其局限性；课程考试的命题质量也有待提高。     

An approach to alcoholism in a university medical center complex

We developed a three-part approach to the problem of alcoholism among the employees and faculty of the Vanderbilt University and Medical Center. This included identification of faculty and staff with problem drinking, guidance of those identified for rehabilitation, and an educational program for students. Forty university employees (37 staff and three faculty) with problem drinking were identified and referred for rehabilitation. The principles of employee assistance used successfully in industry were applied in this employee group. The 65% "job rehabilitation" rate is comparable with that achieved in industrial employee assistance programs. Identification and rehabilitation of faculty in the university required special approaches. The educational program for students as part of the medical school elective curriculum was attended by most of the first- and second-year medical students.     

Effect of a cancer education program on student interest and learning in cancer

In a five-year study of medical students who had participated in a first-year elective course on cancer, the authors found that 47 percent of all participants subsequently became involved in other cancer programs. A sample (n = 40) of the participants was interviewed and studied in depth. Their subsequent expressed and overt interests in cancer were related to their achievement on neoplasm-related test items contained in second-year systemic pathology examinations and to their perception of transfer of learning from the cancer course. Neither expressed nor overt interest in cancer was significantly related to test scores on neoplasm items; but perceived transfer of learning was positively related to scores on neoplasm items, and perceived transfer and overt interest, combined, significantly related to test scores on neoplasm items in systemic pathology.     

The community as preclinical classroom: experience with a first-year clerkship

The required first-year clerkship in family and community medicine at the University of Massachusetts Medical School is a major curricular innovation which has implications for physician education. Students have lived in communities and worked in health service settings with field sponsors, under full-time faculty guidance, in all regions of Massachusetts. This has been one answer to the school's mandate to address the physician maldistribution problem. The goals and objectives and the teaching methods used to implement the program are described. These lessons were drawn from the program experience: community medicine clerkships belong in the first year of the curriculum; full-time medical school faculty working with the field sponsor promotes an optimal learning environment; long-term evaluation remains an important consideration. The first eight years of experience with the clerkship have demonstrated its value, and it should be considered for inclusion in the curriculum of other medical schools.     

高职高专护生自我价值感现状调查分析

目的：研究高职高专护生自我价值感（SW）现状.方法：采取整群和分层抽样方法抽取1 818人,采用“青少年自我价值感量表”对大学一年级、大学二年级和实习护生SW各维度进行团体测试.结果：高职高专护生在总体、一般和特殊SW等多维度上显著高于全国常模（P＜0.01）.大学二年级护生个人取向的人际SW、实习护生社会取向的道德SW得分均低于全国常模（P＜0.01）,实习护生个人取向的人际SW得分与全国常模差异无统计学意义（P＞0.05）.实习护生人际维度异常率均高于大学一年级和大学二年级护生（P＜0.01）,大学一年级和大学二年级护生之间差异无统计学意义（P＞0.05）.结论：高职高专护生SW总体水平较高,随着专业因素的逐步涉入,与专业因素相关的少数维度显示异常,可能与专业对护生的需求有关.     

Undergraduate medical education

The number of applicants to US medical schools continued to decline, while the number of accepted applicants increased slightly. From 1987-1988 to 1988-1989 academic years, the number of first-year medical students (including repeaters) who were white non-Hispanic males decreased 2.5%, the number of black non-Hispanic males decreased 6.3%, and the number of Asians or Pacific Islander males increased 10.3%. During the same period, the number of first-year students who were white non-Hispanic females decreased 0.8%, the number of black non-Hispanic females decreased 4.8%, and the number of Asians or Pacific Islander females increased 13.7%. Women constituted one third of the entering class in the 1988-1989 academic year. During the past 5 years, the ratio of full-time medical school faculty to medical students increased from 0.88 to 1.08. About 4.8% of budgeted full-time faculty positions were unfilled, down from 5% in the 1987-1988 academic year. However, in the 1988-1989 academic year, more than 5% of positions were unfilled in microbiology, anesthesiology, dermatology, family medicine, neurology, obstetrics-gynecology, ophthalmology, orthopedics, pediatrics, and surgery. Many schools are showing signs of adopting new curricular approaches. A majority of medical schools have implemented many recommendations of the GPEP Report, at least at some level. Problem-based learning is present in the curriculum of 82% of schools, mainly as an experience in one or a few courses. In about two-thirds of schools, computer-based instruction is a formal part of one or more courses or laboratories. Thus, the medical schools appear to be addressing the challenges presented by the changing environment of medical education.     

