Longitudinal assessment of medical student attitudes toward older people

Delivering adequate care to older people requires an increasing number of physicians competent in the treatment of this expanding subpopulation. Attitudes toward older adults are important as predictors of the quality of care of older people and of medical trainee likelihood to enter the geriatrics field. This study assessed the attitudes of 404 US medical students (MS) from the start of medical school to graduation using the University of California, Los Angeles (UCLA) Geriatrics Attitude Scale. It is the first study to utilize a longitudinal design to assess attitudes among students in a medical school with a longitudinal geriatrics clinical experience in the first two years and a required geriatrics clerkship in the third year. Participants’ attitude scores toward older people were found to significantly decrease from 3.9 during the first two years to 3.7 during the final two. Significant differences existed between MS1 and MS3, MS1 and MS4, MS2 and MS3, and MS2 and MS4. Women and older students held significantly more positive attitudes than men and younger students. These results show that planned clinical exposures to older adults may not be sufficient to halt the decline in attitudes in medical school. A comprehensive empathy-building intervention embedded in the curriculum may better prevent this decline.     

Academic excellence in Latin America: Social accountability of medical schools

Abstract

Context: Social accountability of medical schools has emerged as a standard of excellence in medical education during the last decade. However, the lack of valid and reliable instruments to estimate social accountability has limited the possibility of measuring the impact that medical schools have in society. Our aim was to develop an instrument and validate its use for assessing social accountability in Latin American countries.

Methods: We used a three–phase mixed methods research design to develop, validate and estimate social accountability in a diverse convenient sample of 49 medical schools from 16 Latin American countries. We used a qualitative framework approach and a Delphi consensus method to design an instrument with high content validity. Finally, we assessed the psychometric properties of the instrument.

Results: The Social Accountability Instrument for Latin America (SAIL) contained 21 items in four domains: mission and quality improvement, public policy, community engagement, and professional integrity. Its reliability index, estimated using Cronbach’s alpha, was very high (0.96). Most of the medical schools that had ranked over the 80th percentile on traditional national academic estimates did not reach the 80th percentile using SAIL.

Conclusions: There are validity arguments (content and reliability) to support the measurement of social accountability using the SAIL instrument. Its application showed that it provides a complementary dimension to that traditionally obtained when estimating quality in medical schools.     

Evaluation and assessment of social accountability in medical schools

Social accountability as an outcome must be measured at institutional (evaluation) and individual (assessment) level. The definitions used in the measurement will be dependent on the social setting of the medical school being scrutinised. A formal framework is needed so that comparisons can be made and progress measured. The World Health Organisation suggests that there are four principles that delineate social accountability--relevance, quality, cost-effectiveness and equity. Medical schools are evaluated according to their planning, doing and impact in relation to these principles. Boelen and Woollard have clarified the ideas of planning, doing and impact into Conceptualisation, Production and Usability. THEnet group of medical schools use a shortened version of Boelen and Woollard's framework with 20 criteria to evaluate their programmes. At the individual level, there is considerable overlap between the concepts of 'social accountability' and 'professionalism'. Attempts are being made to define and measure professionalism, however, if the behaviour and attitudes of individual graduates is a significant component in defining social responsibility new methods of assessment need to be developed. Factors such as the available resources and the structure of the health services have a very large effect on doctors' attitudes and behaviour. As a result, the task of evaluating and assessing the extent to which medical schools are socially accountable is complex. Judgments on how well a school is meeting the standards will have to make allowance for the local political and economic environment.     

Twelve tips to promote excellence in medical teaching

For medical teachers around the world, teaching duties have expanded beyond the classroom and include teaching small groups, assessment, providing instructional materials beyond the syllabus, problem-based learning, learner-centred teaching, clinical teaching on-the-fly--and the list goes on. Faculty development is essential to train medical faculty in essential educational theory and specific teaching skills as well as to encourage a flexible and learner-centred approach to teaching. Finally, self-reflection and critique of teaching techniques are vital to propel medical schools towards promoting and aiming for uncompromising excellence in medical education. The twelve tips described in this article relating to educating teachers, evaluating teaching and eradicating institutional apathy are simple measures that educational leaders can apply to promote excellence in teaching at their parent institutions. The tips introduce a multi-dimensional approach to improving the overall quality of medical education consisting of measures aimed at individual teachers and those aimed at overhauling the teaching climate at medical institutions.     

