Children's perceptions of peers with somatic symptoms: the impact of gender, stress, and illness

OBJECTIVE: To investigate how illness characteristics influence children's responses to ill peers. METHODS: A sample of 363 4th and 5th graders responded to a vignette describing a peer with abdominal pain. In a 2 x 2 x 2 x 2 design, conditions varied by (a) evidence for organic disease, (b) presence of stress, (c) sex of vignette character, and (d) sex of respondent. Children rated symptom severity, liking for the peer, and whether the peer should be excused from normal responsibilities. RESULTS: Same sex preferences significantly influenced children's liking for a peer. Children viewed symptoms with an organic etiology as more severe than those without one. Under certain conditions, symptom severity judgments mediated the relation between the presence of organic disease and (a) liking and (b) granting relief from responsibility. The presence of stress had little effect on ratings of symptom severity, liking, or relief from responsibility. CONCLUSIONS: Gender and evidence of organic disease influence children's perceptions of and responses to symptomatic peers.     

A program to enhance k-12 science education in ten rural New York school districts.

The Rural Partnership for Science Education, designed by educators and scientists in 1991 with funding from the National Institutes of Health, works in two rural New York State counties with students and their teachers from kindergarten through grade 12 to improve pre-college science education. The Partnership is an alliance among ten rural New York school districts and several New York State institutions (e.g., a regional academic medical center; the New York Academy of Sciences; and others), and has activities that involve around 4,800 students and 240 teachers each year. The authors describe the program's activities (e.g., summer workshops for teachers; science exploration camps for elementary and middle-school students; enrichment activities for high school students). A certified science education specialist directs classroom demonstrations throughout the academic year to support teachers' efforts to integrate hands-on activities into the science curriculum. A variety of evaluations over the years provides strong evidence of the program's effectiveness in promoting students' and teachers' interest in science. The long-term goal of the Partnership is to inspire more rural students to work hard, learn science, and enter the medical professions.     

UCLA's outreach program of science education in the Los Angeles schools.

The UCLA School of Medicine's Interactive Multi-media Exercises (IMMEX) Project began its outreach into pre-college education in the Los Angeles area in 1993. The project provides a model in which software and technology are effectively intertwined with teaching, learning, and assessment (of both students' and teachers' performances) in the classroom. The project has evolved into a special collaboration between the medical school and Los Angeles teachers. UCLA faculty and staff work with science teachers and administrators from elementary, middle, and high schools. The program benefits ethnically and racially diverse groups of students in schools ranging from the inner city to the suburbs. The project's primary goal is to use technology to increase students' achievement and interest in science, including medicine, and thus move more students into the medical school pipeline. Evaluations from outside project evaluators (West Ed) as well as from teachers and IMMEX staff show that the project has already had a significant effect on teachers' professional development, classroom practice, and students' achievement in the Los Angeles area.     

Science education partnership between the University of Colorado and a Denver High School.

The authors describe a partnership, begun in 1997, between Manual High School, a school in which about 85% of the students are African, American or Hispanic, and the University of Colorado Health Sciences Center in Denver. There are three partnership goals: help teachers transform a lecture-based curriculum into an inquiry-based curriculum, help students build their science knowledge, and give students opportunities to learn--and become excited--about careers in medicine. The current emphasis of the partnership is at the ninth-grade level. The first unique aspect of the partnership is the Medical Explorers program. One portion of the program begins when a hypothetical teenage car-crash victim arrives at the emergency room; over the next six weeks, practicing health care professionals dramatize their medical responsibilities to this patient and discuss the academic training necessary to fulfill those responsibilities. In addition, the Medical Explorers students travel to the Health Sciences Center, where they tour laboratories and clinics, help conduct experiments, and explore computer-based surgical simulations. The second unique program is a service learning project in which ninth-grade students assist with an activity that gives elementary school students a chance to participate in the process of scientific inquiry and to discover the wonder of real hearts and lungs; the ninth-graders assist with logistics (e.g., they distribute newspapers), and, more important, interact with the younger students by asking thoughtful questions of them. The partnership plans to incorporate the elementary and middle schools that graduate their students to Manual High School in order to encourage the implementation of inquiry-based science curricula and to provide sustained support to teachers throughout the entire K-12 educational pathway. If medical colleges can help teachers provide a consistent classroom draw for student fascination in science and medicine, then the colleges are more likely to help create a rich diversity of students who pursue careers in medicine.     

