多媒体综合教学在乡村医生心肺复苏培训中的作用

目的：研究多媒体综合教学在乡村医生心肺复苏（CPR）培训中的作用,探讨提高乡村医生CPR培训的方法。方法：采用分组研究的方法,按随机分组原则设试验组和对照组,对62名乡村医生分别采用多媒体综合CPR电脑教学模拟人教学法与传统版书教学法情况进行跟踪调查研究。结果：试验组与对照组在理论知识考试和操作考核中成绩显著,差异有统计学意义（X^2=7．4,P〈0．01）。结论：多媒体综合CPR电脑教学模拟人教学在乡村医生CPR培训考核中具有显著效果,应予以推广。     

Communication skills teaching, learning and assessment

This paper outlines an introductory course in teaching communication skills to medical students in a preclinical context. The aims of the course, its content and teaching methods are described. Novel features include the active participation of selected patients in teaching and assessment, and the use of a form of role-play named 'listening triads'. The main focus of the paper is assessment, and results are recorded, relating to a class of 114 second-year students during the academic session 1983-84. Assessment of the students' learning was measured by Modified Essay Question (MEQ); students' problems face-to-face with patients were identified by patients, students, and by staff members observing interactions. Problems of fitting these educational assessments into a traditional academic 'certifying' type of assessment remain unresolved at present. This course was found to be acceptable by the preclinical students, and their lack of clinical knowledge did not appear to interfere with their learning. They were enthusiastic about the supervised contact with patients, which appeared to contribute significantly to the way the course was received.     

Clinical risk management in obstetrics: eclampsia drills*

Problem: Infrequent presentation of patients with eclampsia, leading to staff inexperienced in the condition and untested emergency systems.

Design: "Fire drill" programme using on-site simulation of patients with eclampsia.

Setting: Tertiary referral obstetric unit.

Key measures for improvement: Successful implementation of measures to optimise management of eclampsia.

Strategies for change: Rapid activation of emergency team after one call, development and dissemination of evidence based protocol for eclampsia, strategically placed "eclampsia boxes," individual staff feedback and education.

Effects of change: Efficient and appropriate management of subsequent simulated patients.

Lessons learnt: On-site simulation can identify and correct potential deficiencies in the care of patients with eclampsia.

     

Gynaecological examination: a teaching package integrating assessment with learning

A self-directed learning package which includes assessment was developed to allow students to acquire the psychosocial and motor skills needed to conduct a gynaecological examination with sensitivity. The package integrates assessment with learning and uses the Assessment Form as an educational instrument. The introduction, including a video of a vaginal examination and pap smear, is followed by five learning stations for groups of 3 or 4 students to visit. At each station a series of tasks are given which enable the objectives of the station to be fulfilled. The materials necessary to complete the tasks are provided. Gynaecological assistants, themselves trained by participation in the learning sessions, guide the students throughout the session and act as adviser `patients' to help students acquire the necessary motor skills. In the assessment, students are required to integrate what they have learnt in the learning stations. The students assess themselves and the `patient' and an observer assesses the student using the same Assessment Form. The form assesses and gives examples of the psychosocial, including legal and motor skills required. The assistants–observers give feedback to the students about their performance and make suggestions for future improvement. Of the 232 medical students completing their clinical terms in Obstetrics and Gynaecology in 1995, those students receiving the learning package rated their practical experience as significantly better. They rated the learning method, content, enjoyment and package overall very highly (median 4, 5 point scale 1–5). Open-ended comments by students confirmed these findings.     

A new method of assessment of clinical teaching: ROC analysis

Twenty-five clinical dental students with varying clinical experience were presented with case records consisting of a clinical history and a panoramic radiograph for 25 patients with bilateral lower third molars ('wisdom teeth'). The students were asked to indicate how certain they were that each lower third molar tooth needed removal using a 6-point rating scale. Immediately following the task, the students were presented with information on the indications for removal of lower third molars in the form of a lecture by a senior academic clinical teacher. One week later the students were asked to repeat the rating study, under the same conditions as before, using a further 25 clinical cases. Receiver operating characteristics (ROC) analysis, which provides a graphical and quantitative assessment of a group of observers' ability to detect need for treatment, was utilized to examine differences between junior and senior students and between the matched pre-training and post-training experiments. The ability of junior students to assign lower third molars for surgery was statistically no better than random selection of cases. Formal clinical teaching significantly improved this group's performance, but had no effect on the performance of senior students. Senior students were significantly better able correctly to assign lower third molars for surgical intervention than junior students. Therefore this study shows that clinical experience has a significantly greater influence on treatment-planning ability than formal teaching. ROC analysis is a useful tool for assessing the effectiveness of methods of undergraduate training.     

CPR success stories

What kind of planning goes into implementing a computer-based patient record, and how can HIM professionals participate in this process? Two practitioners who've been there discuss how they were able to use their expertise in CPR projects--and the results that followed.