Factors affecting ratings of clinical teachers by medical students and residents

Ratings of clinical teachers in a department of medicine by medical students and residents were examined to determine whether the ratings were systematically affected by the teachers' academic rank, the level of the teachers' involvement with the trainees, the educational level of trainees (student versus resident), and the type of clerkship (elective versus required). Using 4,050 ratings of 430 faculty members and residents, the authors found no statistically significant differences among academic ranks, although the faculty members' teaching effectiveness was rated significantly higher than that of residents. Higher ratings of teaching effectiveness were associated with the teachers' greater involvement with the trainees and with teaching in elective versus required clerkships. The residents consistently rated faculty members higher than the students did.     

Survey on curriculum committees at U.S. and Canadian medical schools

A 27-item questionnaire was sent to 144 U.S. and Canadian medical schools to identify prevailing patterns in the organization, philosophy, and function of curriculum committees. Overall, 76 percent responded, with 67 percent of the respondents being school administrators and 33 percent being faculty members. Fifty-one percent rated their school's committee as exerting a significant impact on the educational program over the previous five years. Fifty-six percent of the committees had a routine procedure for course review and used data from multiple sources when conducting curriculum evaluations. The committees that annually received a specific assignment from the dean were the most likely (91 percent) to be rated as having a significant impact, followed by committees that conducted frequent course reviews (66 percent). Thirty-eight percent of the committees were primarily faculty oriented, 29 percent were decidedly administrative in composition, and the remaining committees exhibited a mixture of membership.     

Student-directed teaching of medical ethics at a Canadian medical school

The medical faculty at Queen's University, Kingston, Ontario, Canada, in 1982 decided to omit the formal teaching of medical ethics from its curriculum. This decision led both students and faculty members to review the role of ethics in medical education. The outcome was the establishment of a minicourse of four three-hour sessions devoted to the examination and debate of selected ethical issues. The course was directed by students, who chose four general topics for discussion and three subtopics to be the focus in each session. They organized debates between faculty and community members from the fields of medicine, law, philosophy, and theology to be the core of instruction. The course resulted in a high level of satisfaction among the students, who felt that the issues chosen had been appropriately explored. The course, therefore, was continued in the same form by the following medical class.     

An effective integrated learning programme in the first year of the medical course

BACKGROUND: An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course. METHODS: The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members. RESULTS: Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum. CONCLUSION: An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.     

Satisfaction of patients with medical student's clinical skills

A patient satisfaction-dissatisfaction rating scale was developed to measure patients' perceptions of the attitudes and communication skills of medical students. An 11-item questionnaire was completed by trained patients following an end-of-year clinical assessment of the first- and third-year students of a five-year training program. The patients rated 80 percent of the first-year students and 90 percent of the third-year students as acceptable as future doctors. The patients showed a statistically significant preference for the third-year students (p less than 0.05). To assess the reliability over time of patient reactions, two consecutive third-year student groups were compared, and no significant differences in patient satisfaction-dissatisfaction were apparent. The patients tended to perceive female students as more satisfactory than male students. A weak positive correlation between faculty assessments of students and those of the patients was observed. These results suggest that patients are capable of detecting small general improvements in students' attitudes and general manner across years of training and that the patients' ratings are reliable over time.     

Developing a cancer prevention elective course

A comprehensive course on cancer prevention was developed for medical students at the University of Maryland School of Medicine. This course was developed under a three-year contract with the National Cancer Institute during the period from 1979 to 1982. The course development team was multidisciplinary and consisted of faculty members from the departments of pathology, epidemiology and preventive medicine, and family medicine and the Office of Medical Education. The finished course consisted of 20 instructional modules which can be used individually, in groups, or as a complete course in cancer prevention. During the developmental process, all educational objectives were subjected to intensive review and critique by faculty members from the University of Maryland School of Medicine and several other medical schools. The course was pilot tested as a four-week "minimester" elective, revised, and field tested again. This innovative, multidisciplinary, modular curriculum package is now considered complete and appropriate for use by other health sciences institutions.     

Experiences with Evaluation Procedures in Pathology Teaching at Dalhousie University

The experience of evaluation of both students and course in pathology at Dalhousie Medical School indicates that valuable reproducible and probably objective information is obtained by the use of frequent multiple-choice tests combined with substantial final oral examinations. Course evaluation by student questionnaires has provided useful information on course modifications and teaching techniques. The most informative feature of the evaluation program is in the provision of mechanisms for feedback from students to faculty and among faculty members. By these means weaknesses in teaching have been identified and often corrected. The method has aided in the early identification of poor students and of their areas of weakness so that remedial instruction can be instituted before the final examination.     