Teaching in Spanish medical schools

The study reported here assessed the current situation of the teaching of medicine, the healthcare facilities available and the teaching staff employed at Spanish medical schools, on the basis of a national survey devised by the Conferencia Nacional de Decanos de Facultades de Medicina. There was a 100% response rate from the 27 medical schools. Twenty-three of these schools introduced new study plans between 1993 and 2000. In all cases these plans are basically discipline oriented, with different levels of integration between the subjects offered. The study also analysed teaching in bioethics, healthcare management, experience in primary care and alternative or complementary medicine. In the 2000-01 academic year there were 4471 first-year students; as for the healthcare facilities available, there were 67,331 hospital beds in 112 hospitals and 234 Primary Care Centres. There was an average of 4.49 teaching beds per student. There were 3081 full and associate professors, roughly half of whom were teaching in the preclinical cycle and roughly half in the clinical cycle, and 4492 clinical assistant professors. The average student-professor ratio at Spanish medical schools is currently 3.02: 1.0, with variations of between 6.22 and 1.04.     

Medical education in China's leading medical schools

This article gives a general overview of the evolution and present state of the undergraduate medical education system, programs, evaluation methods and conferred degrees in contemporary China. The publication is based on the information collected from on-site visits to the eight (8) leading medical universities, medical education conferences, visits to Ministries of Health and Education and their staff, and the contribution of Chinese medical education experts. As the Ministry of Education of the People's Republic of China (PRC) approves all tracks and strives for uniformity of educational programs as a cornerstone of quality, this overview reflects the general content of all five- and seven-year medical education programs that have provided the great majority of physicians since the founding of the People's Republic of China.     

The foundations of measurement and assessment in medical education

As a medical educator, you may be directly or indirectly involved in the quality of assessments. Measurement has a substantial role in developing the quality of assessment questions and student learning. The information provided by psychometric data can improve pedagogical issues in medical education. Through measurement we are able to assess the learning experiences of students. Standard setting plays an important role in assessing the performance quality of students as doctors in the future. Presentation of performance data for standard setters may contribute towards developing a credible and defensible pass mark. Validity and reliability of test scores are the most important factors for developing quality assessment questions. Analysis of the answers to individual questions provides useful feedback for assessment leads to improve the quality of each question, and hence make students’ marks fair in terms of diversity and ethnicity. Item Characteristic Curves (ICC) can send signals to assessment leads to improve the quality of individual questions.     

A proposal for student assessment in paramedic education

This paper develops a concept of assessment for paramedic education. The aim is to provide an improved learning environment for students as well as to increase the success of the school by providing alternative teaching methods to the current methods used, thus enabling the institution to reach its educational goals ('learning through assessment'). In order for this concept to be fully successful, a valid and reliable procedure must be implemented for these goals to be achieved. This concept was developed and implemented at a private paramedic school in the German-speaking part of Switzerland. First we must identify the strengths, unused opportunities, faults and threats of the actual procedures, so that a new concept can be established. As there are only a limited number of published papers available concerning Assessment in Emergency Medical Service (EMS), it has been necessary to look into other healthcare publications, especially those on medicine and nursing. The following areas are relevant for assessment: knowledge, communication skills, decision-making, technical skills, professionalism, ability for self-reflection, creativity and enthusiasm. For the assessment, nine methods have been selected and made into a blueprint. For the judgement, the European Credit Transfer System (ECTS) for learning achievements has been adopted. The outcome is essentially determined by a triangulation of methods: orientation towards methods stimulating learning, flexible and continual judgement on learning achievements and arrival at high-quality criteria for assessment.