Influence of a vertical subject on research in biomedicine and activities of The Cochrane Collaboration branch on medical students' knowledge and attitudes toward evidence-based medicine

Aim. To investigate whether the introduction of a vertical subject on research in biomedicine and founding of The Cochrane Collaboration branch at the University of Split School of Medicine influenced students' knowledge and attitudes toward evidence-based medicine (EBM), including the use of research literature. Methods. We used a 26-item questionnaire on EBM knowledge and attitudes to survey 1232 medical students of all study years in 3 medical schools in Croatia (Split, Rijeka, Osijek) and the Croatian-speaking medical school in Mostar (Bosnia and Herzegovina). Results. Students from the University of Split School of Medicine who had been exposed to the vertical subject on research in biomedicine and activities of The Cochrane Collaboration at the school had better knowledge and more positive attitudes toward EBM. In general, students rarely searched for evidence; 28% of students searched for evidence more than once a month and 96% of students used only textbooks in Croatian and teachers' handouts, even though 74% of students agreed that articles from scholarly journals were an important supplement for textbooks. Conclusion. Building up an environment that fosters EBM may be beneficial for students' knowledge and attitudes toward EBM. Teachers should encourage and require using evidence during all the courses in medical school.     

Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students

OBJECTIVE: To develop, implement and evaluate a workshop to help adolescents develop independent and active relationships with their physicians. METHODS: A needs-assessment survey informed the development of a workshop delivered by medical student volunteers and incorporated into the career and personal planning curriculum of high schools in Vancouver, Canada. RESULTS: Over a 6-year period, 64 workshops were delivered by 181 medical students to 1651 high school students in six schools. CONCLUSION: The workshop is acceptable, do-able, effective and sustainable, characteristics that arise from the mutual benefits to all the groups involved: the medical school, the school board, the medical students, the high school teachers and students. The workshop provides a model for providing health care education to adolescents in the community. PRACTICE IMPLICATIONS: Teaching adolescents the importance of good doctor-patient communication encourages them to take ongoing responsibility for their health care and is an alternative route to direct health care education.     

Student-teacher relationships and classroom climate in first grade: how do they relate to students' stress regulation?

The present study involved 105 German students at the end of their first semester in elementary school in order to explore the stress that students may experience within the school environment, and how the relationship with the teacher buffers or exacerbates the stress. Student-teacher relationships were explored on both classroom and individual interaction levels. Classrooms were described by external observers in terms of teachers' support and classroom organization. Teachers reported on the relationships with their students regarding closeness, conflict, and dependency, which determined four specific patterns of student-teacher relationships. Furthermore, saliva samples were taken on a Monday and a Friday of the same week (four times each day) to display diurnal cortisol profiles. These profiles were later evaluated by means of slopes and intercepts, reflecting students' daily stress regulation. Comparisons between Monday and Friday profiles of the same student served as an estimate for the stress regulation throughout the week. Finally, associations between the profiles and the specific relationship patterns provided information on significant environmental conditions for students' stress. Students in non-supportive, as compared to supportive, classrooms had flatter cortisol profiles, suggesting that classrooms of low quality hindered sufficient down-regulation of cortisol levels at both the beginning and the end of the week. Moreover, students with conflict-loaded relationships with their teachers were less able to appropriately down-regulate stress (especially on Fridays) than students with proximal-balanced relationships, showing the most optimal cortisol profiles.     

