以问题为基础的教学模式与讲授式教学模式在骨科医学影像学教学中的效果对比

目的 探讨以问题为基础的教学模式（problem based learning, PBL）在骨科影像学教学中的应用效果。方法 选择2016级5年制影像学专业参加我院放射科实习的106名学生作为研究对象,利用随机数字表分为两组（每组53名）,研究组采用PBL教学,对照组采用讲授式教学模式（lecture based learning, LBL）教学。以理论考试、技能测评和问卷调查方式对教学效果进行评价。结果 研究组读片技能测评成绩、总成绩［（40.57±6.58）分、（76.46±13.54）分］高于对照组［（37.01±7.67）分、（71.67±11.75）分］,差异均有统计学意义（P均＜0.05）;而两组理论考试成绩［（35.89±9.51）分 vs. （34.66±10.17）分］的差异无统计学意义（P＞0.05）。研究组在培养团队协作能力和影像诊断思维、提高主动学习能力和临床解决问题的能力以及总体满意情况方面均高于对照组,差异均有统计学意义（P均＜0.05）,而有助于知识点的记忆的差异无统计学意义（P＞0.05）。结论 PBL教学模式在骨科影像学的教学过程中应用效果较好,可以在医学影像学的教学中进一步推广应用。     

Facilitating the integrated small-group tutorial in a medical programme--the University of Transkei (Unitra) experience.

CONTEXT: The Unitra (now Walter Sisulu University) medical programme is problem- and community-based, offered in a small-group tutorial setting under a tutor. The first 3 years of the programme are integrated horizontally and vertically. The hypothetico-deductive format, with progressive disclosure, is utilised in the tutorial process. Regular training of tutors is carried out to assist faculty in adapting to the new methods of training. Performance of tutors is regularly assessed by students. OBJECTIVES: To describe the students' perceptions of the faculty performance as tutors over the past 10 years of the problem-based learning/community-based education programme and to construct a profile of a Unitra tutor. DESIGN: A prospective longitudinal study. SETTING: The first 3 years of the medical programme is divided into 10 blocks lasting 10 weeks each. At the end of each block, students evaluate their tutors using a pre-designed form with items pertaining to both process and content facilitation. For each item, the tutor is assigned a score on a scale that ranges from 'unacceptable' to 'superlative'. Students' evaluations over the years were reviewed and the findings were analysed for trends and similarities. MAIN OUTCOMES: Process facilitation and content facilitation. RESULTS: Evaluations from 460 individual tutorial groups, and of 83 tutors, were analysed. PROCESS FACILITATION: Tutors were regular in attendance, were punctual and showed enthusiasm for the tutorial process. They were proficient in keeping the group on track, in giving feedback to the group, and in helping the group to function. They were less proficient in managing group time and in giving feedback to individuals within the group. They did not give students adequate direction in the clinical reasoning process. CONTENT FACILITATION: Tutors were proficient in asking probing questions, in encouraging students to pursue learning issues, in integrating basic and clinical sciences and in identifying learning errors, and they often shared their experiences with students. They tended to teach within the tutorial session, and did not lay strong emphasis on psycho-social issues raised by the cases. CONCLUSION: The students are generally happy with the Unitra tutors. Content is better facilitated than process. Integrating psychosocial issues into the tutorial process, minimizing teaching in the tutorial room, giving feedback to individuals, and giving appropriate guidance to students in the hypothetico-deductive clinical reasoning process are the major challenges facing the Unitra tutor.     

A focused curriculum in surgical oncology for the third-year medical students

Background

Educating medical students in surgical subspecialty fields can be challenging, and the optimal timing and curriculum remain unknown. Despite advocacy for earlier exposure, competing core clerkship rotations often leave little time for subspecialty fields. We report our experience with a novel, short, and focused curriculum in surgical oncology for the third-year medical students.

Methods

A 2-wk (2009–2010) and a 4-wk (2010–2011) curriculum in surgical oncology were developed for the third-year students at a tertiary-referral cancer center, including formal didactics, rotation in clinical service of students' choosing (breast, gastrointestinal, endocrine, or melanoma), and case-based learning and presentation. Paired pre- and postrotation questionnaires were prospectively completed, including 20 items assessing knowledge and four items assessing experience. Grading was anonymous, and change in score was assessed by Wilcoxon signed-rank test.

Results

Paired questionnaires from 47 students (2-wk rotation, n = 26; 4-wk rotation, n = 21) showed a median improvement of three points (21.4%) from pre- to posttests (P < 0.001). The improvement did not differ by the length of rotation or by the specific clinical service. Nearly all (93%) reported a positive and inspiring experience. The most valuable avenue of learning was reported as the time spent with resident or fellow or attending (92%), followed by self-directed reading (62%) and didactic lectures (28%).

Conclusions

A short and focused curriculum in surgical oncology, including structured didactics and clinical rotation, had positive impact for the third-year students. Given the increasing work-hour limits, it is important to note that the time spent in the clinical setting continues to be ranked as the most educationally valuable by medical students.     

