Introducing medical students to medical informatics

Summary. Medical informatics ( MI ) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill ( NCU ). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.     

An innovative examination ending the medical curriculum

There has been increasing interest in curriculum innovation in many medical schools. The pedagogic principles for learning and for assessment should be congruent. Changing the curriculum and pedagogic principles for medical education implies that the examinations should also be adapted to the new principles. At the Faculty of Health Sciences, Linköping University, we use a student-oriented programme with problem-based learning, early patient contact, multiprofessional integrated education, and integration between basic science and clinical medicine and between traditional medical subjects. We also encourage the students to adopt a scientific attitude from the very beginning. To assess the students at the conclusion of the medical curriculum, we have developed a new form for the final examination containing measurements of clinical ability based on a videotaped patient consultation, an assessment of the student's performance and presentation of a scientific project, the student's analysis of a published scientific paper and an extensive oral examination based on the students' own scientific papers. Our experience, including results from questionnaires to students and teachers, is that the method is suitable for a final examination and assesses qualities that we previously were not able to assess.     

Medical school selection: Screening for dysfunctional tendencies

AIM: One of the aims of medical selection is to deselect students who have personal characteristics that would impact negatively on their ability to interact with patients, supervisors and peers and impede their ability to cope with the stress of medical training. The arduous requirements of the formal curriculum, the customs and rituals of the socialisation process and the mistreatment and abuse reportedly experienced by students all contribute to stress, mental illness, suicide, lowered self-confidence in clinical ability, decreased ability to learn and alcohol and substance abuse. There has been little research on the effectiveness of the selection interview in deselecting students with negative personal characteristics. Our research profiles the dysfunctional interpersonal tendencies of students already selected into a medical programme through the process of academic merit, application and interview. METHODS: During 2001 and 2002, 159 students enrolled in an Australian undergraduate medical programme completed the Hogan Development Survey (HDS), which is a self-report measure of dysfunctional personality characteristics that inhibit the development of working relationships with others. RESULTS: The HDS identified negative personality characteristics in medical students that were not detected in the selection interview. CONCLUSIONS: The presence of patterns of dysfunctional behaviour in medical training has implications for the selection, teaching and pastoral care of medical students. The HDS has the potential to identify negative personal characteristics that are hard to detect during a selection interview, and may be a valuable adjunct to the interview.     

A programme for treating chemically dependent medical students

Summary. The first American programme for chemically dependent medical students at the University of Tennessee, Memphis is described. The goals of the Aid for the Impaired Medical Student (AIMS) Program are to provide confidential treatment for chemically dependent medical students, to assure that recovering students are able to resume their education, and to protect patients and others from the harm that may be caused by impaired students. The Program is administered by the AIMS Council, consisting of medical professionals and elected student representatives. The Council oversees the management of cases, including investigation of students who may be impaired, intervention when chemical dependency is suspected, diagnostic evaluation, treatment and aftercare, and post-recovery advocacy for students. The Program's experience includes 18 cases of suspected chemical dependency, with four self-referrals and 14 students referred by third parties. Eleven students have been diagnosed as chemically dependent and have completed treatment programmes. Nine have maintained recovery and eight have graduated. One student subsequently relapsed and committed suicide. Obstacles in programme implementation have involved absence of perceived need, the view that chemically dependent students should be dismissed from school, and reluctance of students to report classmates. Resources have included highly respected student representatives, a supportive administration, assistance of the impaired physicians programme, and medical insurance and professional courtesy to defray costs. Although the number treated has been modest, the AIMS Program is an important vehicle for training students regarding chemical dependency and their professional obligations toward impaired colleagues.     