African American high school students and variability in behavior across classrooms

Many African American adolescents who enter high school with low achievement are at‐risk for being perceived as defiant and uncooperative by their classroom teachers. This generalized view of risk, however, offers little understanding of the differentiated behavior these students have with their teachers. The study followed 35 African American students, who have a history of low achievement, across multiple classrooms in their school day. Hierarchical linear modeling showed that there was greater variability in teacher‐perceived defiance, cooperation, and office discipline referrals “within‐student” compared with “between‐students.” This shows that individual students tended to be perceived differently across their teachers. Similarly, the study found that students also tended to differentiate their teachers. Students who reported unfair treatment with a particular teacher were more likely to receive a discipline referral and be perceived as defiant and uncooperative by that teacher. Implications for a strengths‐based approach to classroom behavior are discussed. © 2010 Wiley Periodicals, Inc.     

A second look at consequences for medical education of problem solving in science and medicine

This article reports that most freshman and senior medical students in one medical school were not able to solve a written problem case, concerning back pain, that required the examinee to recognize that foot drop was a key physical finding. The students' responses were not influenced by the fact that half of the examinations listed the foot drop finding first and the other half listed it seventh in a list of eight physical findings. The authors conclude that the outcome of this sample problem hints at a fault in medical education: the failure of medical students to learn the skill of formulating overall hypotheses and subhypotheses before choosing treatment options.     

An evaluation of asthma morbidity in Singaporean schoolchildren--a teachers' survey

Asthma is the most common chronic illness in childhood. This study evaluated the asthma morbidity among Singaporean schoolchildren. The survey involved 1,744 schoolteachers using a structured written questionnaire. 73.4% of class teachers reported at least 1 asthmatic student in their class. 37.1% of teachers had students absent from school for up to 3 days per month and 5.1% missed school for 4 to 14 days in a month. 87.4% of the physical education (PE) teachers reported at least 1 asthmatic student in their class. 65.2% reported an average of 1-3 students sitting out at each PE lesson and 15.1% reported students who were exempted from PE for more than 3 months in a year due to asthma. The morbidity of asthma in Singaporean schoolchildren in terms of school absenteeism and exemption from PE classes is substantial. The data supports a need to improve asthma control amongst our schoolchildren.     

Interdisciplinary Integration of the CVS Module and Its Effect on Faculty and Student Satisfaction as Well as Student Performance

ABSTRACT: Background and Aim: Beyond the adoption of the principles of horizontal and vertical integration, significant planning and implementation of curriculum reform is needed. This study aimed to assess the effect of the interdisciplinary integrated Cardiovascular System (CVS) module on both student satisfaction and performance and comparing them to those of the temporally coordinated CVS module that was implemented in the previous year at the faculty of Medicine of the King Abdulaziz University, Saudi Arabia. METHODS: This interventional study used mixed method research design to assess student and faculty satisfaction with the level of integration within the CVS module. A team from the medical education department was assembled in 2010/2011 to design a plan to improve the CVS module integration level. After delivering the developed module, both student and faculty satisfaction as well as students performance were assessed and compared to those of the previous year to provide an idea about module effectiveness. RESULTS: Many challenges faced the medical education team during design and implementation of the developed CVS module e.g. resistance of faculty members to change, increasing the percentage of students directed learning hours from the total contact hour allotted to the module and shifting to integrated item writing in students assessment, spite of that the module achieved a significant increase in both teaching faculty and student satisfaction as well as in the module scores. CONCLUSION: The fully integrated CVS has yielded encouraging results that individual teachers or other medical schools who attempt to reformulate their curriculum may find valuable.     

AIDS education and a volunteer training program for medical students

The process of AIDS education poses exceptional challenges for teachers and students. Medical students are in a unique position in the health care system. They are young enough to be ideal role models for high school and college students. They are mature enough to be responsible educators. We describe a special program designed and implemented by a medical student to train other medical students to become AIDS educators. This student-run program provides education for student volunteers who are able to educate other students and members of the community. The program is designed to educate a generation of physicians who will be well-equipped to combat the HIV epidemic and who can serve the community as AIDS educators while still in medical school.     

School readiness for children with food allergies.

