An e-learning course in medical immunology: Does it improve learning outcome?

Background: E-learning is used by most medical students almost daily and several studies have shown e-learning to improve learning outcome in small-scale interventions. However, few studies have explored the effects of e-learning in immunology. Aim: To study the effect of an e-learning package in immunology on learning outcomes in a written integrated examination and to examine student satisfaction with the e-learning package. Methods: All second-year students at a Norwegian medical school were offered an animated e-learning package in basic immunology as a supplement to the regular teaching. Each student's log-on-time was recorded and linked with the student's score on multiple choice questions included in an integrated end-of-the-year written examination. Student satisfaction was assessed through a questionnaire. Results: The intermediate-range students (interquartile range) on average scored 3.6% better on the immunology part of the examination per hour they had used the e-learning package (p = 0.0046) and log-on-time explained 17% of the variance in immunology score. The best and the less skilled students' examination outcomes were not affected by the e-learning. The e-learning was well appreciated among the students. Conclusion: Use of an e-learning package in immunology in addition to regular teaching improved learning outcomes for intermediate-range students.     

Formal appraisal of undergraduate medical students: is it worth the effort?

Medical student stress is most often related to difficulties of adjusting to university academic standards, and work-social life balance. Faculty systems identify academically failing students for counselling, whilst the majority of students do not have opportunities for individual discussion about progress. This study reports a pilot formal appraisal process for first-year undergraduates. Preparatory material required students to reflect on their academic performance, factors contributing to their university life and satisfaction with career choice. Individual appraisal sessions were held with trained, experienced senior faculty staff, with completion of an appraisal record to document agreed outcomes. Individualized study skills advice was the commonest documented outcome on appraisal records. Students were overwhelmingly positive about the experience, reporting both enhanced perceptions of faculty and reduced anxiety about academic performance. Medical schools have responsibilities to consider ways to optimize students' performance; attainment can be related more to personal and motivational factors than academic ability.     

Lifelong learning skills: how experienced are students when they enter medical school?

Widening participation initiatives together with changes in school curricula in England may broaden the range of lifelong learning skills experience of new undergraduates. This project examines the experience levels of current students, as a comparative baseline. First-year medical students completed a questionnaire on arrival, investigating their practice of 31 skills during the previous two years. Responses show that most students have regularly practised transferable skills. However, significant numbers report little experience, particularly in IT skills such as email, using the Internet, spreadsheets and databases. Some remain unfamiliar with word processing. Library research, essay writing and oral presentation are also rarely practised by substantial numbers. One-third of students lack experience of evaluating their own strengths and weaknesses. Current students already show diversity of experience in skills on arrival at medical school. Changes in the near future may increase this range of experience further, and necessitate changes to undergraduate courses.     

From undergraduate medical education to pre-registration house officer year: how prepared are students?

Studies in the United Kingdom show that the first year of being a new doctor is a difficult transition from being an undergraduate medical. These doctors feel ill-prepared by their undergraduate medical student education and ill-equipped for their new role. This is a questionnaire study looking at 193 pre-registration house officers (PRHOs) and 212 consultant educational supervisors within the West Midlands Deanery in England, UK. The study asked how well prepared these new doctors were in seventeen basic subject areas (using a General Medical Council based template), and also, using the same template, how well prepared their consultant educational supervisors felt they were. Statistical testing included ranking of subject areas for each group, reliability testing and comparisons of views of house officers and consultants. Both groups ranked communication skills areas highest (best prepared) and ranked basic doctoring skills (such as prescribing, treatment, decision making and emergencies) lowest. House officers rated themselves significantly higher than did their consultant supervisors in thirteen out of the seventeen areas tested. In discussion, we ask if we have gone too far in teaching effective communication at the expense of basic doctoring skills. We also consider whether indeed young doctors have an inflated opinion of their own competencies, or are the older generation seeing the world through rose tinted spectacles?     

Distributing menus to hungry learners: can learning by simulation become simulation of learning?

Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of 'integration'. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education.     

Alternative learning environments: what do they contribute to professional development of medical students?

Special study modules provide opportunities for students to develop lifelong learning skills and develop areas of interest. The GMC also recommends opportunities to study topics not included in the core medical curriculum. This paper reports the evaluation of modules based within alternative learning environments developed to provide students with experiences outside traditional medical, scientific or academic cultures. The attachment was highly rated as contributing to professional development, provided novel learning experiences, and was stimulating for both students and supervisors. All students achieved new skills that they felt were pertinent to their personal development. Assessment was by standardized pro forma, including generic transferable skills and module specific outcomes. Whilst overall assessment grades were comparable to similar course components, unease amongst both students and supervisors was expressed reflecting anxieties in the diversity of workloads and assessment. Attempts to standardize assessment across the diversity of modules did not reduce anxieties and potentially detracted from the learning experiences.     