The first sunrise: an experience of cultural immersion and community health needs assessment by undergraduate medical students in New Zealand

CONTEXT: Cultural factors in health and illness, and an awareness of community health needs analysis, are important issues for medical education. Both have received relatively little recognition in the medical education literature. This paper describes the development of an educational attachment to remote predominantly Maori rural communities in New Zealand. The twin purposes of the programme were to encourage students to adopt broad public health approaches in assessing the health needs of defined communities, and to increase their awareness of the importance of cultural issues. METHODS: During a one week attachment, 51 students from the Wellington School of Medicine were hosted in six small communities in the East Cape region of New Zealand. Students gained an insight into the health needs of the communities and were encouraged to challenge their own attitudes, assumptions and thinking regarding the determinants of health and the importance of cultural factors in health and illness. The programme included both health needs assessment and cultural immersion. Students made visits with primary health care professionals and were also introduced to Maori history and cultural protocol, and participated in diverse activities ranging from the preparation of traditional medicines to performing their own songs in concert. CONCLUSIONS: The students evaluated the course extremely highly. Attachments of this sort provide an opportunity for students to appreciate how cultural values have an impact on health care, and how they also make the teaching and learning of topics such as community health needs analysis an enjoyable and dynamic experience.     

A community-based learning experience for medical students

A programme in which medical students are attached to Children's Institutions for one year is described. The students' role embraces a medical and psychosocial component in which students conduct clinics, screening programmes and health education as well as develop relationships with individuals and groups of children. This experiential learning programme enables medical students to obtain an understanding of children's needs and work through their own feelings which are aroused when confronted with children who have been deprived and abused.     

The influence of gender and specialty on reporting of abusive and discriminatory behaviour by medical students, residents and physician teachers

INTRODUCTION: The perception of whether a given behaviour is abusive differs between students and teachers. We speculated that attitudes towards reporting abusive and discriminatory behaviour may vary by specialty as well as by gender. METHODS: We report a cross-sectional survey of incoming medical students, medical students, residents, and teaching faculty at one Canadian medical school. The discrimination and abuse questions were in the following domains: (i) psychological abuse, (ii) sexual abuse, (iii) physical abuse, (iv) gender discrimination, (v) racial discrimination, (vi) disability discrimination, (vii) derogatory remarks regarding homosexuality. The frequency of self-reported witnessed or experienced abusive and discriminatory behaviour was compared by gender, specialty choice and stage of training. RESULTS: The response rates varied by respondent group: 44/56 (79%) of incoming medical students, 177/218 (81%) of medical students, 134/206 (65%) of residents and 215/554 (38%) of physician teachers. The frequency of these behaviours was perceived to be low by both male and female respondents. Abusive and discriminatory behaviour by physician teachers was noted more frequently by residents (P < 0.001) and physician teachers themselves (P < 0.001) compared with incoming medical students. As well, in general, women noted more abusive and discriminatory behaviour by all teachers, compared with men (P < 0. 003). Each response to the abuse/discrimination questions was also modelled as the independent variable using stepwise multiple regression. The area of specialization (surgical versus non-surgical) altered the reporting of abusive and discriminatory behaviour by women. CONCLUSION: We conclude that female surgical residents and medical students undergo a process of acclimatization to the patriarchal surgical culture. As female surgeons become physician teachers they revert to a culture more similar to that of their female non-surgical colleagues. Although a process of deidealization occurs in medical training, these attitudes are not necessarily retained throughout the practising lifetime of physicians as they regain autonomy and more personal control.     

Return to basic sciences after clinical experience in undergraduate medical training

As part of the restructured undergraduate medical curriculum at McGill Medical School, a return to basic sciences was introduced in the students' final year. This follows the completion of the formal portion of their undergraduate clinical education. This paper describes this unique return to the basic science programme including the rationale behind the change and the effects of this programme on student learning, and student attitudes towards the programme. Final-year medical students in 1978 and 1981 were tested on educational and attitudinal variables. Data were collected using achievement tests, questionnaires and interviews. The findings of the study indicated that the major objectives of the programme, which were to facilitate student learning in greater depth and to integrate basic sciences with clinical knowledge, were achieved. The programme was enthusiastically received by the students in 1978 and also in 1981, indicating the outcome of the return to the basic science programme to be more than a 'Hawthorne effect' as suspected in 1978. The concept of a return to basic science is recommended for consideration by medical faculties.     