中美医学人文教育的特点比较及启示

美国医学院校重视人文素质培养,将丰富的人文课程充分整合到教学实践中,实现了医学与人文科学的相互渗透。教学方式上注重实践性和参与性,并且有具体、细致的考核评价系统。而我国存在轻视人文学科建设和医学生人文精神的培养,存在人文课程设置面较窄、师资不足等问题;需通过重视医学人文学科建设、合理设置课程体系、加大师资投入、改革教学方式和考核方式等措施予以完善。     

The Role of a Tutorial System in Undergraduate Medical Education

A tutorial system for first- and second-year medical students is now in its third year of operation at McGill University. The program was designed to meet the specific needs of McGill students. The aims and objectives were intentionally defined in a general way, application of detail being the responsibility of individual tutors and their groups of students. The main purpose of the program is the repeated exposure of students to the individual competence of outstanding teachers. A large majority of students and tutors favour the program. It has provided faculty members with insight into some of the problems of present-day medical education. The consensus is that, in the Faculty of Medicine at McGill University, the tutorial system serves an important role, complementing the normal curriculum.     

Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents

BACKGROUND: The acquisition and nurturing of humanistic skills and attitudes constitute an important aim of medical education. In order to assess how conducive the physician-learning environment is to the acquisition of these skills, the authors determined the extent to which clinical teachers are perceived by their trainees as humanistic with patients and students, and they explored whether undergraduate and graduate students share the same perceptions. METHODS: A mail survey was conducted in 1994/95 of all senior clerks and second-year residents at Laval University, University of Montreal and University of Sherbrooke medical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-point Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). RESULTS: On average, only 46% of the senior clerks agreed that their teachers displayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of clerks) and that their teachers did not try to understand students' difficulties (78%) or to support students who have difficulties (77%). Compared with the clerks, the second-year residents were significantly less critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. INTERPRETATION: This study suggests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the course of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent research is needed to understand better the factors influencing students' perceptions.     

Occupational stress, personal strain, and coping among residents and faculty members

Differences in ratings by 155 individuals at four levels of medical experience (faculty members and first-, second-, and third-year residents) on measures of occupational stress, personal strain, and availability of coping resources were examined. Multivariate and univariate analyses of data indicated significant differences in the measures among the experience levels. Measures of the availability of coping resources reflected the major source of differences, with the first-year residents reporting significantly fewer overall coping resources than faculty members. No significant differences were detected among the four groups on overall measures of occupational stress and personal strain. There were differences between first-year residents and faculty members on the subscales measuring physical environment stress, physical strain, recreation, and self-care. The findings suggest that residency education interferes with first-year residents' abilities to cope and places their physical well-being at risk. The findings support the need for residents to employ coping strategies during the residency years and provide empirical guidance regarding the kind of coping strategies needed.     

对医学物理学教学满意度调查与建议

目的 调查分析一年级临床本科学生对医学物理学课程教学满意度,为进一步做好医学物理学课程改革提供依据与建议。方法 采用问卷星网络问卷以不记名方式进行调查。问卷分为教学内容、教学方法、能力培养、学习成长帮助四个维度12项指标,同时对“不喜欢医学物理课的原因”行单项选择,了解学生学习态度和需求。结果(1)学生对该课程教学内容和教学方法满意度均较高(进行5个等级赋值评价,均分分别为4.201和3.984)。(2)学生对培养其自主学习能力、批判性思维能力、解决实际问题能力、开拓性思维与创新能力4项指标的满意度均较高(满意率最高84.12%,最低75.79%),4项指标满意度彼此间差异无统计学意义(P>0.05);对能力培养满意度与学习成长帮助满意度比较差异有统计学意义(χ²=19.886,P=0.001)。(3)回答“不喜欢医学物理课的原因”中有47.22%的人选择“高中物理基础差”。结论 教师需要与学生加强交流,关注学生学习与成长需求;教学中恰当运用翻转课堂等多种方式,加强课程内容与已有知识的衔接与拓展,更多介绍物理知识在临床及生活中应用;进一步设法多方面调动学生学习积极性。     

Internal medicine house officers' performance as assessed by experts and standardized patients

Three chronically ill patients were trained to evaluate the performance of 31 second-year internal medicine house officers based upon: a checklist for the medical data elicited during the medical interview; the process of the interview (that is, the house officer's interviewing style); and the physical examination technique. Four standardized rating scales were completed by the patients for the evaluations. Expert evaluations of the same house officers were conducted by a trained evaluator who reviewed videotapes of the interview and a faculty member who reviewed the adequacy of the medical history write-ups. Results of the study indicate a high correlation between the patients' and the experts' evaluations of the adequacy of the medical history data collected; less agreement was found in evaluations of the adequacy of the psychosocial data collected. These findings suggest that, if carefully selected and trained, patients with chronic medical conditions can provide reliable and standardized evaluations of house officers' performance at a level consistent with but less expensive than faculty members' evaluations.     