Basic ultrasound curriculum for medical students: validation of content and phantom

Effective use of ultrasound requires an understanding of the physics, combined with the ability to interpret the sonographic images. The aim of our study was to evaluate the impact of a basic ultrasound curriculum using a phantom to train medical students. Twenty-eight first- to fourth-year medical students were randomized to two groups: a control group that received no formal training and a trained group that received basic ultrasound training. Both groups took an initial multiple-choice written test and an ultrasound hands-on test using an agarose-based tissue mimic containing various objects. The curriculum for the trained group consisted of reading the principles of ultrasound and a hands-on session over the phantom. After training, both groups underwent a second multiple-choice exam and ultrasound practical test. The initial and the post-training test results were analyzed using a two-tailed Student's t-test. Baseline written and practical test scores were similar for both groups. After training, written test scores improved (82% trained vs. 66% control, P < 0.001). Hands-on ultrasound task performance also improved with training (96% trained vs. 60% control, P <0.001). The trained group took a shorter time to obtain a clear image and found on average one more object per scan. Parameters such as time to obtain a useful image and number of objects recognized also improved with training. Basic sonographic physics, imaging, and interpretation can be effectively taught to medical students during a short training session.     

Development and initial evaluation of a novel urology curriculum for medical students

PURPOSE: After the development and implementation of a novel urology curriculum for medical students we evaluated urological learning by medical students using a validated measure of learning in the 4 clinical areas of benign prostatic hyperplasia, erectile dysfunction, prostate cancer and prostate specific antigen screening. MATERIALS AND METHODS: Third year medical students completed an online validated pre-test and post-test immediately before and after the mandatory 1-week clinical rotation in urology. Online pre-surveys and post-surveys were also administered. Overall student participation was 90% (37 of 41) with 63% of students (26 of 41) completing all 4 tests and surveys. RESULTS: Student overall test scores improved significantly upon completion of the 1-week clinical rotation in urology (p <0.001). A trend toward increased learning by male students was identified (p = 0.07). Significant variation in exposure to outpatient clinics and in the performance of physical examination skills was observed among the different teaching sites. CONCLUSIONS: This study demonstrates significant learning by medical students during their 1-week clinical rotation in urology. Further data are needed to confirm the trend toward increased learning by males and elucidate its etiology. Scheduling changes have been implemented to address the inconsistencies across clinical sites.     

护理与其他医学专业学生学习动机和成绩的比较研究

目的了解护理本科生与其他医学专业学生学习动机和学业成绩状态,并探究学习动机与学业成绩的关系。方法采用学习动机与策略问卷调查护理、医药卫生管理、临床医学（五年制）3个专业325名本科生,另外收集每位学生的一般资料和最近学期的学习成绩加权分数。结果不同专业学生内在价值差异显著（P〈0．01）;不同专业、性别、年级、专业调剂学生加权成绩比较,差异有统计学意义（均P〈0．01）;学业表现与自我效能、内在价值呈显著相关（均P〈0．01）。结论不同专业学生对学习重要性的认识,对挑战的态度和对目标的定位会影响他们的学习动机。护理学生要加强学习动力水平的提升,进而提高本科护理教育质量。     

Simulation technology: a comparison of experiential and visual learning for undergraduate medical students.

BACKGROUND: The availability of simulator technology at the University of Toronto (Toronto, Ontario, Canada) provided the opportunity to compare the efficacy of video-assisted and simulator-assisted learning. METHODS: After ethics approval from the University of Toronto, all final-year medical students were invited to participate in the current randomized trial comparing video-based to simulator-based education using three scenarios. After an introduction to the simulator environment, a 5-min performance-based pretest was administered in the simulator operating room requiring management of a critical event. A posttest was administered after students had participated in either a faculty-facilitated video or simulator teaching session. Standardized 12-point checklist performance protocols were used for assessment purposes. As well, students answered focused questions related to the educational sessions on a final examination. Student opinions regarding the value of the teaching sessions were obtained. RESULTS: One hundred forty-four medical students participated in the study (scenario 1, n = 43; scenario 2, n = 48; scenario 3, n = 53). There was a significant improvement in posttest scores over pretest scores in all scenarios. There was no statistically significant difference in scores between simulator or video teaching methods. There were no differences in final examination marks when the two educational methods were compared. Student opinions indicated that the experiential simulator sessions were more enjoyable and valuable than the video teaching sessions. CONCLUSIONS: Both simulator and video types of faculty-facilitated education offer a valuable learning experience. Future work is needed that addresses the long-term effects of experiential learning in the retention of knowledge and acquired skills.     

Teaching of the renal system in an integrated, problem-based curriculum

To assess teaching in the Renal System Block of an integrated problem-based learning (PBL) undergraduate medical curriculum by the students' and tutors' according to their perceptions of relevance, stimulation and amount learned from the problems, a 16-item questionnaire focusing on these issues was distributed to a group of 1st year medical students in Riyadh, Saudi Arabia (n = 17) and their tutors (n = 3). Group ratings on Likert-type rating scales and open-ended comments were analyzed to determine median and qualitative differences. Students' and tutors had favorable, congruent perceptions of amount learned, stimulation and relevance of renal medicine problems to the Saudi Arabian healthcare context. Open-ended comments of both groups were highly supportive of the Block objectives, content and integrated teaching. It is concluded that exploring the congruence of students' and tutors' perspectives has been helpful in determining the necessity for renal medicine block modifications; emulating a PBL collaborative knowledge-building approach in curriculum development.