The new Dundee medical curriculum: a whole that is greater than the sum of the parts

The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.     

Higher medical and surgical degrees in the University of Sydney

Three hundred and twenty-six higher medical and surgical degrees were awarded by the University of Sydney between 1883 and 1977. A questionnaire was sent to 209 graduated known to be alive to gather data regarding their prior and subsequent careers. As many of the graduates were in their fourth decade before commencing the research studies for the M.D. thesis, there would appear to be reasons for recommending the Ph.D. degree, with its three years of supervised course work, to prospective higher degree candidates. 286 B.Sc. (Med.) degrees were awarded midway through the medical course between 1949 and 1974. This earlier introduction to research probably does more to encourage and academic or research career than the M.D. degree which currently appears to be a prerequisite to a University appointment. Some concern is raised by the comment of 27% of M.D. graduates who claimed no personal scientific benefit from their studies.     

Factors determining the performance of medical students of the Faculty of Medicine, University of Kuwait

An investigation was undertaken to determine the factors influencing performance of medical students at the Faculty of Medicine, University of Kuwait. Data were collected for the first batch of 42 candidates who successfully passed the 7-year medical programme. Results showed high correlations between high-school admission grades and subsequent performance during the medical programme. Similar results were also obtained with English proficiency. A partial correlation controlling for English proficiency, however, showed a systematic decline in the magnitude of the correlations between high-school grades and performance during the medical programme. In fact the relationship between high-school GPA and clinical GPA was non-significant. A prominent influence of English proficiency on performance is indicated.     

Introducing first-year students to medical school: experiences at the Faculty of Medicine of Erasmus University, Rotterdam, The Netherlands

A system, in which more advanced students provide guidance to small groups of first-year students with respect to the educational programme, problems students may encounter in studying medicine and with respect to the living circumstances associated with going to medical school, and which has been operating for 14 years, is described. Each group consists of ten first-year students and two advanced students, called mentors, and meets about once every fortnight to discuss questions that come up among the first-year students. The mentors receive some professional training in the field of group psychology.
This system has now operated for 14 years, and therefore may be regarded as evidence that it meets real needs of students entering medical school.     

Neurobehaviour rounds and interdisciplinary education in neurology and psychiatry

Increasing emphasis on interdisciplinary medical treatment and education suggests that something valuable has arisen from medical specialization beyond the further development of specialty knowledge: an integration of specialty knowledge that compliments and extends the integrating aspects of the primary care approach to medicine. Several educational models have been described which serve this function. In this paper the authors describe interdisciplinary clinical teaching, and research team linking neurology, neuroradiology, psychiatry and neuropsychology. The team provides neurobehavioural evaluations and sponsors monthly Neurobehaviour Rounds, an interdisciplinary patient conference that is the main formal teaching vehicle for the programme. After the model had been in place for 1 year, eight of nine neurology residents had Residency In-Service Training Examination scores in behavioural neurology that exceeded their overall average scores. This suggests that encouraging neurology residents to see patients through the eyes of different specialists may have contributed to improvement in their performance on a test of interdisciplinary knowledge. A neurobehavioural programme anchored to a formal neurobehaviour conference may encourage interdisciplinary learning within the related disciplines of neurology, neuropsychology and psychiatry.     

