A prospective randomized trial of an urban general practice attachment for medical students

A randomized controlled trial was undertaken to evaluate the effectiveness of a new model for providing urban general practice attachments for final-year medical students at the Flinders University of South Australia. All the student groups in that year were randomized prospectively to either the standard student attachment, as run by the university, or to an attachment organized by a project team from a local network of general practitioners. Students in the intervention group had their personal learning goals assessed and matched with their general practice preceptors, and the students were set a task that developed their contact with other health resources in the community. Results from an evaluation questionnaire completed by the students at the end of their terms showed that the students in the intervention group rated their general practice preceptors more highly, had more contact with allied health and community organizations, felt that they had met their own learning goals to a greater extent, and enjoyed their term more. Student examination results showed that the students in the intervention group did not perform as well in one of the four areas of their end of term examination as did the students in the standard attachment. The additional cost of providing the intervention was estimated to be A$340 per student. We conclude that long-term decisions about adopting this new model of organizing general practice attachments on a wider scale will need to balance the apparent benefits against the increased resources required.     

Assessing the ACGME General Competencies: General Considerations and Assessment Methods

The Accreditation Council for Graduate Medical Education's (ACGME's) general competency and outcome assessment initiative (i.e., the ACGME Outcome Project) is an effort to enhance residency education and accreditation effectiveness by increasing emphasis on educational outcomes. The Project is also a response to concerns about new graduates' ability to meet the demands of today's practice environment. The competencies emphasize learning in new domains (e.g., Practice-Based Learning and Improvement and Systems-Based Practice) and more traditional ones (e.g., Patient Care and Medical Knowledge). Outcome assessment will provide evidence of residency program educational effectiveness and information to guide improvement. This paper discusses the development and implementations of assessment methods appropriate to evaluate the performance of residents in each of the core competencies.     

Content validity of a trainer's report: summative assessment in general practice

A structured trainer's report for use in summative assessment in general practice has been designed, and it is important that the content validity of this report is tested before it is widely adopted. The aim of this paper was to assess the content validity of a proposed report from the perspective of doctors who have recently completed vocational training. A postal questionnaire survey was sent out seeking the views of 220 doctors who had completed vocational training in 1994 as to whether or not the proposed contents were items that are needed in general practice, and whether or not the items were suitable for assessment by means of a trainer's report. The response rate was 73.3%. More than 85% of respondents agreed that the 31 items proposed for inclusion in the trainer's report were needed in general practice. While the proportions agreeing that the items were suitable for assessment by a trainer's report were considerably lower, for 26 items significantly more agreed that they were suitable than disagreed. Analysis of the freetext comments made by respondents illustrated their concerns. The results provide support for the content validity of this proposed trainer's report; however it is important that the concerns expressed are addressed.     

Effectiveness of problems used in problem-based learning

Where problem-based learning (PBL) is the main method used in medical curricula, the literature suggests that it is crucial that the problems used are effective in facilitating students to identify relevant learning issues. These learning issues guide the students' studying. The present investigation explores the extent to which students identify relevant issues following exposure to prepared paper problems. In the preparatory year, in an Introduction to Medicine module, four groups of students were exposed to six themes (Health Care System, Environment and Health, Alternative and Islamic Medicine, Chronic Illness, Infectious Diseases, and Prevention and Health Promotion). Each group had two facilitators per theme. Having discussed the prepared problems, the students identified learning issues which were collected for the purpose of the study. Two content experts, using a Likert scale, analysed learning issues for their concordance to staff objectives per theme. Kappa coefficients were computed for the six PBL themes in order to assess inter-rater agreement. Learning issues identified as having no relationship to theme objectives were further analysed for their relevance to theme objectives. No objective was totally omitted by any student group. There was a 100% concordance of objectives to learning issues demonstrated over four themes. The relationship of learning issues to theme objectives ranged from 55–85% in the theme on health care system, and 73–94% in the theme on environment and health. Irrelevant learning issues were identified in the first two PBL themes addressed. Kappa coefficients over the six PBL themes varied from 0·49 to 0·82.     

广州市医学生恋爱态度、恋爱及性行为研究

目的 了解新世纪医学生恋爱态度、恋爱及性行为现状。方法 运用自编问卷对450名医学生进行调查。结果90％以上的医学生对恋爱持肯定的态度；42.4％的医学生有正确恋爱目的；近半数以上的医学生有恋爱经历；近三分之一的学生目前仍在恋爱；半数以上的医学生有手淫，男生明显多于女生；性行为的发生率为7.6％。性别、身高、体重、班干、父母亲文化程度、父母职业、父亲的健康状况、家庭经济情况、家庭住地等因素会对医学生恋爱态度、恋爱及性行为现状产生一定的影响。结论 与20世纪90年代中后期比较，新世纪大学生恋爱态度、手淫及性行为发生了某些变化。     

英国医学教育环境测量理论的引进与应用

作者在概述教育环境的作用、医学教育环境研究发展现状的基础上,利用英国Dundee大学开发的教育环境测量简表(DREEM)对中国医科大学教育环境现状及存在的问题进行了测量诊断,并结合国际先进的教育环境建设理念及作者在课程体系改革中的经验体会,提出了改善教育环境,提高教学质量应采取的对策。     

北京市东城区高血压社区管理初步分析

为开展城市慢性病预防自1989年起在北京市东城区疾病监测点作高血压调查,将居民按居委会随机分组,对干预组高血压进行管理,定期家访,健康教育,家庭保健指导。1991年共管理3190例患者,与1989年基线调查相比,高血压患者吸烟率下降8.37%,戒烟及减少吸烟增加5.81%,饮酒率下降8.77%,注意少吃盐增加5.49%,DBP<95mmHg者增加27.81%。将上述各指标在干预组和对照组与基线调查相比,二者差别显著,说明高血压社区管理效果良好。