Student-directed teaching of medical ethics at a Canadian medical school

The medical faculty at Queen's University, Kingston, Ontario, Canada, in 1982 decided to omit the formal teaching of medical ethics from its curriculum. This decision led both students and faculty members to review the role of ethics in medical education. The outcome was the establishment of a minicourse of four three-hour sessions devoted to the examination and debate of selected ethical issues. The course was directed by students, who chose four general topics for discussion and three subtopics to be the focus in each session. They organized debates between faculty and community members from the fields of medicine, law, philosophy, and theology to be the core of instruction. The course resulted in a high level of satisfaction among the students, who felt that the issues chosen had been appropriately explored. The course, therefore, was continued in the same form by the following medical class.     

A model for predicting performance on the NBME Part I examination

Multiple regression analyses were employed to determine the relationships between achievement variables as predictors of the performance on Part I of the National Board of Medical Examiners examinations (NBME-I) of 366 medical students. The students' examination score averages in first- and second-year basic science courses were sequentially added to a composite Medical College Admission Test (MCAT) score to investigate the increases in prediction accuracy. Four prediction equations were cross validated on two subsequent medical school classes. While the multiple correlation between the predicted NBME-I score and the actual score significantly increased as first- and second-year course examination scores were added to the equations, the overall accuracy in predicting passing or failing did not substantially increase. The most useful equation employed a combination of the MCAT score and the first semester anatomy course examination score. The NBME-I predictions were given by letter to the 1984 and 1985 students approximately a year before they were to take the NBME-I examination so that students at risk of failure could undertake remedial study.     

Educational programs in US medical schools, 1999-2000

We used data from the 1999-2000 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and other sources to describe the status of medical education programs in the United States. In 1999-2000, the number of full-time faculty members was 102,446, a 4.3% increase from 1998-1999. The number of basic science faculty increased by less than 0.5%, while the number of clinical faculty increased by about 5%. There were 38,529 medical school applicants in 1999, a 6% decrease from 1998. Women constituted 45.8% and underrepresented minorities made up 12.1% of the 1999-2000 first-year class. New content, such as alternative medicine and cultural competence, and new methods of instruction, such as computer-based learning, are being incorporated by many schools. Seventy schools (56% of the total) require students to pass both Step 1 and Step 2 of the US Medical Licensing Examination for advancement or graduation, an increase from 62 schools (50%) in 1998-1999. The use of standardized methods of assessment, such as objective structured clinical examinations, to evaluate students' clinical performance was highly variable among schools. JAMA. 2000;284:1114-1120     

对医学本科毕业生教育目标的认知调查与分析

为探讨医学本科生毕业时应具备哪些基本知识、医疗技能和医德修养,用毕业生终期目标（TheExitObjectivesSurvey,EOS）评估表,调查了192位师生,统计分析了90条项目,其中师生一致（75％赞成）认为必要的有38条（42％）,以及四川大学华西临床医学院与美国华盛顿大学之间、师生之间认识的差异,并讨论其含义和影响因素。希望调查结果可供规划医学生毕业前教育内容的参考,为今后随着社会发展、科技进步和医疗改革的现状,调整传统的教育模式,制定一套层次分明、切实可行的教育目标体系。     

国内信息管理与信息系统专业课程设置调查研究

采用内容分析法对国内排名前100名高校信息管理与信息系统专业课程设置进行调查,根据课程内容进行聚类分析,并提取主干课程,将大学按课程建设分成4类。建议医学院校信管专业借鉴公共院校课程设置,保存原有特色方向,为适应国家卫生信息化建设需求进一步优化课程体系。     

A curriculum for the times: an experiment in teaching health policy to residents in family medicine

The Department of Family Medicine at Queen's University in Kingston, Ont., recently undertook a pilot project to familiarize residents in family medicine with physician-related health policy issues. The objective of the project was to ease the residents' transition into practice and to equip them to participate effectively in future policy debates. All first-year residents assigned to a 4-month clinical rotation in the Department of Family Medicine took part in the program, which consisted of 5 weekly 1-hour lecture and discussion sessions. The program was offered as one component of the 130-hour core curriculum for first-year residents. Participants evaluated the program as highly informative and extremely relevant to their career plans. The authors conclude that health policy is a subject that can be incorporated into the core curriculum of residency training programs.