A transitional course from high school to medical school in a new medical curriculum in Asia: how do the students see it?

The objective of this study was to examine the students' views on a transitional course for Asian freshers in a revised medical curriculum. Data were collected through the year-end questionnaire distributed to all first-year students over three academic years from 1997 to 2000. The students considered the transitional course had encouraged them to become more active and self-directed although there were different views about its overall effectiveness. Students appeared uncertain as to the depth in which they were expected to master the subjects, thus leading them to call for more clearly stated learning objectives to help relieve the anxiety they had towards the examinations. Lectures and self-assessment exercises were seen to be providing the general guides for that.     

Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students’ non-technical skills

Introduction: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical students.

Methods: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students’ perceptions of participating in the TDG session and transcribed data from the focus groups was thematically analyzed.

Results: Six key themes emerged from the data: “the value of non-medical games”; “giving and receiving feedback”; “observing and reflecting”; “recognizing and understanding NTS”; “dealing with uncertainty and ambiguity”, and “introducing TDGs into the curriculum”.

Conclusions: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. Medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.     

Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students’ on-ward activities

Introduction: To our best knowledge, a rigorous prospective analysis of final year medical students’ (FY medical students) activity profiles during workplace learning is lacking. The present study investigated the CanMEDS characteristics of all on-ward activities performed by internal medicine FY medical students. We tested the hypotheses that during FY medical student workplace training (I) routine activities are predominantly performed, while supervised, more complex activities are underrepresented with (II) FY medical students performing an insufficient number of autonomous activities and that (III) the CanMEDS roles of the Communicator and the Professional prevail.

Methods: During the second and the sixth week of their final year trimester at the University of Heidelberg Medical Hospital, N?=?34 FY medical students (73% female; mean age 26.4?±?2.4) were asked to keep a detailed record of all their on-ward activities and to document the duration, mode of action (active versus passive; independent versus supervised), estimated relevance for later practice, and difficulty-level in specially designed activity logbooks. CanMEDS roles were assigned to the documented activities via post-hoc expert consensus.

Results: About 4308 activities lasting a total of 2211.4?h were documented. Drawing blood (20.8%) was the most frequently documented medical activity followed by full admission procedures (9.6%). About 14.9% of the time was spent with non-medical activities. About 82.1% of all medical activities performed went unsupervised. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles.

Conclusions: The results call for increased efforts in creating more authentic learning experiences for FY medical students shifting towards more complex, supervised tasks, and improved team integration.     

Where are we with Web-based learning in medical education?

This article summarizes several years of research in Web-based learning (WBL) to illustrate that, in general, research fails to address the questions that will inform our use of this powerful tool. In particular, media-comparative research--the comparison of WBL to another medium (e.g. lecture)--is hopelessly confounded and does little to inform practice. Rather than asking 'If' we should use WBL (we should!), researchers should ask 'How' and 'When' to use WBL. 'How' will be answered by evaluating specific elements of instructional design including theory-based instructional methods, adaptations to individual characteristics and details of presentation enhancements. 'When' will require study of issues such as just-in-time learning, effective use of simulation, and integration of WBL within and between institutions. Both quantitative and qualitative research methods will be useful. Educators should also look outside medical education for evidence and theories to guide their practice. Finally, while WBL has many advantages it is not inherently better than other media. The author suggests that learning outcomes be defined first and WBL be used only when it appears to be the most effective means of achieving these outcomes.     

How much basic science content do second-year medical students remember from their first year?

While most medical students generally perform well on examinations and pass their courses during the first year, we do not know how much basic science content they retain at the start of their second year and how that relates to minimal competency set by the faculty. In the fall of 2014, before starting their second-year courses, 27 medical students volunteered to participate in a study of long-term retention of the basic sciences by taking a “retention exam” after a delay of 5–11 months. The overall mean performance when the students initially answered the 60 multiple choice questions (MCQs) was 82.8% [standard deviation (SD)?=?7.4%], which fell to 50.1% (SD?=?12.1%) on the retention exam. This gave a mean retention of 60.4% (SD?=?12.8%) with the retention for individual students ranging from 37 to 81%. The majority of students (23/27; 85%) fell below the minimal level of competency to start their second year. Medical educators should be more aware of the significant amount of forgetting that occurs during training and make better use of instructional strategies that promote long-term learning such as retrieval practice, interleaving, and spacing.