BACKGROUND: Food allergy reactions and anaphylaxis may occur in children while at school. However, information regarding school readiness for children with food allergies is unknown. OBJECTIVE: To identify school education and prevention and treatment policies for food-allergic children in Michigan. METHODS: A questionnaire assessing food allergy awareness and avoidance and treatment strategies was mailed to a randomized sample (n = 273) of 2,082 public elementary school principals. RESULTS: One hundred four responses representing 109 schools were collected. From school estimates of 66,598 children, there was a 1.7% self-reported prevalence of food allergy. The most common allergens were milk and peanut, followed by tree nuts, shellfish, egg, and wheat. Affected children were identified primarily through office records, with few reporting individual emergency plans or designated classrooms, teachers, or lunch tables. Methods of food allergy education included parents of students and in-services. Avoidance strategies, food substitution, and "no-sharing" policies were common, whereas other measures such as food-label-teaching were uncommon. A minority of schools had epinephrine immediately accessible, either in the student's classroom, carried by the student, or passed by teachers. Principals, nurses, and teachers were most often trained to administer epinephrine. CONCLUSIONS: There appears to be a need for schools to formally educate staff on food allergy, provide information on prevention measures such as reading of food labels, establish immediate accessibility to emergency epinephrine, and train staff for appropriate epinephrine use.     

Patients' attitudes and comfort levels regarding medical students' involvement in obstetrics-gynecology outpatient clinics.

PURPOSE: To identify patients' attitudes toward the role of medical students, their preferences regarding medical student involvement, and their comfort level with a medical student's presence during common clinical situations in obstetrics-gynecology. METHOD: A self-administered questionnaire was distributed to patients waiting for an office visit with the obstetricians or gynecologists who served as preceptors for both male and female medical students. The questionnaire asked patients about their comfort levels with having medical students present during commonly encountered clinical situations. A random subsample of these patients were also asked whether they would allow a medical student to be present during future visits, and why or why not. RESULTS: A total of 229 patients completed the survey and 124 responded to the supplemental survey. Sixteen respondents were excluded due to missing data or a lack of an adequate comparison group. A majority responded they would feel comfortable having a medical student present during most clinical situations. Almost half of the patients preferred to see the doctor and medical student together, while less than a quarter wanted to see just the physician. Patients with more experience with medical students were more likely to favor medical student involvement and would feel more comfortable having a medical student present during obstetrics or gynecology clinical situations. CONCLUSION: Patients are willing to involve and feel comfortable with medical students in the obstetrics-gynecology clinic. However, physicians and clinics need to take steps to ensure that patient willingness and comfort are maintained by asking patients about their comfort with medical student involvement, clearly outlining the roles and responsibilities of participating medical students, and gradually increasing medical students' responsibilities as patients gain more experience with them.     

临床微生物学教学模式改革探索

"实验诊断学"中的"感染性疾病的实验室诊断及常见病原体的医院感染控制"课程,是大多数医学生了解临床微生物的起点,也是医学生们进行相关基础知识学习的平台。既往,该课程由教师在教室中通过电子课件进行灌输式讲授,学生因缺乏现实、直观的认识,学习积极性不高。为充分发挥学生主观能动性,最大程度激发学习兴趣,教学组对授课形式进行新的尝试与探索。通过增加小组互动讨论,提高学生自主学习、团队协作、语言表达的能力,使得学习成果多元化;以及进行实物教学,呈现乐寓于学、身临其境的学习新面貌。     

Educational benefits of diversity in medical school: a survey of students.

PURPOSE: Many U.S. medical schools have abandoned affirmative action, limiting the recruitment and reducing the admission of underrepresented minority (URM) students even though research supports the premise that the public benefits from an increase in URM physicians and that URM physicians are likely to serve minority, poor, and Medicaid populations. Faculty and students commonly assume they benefit from peer cultural exchange, and the published evidence for the past two decades supports this notion. This research examined the students' perceptions of the educational merits of a diverse student body by surveying medical students at two schools. METHOD: In 2000, medical students from all four years at Harvard Medical School and the University of California, San Francisco, School of Medicine were enrolled in a telephone survey about the relevance of racial diversity (among students) in their medical education. Students responded to the interviewer's questions on a five-point Likert-type scale. RESULTS: Of the 55% of students who could be located, 97% responded to the survey. Students reported having little intercultural contact during their formative years but significantly more interactions during higher education years, especially in medical school. Students reported contacts with diverse peers greatly enhanced their educational experience. They strongly supported strengthening or maintaining current affirmative action policies in admissions. The responses and demography of the Harvard and UCSF students did not differ significantly, nor did they differ for majority students and URM students-all groups overwhelmingly thought that racial and ethnic diversity among their peers enhanced their education. CONCLUSIONS: Diversity in the student body enhanced the educational experiences of students in two U.S. medical schools.     

