Comparing postgraduate medical education at university and non-university hospitals in Japan.

In 1988 the authors surveyed all the teaching hospitals in Japan to evaluate the present status of postgraduate medical education (PGME); they received responses from 67 (84%) of the university and 172 (89%) of the non-university teaching hospitals. It was found that a large proportion of residents had spent two years in a residency without having had a single experience of some of the basic clinical skills. Consequently the residents' confidence in their abilities to perform these skills was low. The residents at the university hospitals, in particular, had had fewer experiences and were less confident about their clinical skills than were the residents at the non-university hospitals. The lack of standard and minimum requirements for PGME in Japan may be the cause of the poor level of acquisition of clinical skills of residents during PGME. Other possible causes are the tendency in Japanese medical society to attach greater importance to academic attainment than to clinical competence and the excessive gravitation of residents toward university hospitals. The authors suggest their results show the necessity to improve the training in basic clinical skills in PGME in Japan, especially in university hospitals.     

Personality evaluation of doctoral applicants: A survey of clinical psychology training directors

The growing dissatisfaction with traditional criteria used to select doctoral applicants has led clinical faculties to consider alternative selection criteria, including the use of a formal personality evaluation. A survey of training directors of APA-approved clinical psychology programs was conducted to assess their opinions with regard to this proposal. The results showed that 75.3% of the respondents opposed the use of a personality evaluation. Opposition was based primarily on the applicant's right to privacy and the inadequacies of assessment alternatives.     

Cognitive simulators for medical education and training

Simulators for honing procedural skills (such as surgical skills and central venous catheter placement) have proven to be valuable tools for medical educators and students. While such simulations represent an effective paradigm in surgical education, there is an opportunity to add a layer of cognitive exercises to these basic simulations that can facilitate robust skill learning in residents. This paper describes a controlled methodology, inspired by neuropsychological assessment tasks and embodied cognition, to develop cognitive simulators for laparoscopic surgery. These simulators provide psychomotor skill training and offer the additional challenge of accomplishing cognitive tasks in realistic environments. A generic framework for design, development and evaluation of such simulators is described. The presented framework is generalizable and can be applied to different task domains. It is independent of the types of sensors, simulation environment and feedback mechanisms that the simulators use. A proof of concept of the framework is provided through developing a simulator that includes cognitive variations to a basic psychomotor task. The results of two pilot studies are presented that show the validity of the methodology in providing an effective evaluation and learning environments for surgeons.     

Global health in medical education: a call for more training and opportunities.

Worldwide increases in global migration and trade have been making communicable diseases a concern throughout the world and have highlighted the connections in health and medicine among and between continents. Physicians in developed countries are now expected to have a broader knowledge of tropical disease and newly emerging infections, while being culturally sensitive to the increasing number of international travelers and ethnic minority populations. Exposing medical students to these global health issues encourages students to enter primary care medicine, obtain public health degrees, and practice medicine among the poor and ethnic minorities. In addition, medical students who have completed an international clinical rotation often report a greater ability to recognize disease presentations, more comprehensive physical exam skills with less reliance on expensive imaging, and greater cultural sensitivity. American medical students have become increasingly more interested and active in global health, but medical schools have been slow to respond. The authors review the evidence supporting the benefits of promoting more global health teaching and opportunities among medical students. Finally, the authors suggest several steps that medical schools can take to meet the growing global health interest of medical students, which will make them better physicians and strengthen our medical system.     

Profiles of applicants for junior faculty posts to teach anatomy in the UK: Changing populations of candidates

This study was undertaken to document the popularity of appointments as temporary lecturer in anatomy (TLA) at the University of Manchester during the period 1991–1998, and to profile the applicants for the posts. Data concerning 465 applicants were collated from departmental records and application forms. Prior to 1996, there were about seven applicants per post and most were men who intended to pursue surgical careers. The mean age of the applicants was 26 years, range 22–61 years. Graduates of Manchester University formed 28% of applicants, non‐UK graduates 11%, and 52% possessed qualifications additional to their medical degrees. After 1996, there were fewer applicants, about three per post, who were somewhat older, mean age 30 years, range 21–52 years, and from more diverse backgrounds; 40% were non‐UK graduates. The probable reasons for the decline in popularity of the appointments are explored. Clin. Anat. 12:272–276, 1999. © 1999 Wiley‐Liss, Inc.     

Competency-based residency training: the next advance in graduate medical education.