PDCA理念下的《护理管理学》课程设计改革与实践研究

目的 探索PDCA指导护理管理学课程设计和教学管理改革的实践及效果。方法 将PDCA循环的4个阶段8个步骤,贯穿于护理管理学的课程设计和教学管理的全过程中。以每一次课为小循环,整门课程为大循环,对课程的教学目标、教学内容、教学方法、教学实施、课堂质量、学习效果等进行动态控制和反馈,评价其实施效果。结果 质性分析表明：本课程教学设计合理,教学目标明确具体,教学内容层次结构清晰,编排与组织合理;同行及专家听课课堂评价结果优秀。量性分析发现：学生过程性考核成绩（88.14±1.23）分,笔试成绩（80.21±6.25）分,总评成绩平均（82.60±4.43）分,横向比、纵向比均有所提升,且差异具有统计学意义;学生管理意识、管理能力及实践应用的能力和信心较前提升,课程评价满意度较好。结论 通过PDCA全过程管理,优化了护理管理学课程教学设计,有助于学生管理实践运用能力的发展,提高教学质量。     

Survey of biochemical topics used by clinicians in teaching and practice.

In a pilot survey of biochemical topics, implied and overt, one of us (M.K.) attended 14 clinicians in 7 London medical schools during 4 half-day sessions, chosen at random, and recorded the activities and their relation to biochemistry. The sample was not intended to be representative but aimed at reasonable comprehensiveness. A list of twenty 'biochemical and related' topics was derived from these records, sent to the clinician for approval and comment, and used for rating the incidence of topics during the sampled sessions. Ratings by the two authors independently and the clinicians were combined. Collaboration between biochemist and clinicians was found crucial for the interpretation of clinical events in biochemical terms. Extension of this survey, using a questionnaire embodying the 20 biochemical categories, is to serve as a basis for defining objectives in biochemistry teaching for medical students.     

临床医学本科临床病理讨论选修课模式的实施与效果评估

针对病理学教学环节中课时少,教学任务重的现状,开设临床病理讨论选修课,充分发挥病理学的桥梁作用具有重要的创新意义。本课题以第二军医大学2008级,2009级临床医学专业5个班学生为观察对象,由学生自愿报名参加选修课,以临床病例讨论课为载体,开展PBL式讨论。进行调查问卷结果显示:临床病理讨论选修课模式有利于学生灵活选择学习方式,激发学生学习病理的兴趣和临床思维能力的培养,实施过程中以临床典型病例为基础,引入PBL启发式教学模式能充分调动医学生学习临床病理知识的主动性。     

Faculty and house staff members as role models

In the fall of 1986 approximately 100 faculty members, community physicians, house staff members, and students associated with Indiana University School of Medicine participated in a conference on "Teachers as Role Models: The Impact on the Learning Process." Small-group discussions allowed the participants to define and discuss the impact of role-modeling in medical education. It was anticipated by the organizers that after the conference the participants would be more cognizant of their influence as role models and would be motivated to become better role models and support good role-modeling. A synopsis of the conference indicates that the participants identified both the positive and negative impact of role-modeling and concluded that medical educational programs should use positive role-modeling as a teaching tool to instill within students the desire to gain new knowledge and to apply that knowledge as medical professionals.     

Relationships between clinical competence ratings and examination performance.

Relationships between faculty ratings and performance on components of the National Board of Medical Examiners Certifying Examination for Primary Care Physician's Assistants were investigated. A factor analysis of the clinical competence rating form yielded three discrete factors. Results of tests of simple relationships between each rating factor and examination component indicated that four of the six examination components correlated significantly though modestly with at least one of the rating scale factors. The results of multiple regression analyses indicated complex relationships between each of two examination components and the set of rating factors. One implication is that faculty members are able to make discrete judgments about students on more than one dimension.     

Long-term evaluation of training residents in clinical teaching skills

In the present study, the authors examined the long-term effectiveness of a course for residents on how to teach students, patients, and peers. Residents of various specialties attended a mandatory short course on clinical teaching skills in the middle of their first year of postgraduate medical training. Three types of evaluation data were collected at three times during a two-year period: self-ratings by the residents, questionnaires completed by the residents, and ratings completed by students taught by the residents. Complete data for 18 residents indicated that the residents rated their teaching skills significantly higher after the course (at the end of both the first year and the second year) than before it. At the end of the second year, 94 percent of the residents stated that the course was helpful, 67 percent could recall and explain specific principles of teaching, and 61 percent reported using principles from the course in their teaching. Students' ratings of these 18 residents were too scanty to be interpreted validly. The study suggests that residents of varying specialties can profit from an introductory course on teaching skills and that the effects endure for at least one and a half years.     

Tutored videotape-instruction in clinical decision-making

Tutored videotape-instruction (TVI) is a method for providing high quality instruction in topics for which the supply of expert teachers is limited. A small group of students and a tutor can watch a videotaped lecture that can be interrupted for discussion or questions. The tutor facilitates discussion and directs the students to outside reading. The authors in this report describe the use of tutored videotape-instruction in teaching clinical decision-making. Students were randomly assigned to a tutored videotape-instruction group or to a group that heard identical live lectures. The two groups had the same mean score on a final examination on the course material. The group that heard the live lectures rated the quality of instruction higher than the videotape group; however, the ratings were high for both groups. Tutored videotape-instruction provides expertise in a specialized topic and the advantages of instruction in small groups.     