Pedagogical methods and affect tolerance in medical students

OBJECTIVES: There has been little evaluation, by means other than cognitive variables, of medical school curricula that include problem-based learning (PBL). This study aimed to investigate whether medical students' affect tolerance, an important prerequisite of empathy, was influenced by individual courses. DESIGN: The study is pseudo-randomised and cross-sectional, using a test of affect tolerance in students in their first, sixth and eighth term of medical school, during which they were kept together as one group for their pre-clinical studies, but were subsequently separated during the clinical part and were sent to two different university hospitals that used different teaching methods. SUBJECTS: Medical students. SETTING: University of Lund Medical School, Sweden. RESULTS: After receiving a short course in communications skills training, students in the sixth term had significantly higher mean scores on the test than students in their first term. In the eighth term, which is the surgery term, the mean scores for students attending the PBL course were still as high as those for students in the sixth term, while students in the course using conventional pedagogical methods had significantly lower mean scores. DISCUSSION: Since the content of the courses was similar and the composition of the two groups also fairly similar, we attribute the difference to the differing teaching methods. In the PBL course, the students were given continued and integrated communication skills instruction, in which it was possible for them to learn strategies to counteract the development of rigid psychic defences, which constitute an obstacle to affect tolerance and empathy.     

Training for health care in developing countries: the work of the Tropical Health and Education Trust

The Tropical Health and Education Trust (THET) was established to strengthen medical education and training for health care in developing countries. The Trust responds to requests from training institutions with a wide range of activities and programmes. Projects to meet specific needs are planned in outline with the Deans or Directors of institutions, as a basis for a long-term link with a similar institution in the United Kingdom. These links are now the preferred method for meeting requests to develop skills, strengthen services and promote staff development. However, funding is always necessary for their support. THET has promoted students' community-based training by enabling students in a team-training programme in Ethiopia to make interventions in primary health care. A prize for the best students' community, clinical or laboratory projects in six African countries encourages enquiry by the students, promotes independent learning, and relates academic work to problems in health care. Work with Ministries of Health includes a continuing medical education programme for rural medical officers in Uganda, courses in basic and life-saving surgery for Ethiopian health and medical officers, and a programme to update the skills of laboratory technologists in rural hospitals in Ghana. The range of projects that THET supports is wide because the needs, defined by those who are working in, and responsible for, training in the health service are diverse.     

Clinical electives: setting up an overseas programme in a new medical school

Summary. This paper describes the methods used to establish an overseas elective programme in a new medical school, the objectives and the perceived results. The aims and objectives of the programme are listed. The students who participated in the programme were from the charter class and had completed the second year of a 3-year clinical programme. The methods used to establish the programme are described. Destinations were organized through academic staff contacts. Systematic preparation of students was an important feature of the programme. Comparative costs and methods of financing the programme are described in detail. The results of the programme are analysed together with the form of assessment used and feedback from both the host institution and the student. The importance of monitoring progress while students are abroad is described. The discussion focuses on the benefits derived from an overseas elective programme for both students and teachers. The advantages and disadvantages of different destinations are compared. Further refinements to the programme are discussed including alternative methods of obtaining funding. The importance of developing reciprocal arrangements with other medical schools and institutions throughout the world is emphasized.     

Day surgery: teaching the next generation

The advent of day surgery presents new opportunities and challenges for medical education. The opportunity to see patients pre-operatively and follow them through surgery to discharge on the same day is unique to day surgery. However, with rare exceptions, the development of educational programmes in ambulatory surgical settings is still largely at a rudimentary level. An undergraduate pilot programme was conducted at the University of Adelaide to explore the practicalities, acceptance and educational value of a day surgery programme for final-year medical students. The programme had three components: day surgery patient follow through, practical procedure tutorials and problem-based learning tutorials. It incorporated assessment of practical skills and theoretical knowledge with the use of log books and clinical and practical simulations as important elements in the assessment process. The pilot programme was accepted by all stakeholders and students' perceived significant gains in knowledge and skills. This programme may provide a teaching model that could be adapted for use in other medical schools.     

Training medical practitioners in information transfer skills: the new challenge

Summary. Traditionally, undergraduate medical education has concentrated on teaching students how to gather information or take medical histories from their patients. However, research increasingly indicates that there is a need for medical practitioners to improve their skills in information transfer in a way which will increase the probability that patients are active collaborators in their treatment. Consequently, Newcastle Medical School has sought to develop training packages for medical students in information transfer skills. This paper describes the resulting training programme with particular emphasis on the areas selected for training, the methods by which students are taught, the necessary interactional skills and the assessment procedures which are applied.