The goal of all graduate medical education is to ensure that the graduating physician is competent to practice in his or her chosen field of medicine. The evaluation of a resident's competency to practice, however, has never been clearly defined, nor has the fixed period of time given for residency training in each specialty been shown to be the right amount of time for each individual resident to achieve competency. To better ensure that new physicians have the competencies they need, the author proposes the replacement of the current approach to residents' education, which specifies a fixed number of years in training, with competency-based training, in which each resident remains in training until he or she has been shown to have the required knowledge and skills and can apply them independently. Such programs, in addition to tailoring the training time to each individual, would make it possible to devise and test schemes to evaluate competency more surely than is now possible. The author reviews the basis of traditional residency training and the problems with the current training approach, both its fixed amount of time for training and the uncertainty of the methods of evaluation used. He then explains competency-based residency education, notes that it is possible, indeed probable, that some trainees will become competent considerably sooner than they would in the current required years of training, quotes a study in which this was the case, and explains the implications. He describes the encouraging experience of his neurosurgery department, which has used competency-based training for its residents since 1994. He then discusses issues of demonstrating competency in procedural and nonprocedural fields, as well as the evaluation of competency in traditional and competency-based training, emphasizing that the latter approach offers hope for better ways of assessing competency.     

Virtual microscopy in pathology teaching and postgraduate training (continuing education)

As with conventional microscopy, virtual microscopy permits histological tissue sections to be viewed on a computer screen with a free choice of viewing areas and a wide range of magnifications. This, combined with the possibility of linking virtual microscopy to E-Learning courses, make virtual microscopy an ideal tool for teaching and postgraduate training in pathology. Uses of virtual microscopy in pathology teaching include blended learning with the presentation of digital teaching slides in the internet parallel to presentation in the histology lab, extending student access to histology slides beyond the lab. Other uses are student self-learning in the Internet, as well as the presentation of virtual slides in the classroom with or without replacing real microscopes. Successful integration of virtual microscopy depends on its embedding in the virtual classroom and the creation of interactive E-learning content. Applications derived from this include the use of virtual microscopy in video clips, podcasts, SCORM modules and the presentation of virtual microscopy using interactive whiteboards in the classroom.     

Status of the clinical laboratory in the mandatory postgraduate medical training system: introduction

To understand the role of the clinical laboratory in the era of mandatory postgraduate medical training, I carried out a questionnaire survey in April 2005 among both university hospitals and clinical teaching hospitals located in the Kinki area. As a result, eleven (84.6%) of the 13 responding laboratories participated in clinical laboratory medical education with an obligatory training program (5 laboratories), with an elective program (3 labs) or both (3 labs). Among the 8 laboratories with an obligatory program, educational lecture subjects included reversed clinicopathological conference (7 labs), blood transfusion (4 labs), laboratory microbiology (4 labs), and blood gas analysis (BGA) (3 labs). On the other hand, in the elective training programs among 6 laboratories, laboratory microbiology including infection control was most frequently held (4 labs) followed by blood transfusion, laboratory hematology and urinalysis (3 labs respectively). Concerning 4 areas, namely, blood transfusion, 12-lead electrocardiography at rest, BGA and ultrasonography, which have been defined as obligatory laboratory techniques for all trainees in mandatory postgraduate medical training, the majority (84.6%) of the responders in this survey replied that they were not sufficient, whereas, Gram's staining was most frequently (69.2%) recommended as an additional obligatory technique in mandatory postgraduate medical training.     

Trends in medical education: challenges and directions for need-based reforms of medical training in South-East Asia

Most medical schools, especially in South-East Asia, currently are experiencing difficulties in providing the right quality and quantity of educational experiences as the curricula have failed to respond to the needs of the community and country. The pedagogic shift from traditional approach to a need-based approach requires a fundamental change of the roles and commitments of educators, planners and policymakers. Teachers of health professional education in the region are to be well-informed of the trends and innovations and utilize these to increase relevance and quality of education to produce competent human resources for the region. The purpose of this paper is twofold: (i) to discuss innovative strategies and emerging trends, which have been successfully adopted by educators around the world for the reorientation of medical education to overcome existing traditions of educational planning, review and development and (ii) to highlight their implications and importance to initiate need-based reforms of medical training in South-East Asia.     

Residents’ perceived barriers to communication skills learning: Comparing two medical working contexts in postgraduate training

Objective

Contextual factors are known to influence the acquisition and application of communication skills in clinical settings. Little is known about residents’ perceptions of these factors. This article aims to explore residents’ perceptions of contextual factors affecting the acquisition and application of communication skills in the medical workplace.

Method

We conducted an exploratory study comprising seven focus groups with residents in two different specialities: general practice (n = 23) and surgery (n = 18).

Results

Residents perceive the use of summative assessment checklists that reduce communication skills to behavioural components as impeding the learning of their communication skills. Residents perceive encouragement to deliberately practise in an environment in which the value of communication skills is recognised and support is institutionalised with appropriate feedback from role models as the most important enhancing factors in communication skills learning.

Conclusion

To gradually realise a clinical working environment in which the above results are incorporated, we propose to use transformative learning theory to guide further studies.

Practical implications

Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.