Illness in context and families as teachers: a year-long project for medical students.

The authors describe a program for second-year students in Tel Aviv University's six-year medical school. The program's aim is to teach students the importance of context and interactions in patient care by exposing them to a real patient-family-doctor interaction using narrative-based methods to encourage reflective learning. Each student meets five times a year with a volunteer family, one of whose members suffers from a chronic disease. The program endorses a "patients as teachers" approach, as families are considered to be teachers for the students and not as objects of investigation and assessment. The students receive supervision in small groups, to enhance learning and reflection. To appraise the extent to which students had obtained the required knowledge, skills, and attitudes, the authors extracted reflections regarding the learning experience from students' essays. Major themes identified were becoming "family sensitive," building and improving communication skills, questioning intrusiveness, adopting a nonpatronizing and nonjudgmental attitude, developing reflective skills, creating a future professional model, and experiencing and appreciating continuity of care. The authors argue that learning to listen to patients' narratives, developing a reflective attitude, and being sensitive to patient-family-doctor interactions are of value to all doctors, and therefore programs similar to theirs should be established as part of general medical school education and not just in the context of family medicine.     

A strategy for the detection and evaluation of unprofessional behavior in medical students. University of California, San Francisco School of Medicine Clinical Clerkships Operation Committee.

The authors describe the first four years (1995-1998) in which the University of California, San Francisco School of Medicine operated an evaluation system to monitor students' professional behaviors longitudinally through their clinical rotations. The goals of this system are to help "turn around" students found to have behaved unprofessionally, to demonstrate the priority placed by the school on the attainment of professional behavior, and to give the school "muscle" to deal with issues of professionalism. A student whose professional skills are rated less than solid at the end of the clerkship receives a "physicianship report" of unprofessional behavior. If the student receives such a report from two or more clerkships, he or she is placed on academic probation that can lead to dismissal even if passing grades are attained in all rotations. Counseling services and mentoring by faculty are provided to such students to improve their professional behaviors. From 1995 to 1998, 29 reports of unprofessional behavior on the part of 24 students were submitted to the dean's office; five students received two reports. The clerkship that submitted the most reports was obstetrics-gynecology. The most common complaint for the five students who received two reports was a poor relationship with the health care team. Four of these students had their difficulties cited in their dean's letters and went on to residency; the fifth voluntarily withdrew from medical school. The authors describe the students' and faculty members' responses to the system, discus lessons learned, difficulties, and continuing issues, review future plans (e.g., the system will be expanded to the first two years of medical school), and reflect on dealing with issues of professionalism in medical school and the importance of a longitudinal (i.e., not course-by-course) approach to monitoring students' behaviors. The authors plan to compare the long-range performances of students identified by the evaluation system with those of their classmates.     

学校气氛对初中生学习倦怠的影响

目的:探索学校气氛对初中生学习倦怠的影响。方法:使用学校气氛问卷和初中生学习倦怠问卷对深圳市两所市级中学(N=266)的初中生进行问卷调查。结果:师生关系、学业压力对身心耗竭产生影响,这两个因素可以解释23.4%的身心耗竭。师生关系、发展的多样性、秩序纪律负向预测学业疏离,总共可以解释62.3%的学业疏离;师生关系、同学关系、秩序纪律负向预测低成就感,这些因素可以解释57.4%的低成就感。学习倦怠是一个过程,身心耗竭使学生产生了学业疏离,最后导致了低成就感。结论:学校气氛对初中生学习倦怠有一定的影响。