Participation of volunteer faculty members in education research projects

Physicians in private practice who are also volunteer clinical faculty members are a recognized resource for teaching and patient care at teaching hospitals. Clinical faculty members have seldom been included in education research despite the frequent complaint from community practitioners that the results from studies at teaching hospitals are not applicable to community practice. The authors report on a study involving volunteer clinical faculty members in a randomized education trial to improve patients' everyday functioning. Seventy-six clinical faculty physicians in office practice of internal medicine participated. At the end of the study the physician participants were asked to complete an evaluation questionnaire concerning the appropriateness of clinical faculty members' participation in such research projects. Ninety-five percent said the experiment was appropriate, and 88 percent would participate again.     

A community medicine clerkship on the Navajo Indian reservation

An elective clerkship in community medicine for medical students has been conducted for 16 years on the Navajo Indian reservation. An important part of the clerkship is a project in which most students select a health problem which they investigate using epidemiological methods of assessment and for which they seek a solution. The requisites for the projects are that real health problems are involved, scientifically sound methods are used, usable information is provided, and data collection can be completed within the clerkship tenure. Topics for the projects are selected jointly by the students and the faculty members from several general subject areas; this allows the work of individual students to be carried out as independent subprojects of larger projects, and this, in turn, produces more information about and has more impact on the problems addressed. Other clerkship objectives also are achieved through investigative projects that may involve students in planning, organization, and evaluation of health care and in public health practice.     

Students' and physicians' evaluations of gynecologic teaching associate program

Gynecologic teaching associates (GTAs) taught third-year medical students to perform physical examination of the female pelvis and breasts. Evaluations by the students of this teaching method and assessment by the GTAs of student problems with the examinations were obtained from questionnaires completed immediately after the single three-hour teaching sessions. A follow-up questionnaire was sent to the program's first-year participants. Items were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). The GTAs found student problems in 30 percent of the encounters. The students gave high ratings to the learning experience. The graduates strongly agreed that the program should be continued (4.21) and felt that the program most improved their ability to perform the pelvic examination (4.15).     

Knowledge and attitude of faculty members on problem based learning

An intervention study was carried out in Mymensingh Medical College during the second week of January, 2003 to compare knowledge and attitude of the faculty members of Mymensingh Medical College on PBL before and after exposure to a symposium. Pretest was done among 48 faculty members before and 45 faculty members after exposure to the symposium using a self-administered questionnaire. Before the symposium about 17% of faculty members had a sound knowledge on PBL, the figure rose significantly to about 61% after exposure to the symposium (P < 0.001). About 73 % of faculty members felt that PBL is effective in problem solving after exposure to the symposium, as compared to about 60% who felt that PBL is effective in problem solving before the symposium (P < 0.01). About 69% of faculty members stated that PBL is better than traditional ward teaching after exposure to the symposium, as compared to 51.1% who stated that PBL is better than traditional ward teaching before the symposium (P < 0.001). About 69% of faculty members stated that PBL enhances self-directed learning after exposure to the symposium, as compared to about 52% who stated PBL enhances self-directed learning before the symposium(P <0.005). About 64% of faculty members affirmed that they will welcome PBL in clinical teaching after exposure to the symposium, as compared to 62.5% of faculty members who would welcome PBL in clinical teaching before the symposium (P < 0.01). A total of 59% of faculty members asserted that they will recommend PBL to be included in Undergraduate Medical Curriculum after exposure to the symposium, as compared to 60.3% who would recommend PBL in Undergraduate Medical Curriculum before the symposium. About 51 % of faculty members agreed that practicing PBL will help students after graduation to continue independent learning before the symposium, as compared to 60% who agreed that practicing PBL will help students after graduation after exposure to the symposium (P < 0.05). It can be concluded that exposure to a symposium centered on PBL can improve knowledge and attitude of faculty members on PBL positively & significantly.     

Evaluating continuity and comprehensiveness of care in an elective family practice clerkship

The University of Wisconsin Medical School has operated an intensive, elective, three-month family practice clerkship since 1980. Beginning in 1981, a computerized, sampling instrument has been used to generate measures of the continuity and comprehensiveness of care being learned by the students and the clinical content of the students' experience. This tool has proved useful for motivating students and faculty members to concentrate on the factors of continuity and comprehensiveness in the clerkship experience. The data collected regarding the students' activities are presented here.     

Interviewing skills: a comprehensive approach to teaching and evaluation.

Evaluation procedures utilizing standardized interviews scored by means of a formal objective rating system which make it possible to measure the interviewing skills of health professional students have been developed in recent years. These procedures have been used in the Child Health Associate Program at the University of Colorado Medical School to evaluate the ability of a group of students to achieve the objectives of a practice-oriented interviewing course. Results from the standardized interviews indicate that students taking the course gathered an average of 76 percent of all available data and used 86 percent of the process skills defined as necessary for positive interview interaction. A previous group of child health associate students who did not take the course gathered an average of 47 percent of all available data and used an average of 62 percent of the necessary process skills.