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Biomedical subjects

A V Blue

Publications and source records attributed to A V Blue.

16 recordsLinked to original sources
PubMed1998

The effectiveness of the structured clinical instruction module.

BACKGROUND: The Structured Clinical Instruction Module (SCIM) provides students with a structured educational experience related to clinical skills on a single clinical topic. This study examined the effect of the SCIM on students' performances on breast stations in an objective structured clinical examination (OSCE). METHODS: Three student groups each experienced a different type of instruction about breast care and treatment (condition A = lecture; condition B = nine-station SCIM, lecture, and manual; and condition C = five-station SCIM). All students subsequently participated in a surgery OSCE that included standardized patient stations on taking a breast history and performing breast examinations. RESULTS: One-way analysis of variance (ANOVA) tests consistently found that the mean scores of students in conditions B and C were significantly (P < 0.05) higher than those of students in condition A. CONCLUSIONS: These results suggest that the SCIM is an effective patient-based standardized instructional program that enhances the instruction of clinical skills to students.

Analysis of Variance↗
PubMed1998

Comparing fourth-year medical students with faculty in the teaching of physical examination skills to first-year students.

PURPOSE: To see whether fourth-year medical students can teach the physical examination to first-year students as effectively as can faculty preceptors. METHOD: Ninety-three first-year students studying the physical examination were randomly assigned to one of ten fourth-year student preceptors or one of 15 faculty preceptors. Test results and course evaluations were compared by type of preceptor. Fourth-year student preceptors were surveyed regarding their experience. RESULTS: The mean test scores did not differ between the first-year students with fourth-year student preceptors and those with faculty preceptors. The first-year students rated the fourth-year student preceptors higher than they did the faculty preceptors. The fourth-year students rated their experience favorably. CONCLUSION: A select group of fourth-year medical students provides a successful alternative to faculty in the teaching of the physical examination to first-year students.

Attitude↗
PubMed1998

Evaluation of students' learning in an interdisciplinary medicine--surgery clerkship.

PURPOSE: To evaluate the impact of an interdisciplinary medicine-surgery clerkship (created to foster generalist education) on students' performances on National Board of Medical Examiners' (NBME) subject examinations. METHOD: Test data for the 226 students who participated in the 16-week combined clerkship and for the 265 students who had completed the traditional clerkships (12 weeks of medicine, 12 weeks of surgery) were compiled and analyzed using t-tests for independent samples. RESULTS: Mean scores on the NBME subject examination in medicine increased significantly after the combined medicine-surgery clerkship (from 433 to 455, p < or = 0.5). Mean scores on the NBME subject examination in surgery were similar to those achieved in the traditional clerkship years. CONCLUSION: Since the medicine and surgery clerkships were combined into a single, interdisciplinary clerkship, students' scores have increased on the medicine NBME subject examination and have remained relatively unchanged on the surgery NBME subject examination, despite a substantial reduction in students' clinical experience in the combined clerkship from the traditional clerkships (16 vs 24 weeks).

Clinical Clerkship↗
PubMed1998

Assessing residents' clinical performance: cumulative results of a four-year study with the Objective Structured Clinical Examination.

BACKGROUND: The Objective Structural Clinical Examination (OSCE) is an objective method for assessing clinical skills and can be used to identify deficits in clinical skill. During the past 5 years, we have administered 4 OSCEs to all general surgery residents and interns. METHODS: Two OSCEs (1993 and 1994) were used as broad-based examinations of the core areas of general surgery; subsequent OSCEs (1995 and 1997) were used as needs assessments. For each year, the reliability of the entire examination was calculated with Cronbach's alpha. A reliability-based minimal competence score (MCS) was defined as the mean performance (in percent) minus the standard error of measurement for each group in 1997 (interns, junior residents, and senior residents). RESULTS: The reliability of each OSCE was acceptable, ranging from 0.63 to 0.91. The MCS during the 4-year period ranged from 45% to 65%. In 1997, 4 interns, 2 junior residents, and 2 senior residents scored below their group's MCS. MCS for the groups increased across training levels in developmental fashion (P < .05). CONCLUSIONS: Given the relatively stable findings observed, we conclude (1) the OSCE can be used to identify group and individual differences reliably in clinical skills, and (2) we continue to use this method to develop appropriate curricular remediation for deficits in both individuals and groups.

Clinical Competence↗
PubMed1997

Assessing residents' readiness for working in a managed care environment.

PURPOSE: A the pilot study to assess the state of residents' training for practice in a managed care environment. METHOD: In May and June 1996, all 178 residents at the University of Kentucky College of Medicine in six programs were approached to participate in the study. An instrument was created to assess the residents' knowledge of, attitudes toward, and exposure to managed care, as well as their perceptions of their residency experience. Attitudinal items were measured using a five-point Likert scale (1 = strongly agree, 5 = strongly disagree), as were the assessments of experience (1 = excellent, 5 = poor). Bivariate statistics were computed between the number of correct responses to the knowledge questions and both the year of training and reported exposure to managed care. The relationship between exposure and knowledge was analyzed using a two-tailed t-test. A Pearson product-moment correlation was computed between residents' knowledge and year of training. RESULTS: In all, 140 (79%) residents participated, 76% of whom were men. Seventy-three percent of the residents rated their experiences as fair or poor; the mean rating across all the residents was 3.8 (SD, 0.8). Among those reporting some exposure, attitudes toward the effectiveness of their exposure generally ranged from neutral to negative. Across all the residents, the mean number of correct responses to the five knowledge questions was 3.2 (SD, 1.1). No statistically significant relationship was found between year of training and the number of correct responses. The residents who reported some exposure to managed care had a significantly higher mean number of correct responses than did those with no reported exposure (3.4, SD, 1.1, vs 2.8, SD, 1.3, p = .04). CONCLUSION: The residents reported limited exposure to managed care and that their training experience did not prepare them for working in managed care; this was confirmed (in a limited way) by the responses to the knowledge questions. As managed care expands in the United States, the systematic incorporation of managed care instruction into training is necessary to appropriately prepare residents for future practice.

Attitude of Health Personnel↗
PubMed1997

Computer requirements for medical school students--implications for admissions.

Computers are increasingly being used in clinical practice settings. Aware of the need to educate students regarding computer applications in medicine, the University of Kentucky College of Medicine is in the midst of developing a computer curriculum. To that end, many courses and clerkships have devised software packages for transmittal of course information and for evaluation of student performance. This paper outlines requisite computer skills that applicants applying to medical school should possess, broadly reviews how those computer skills will be used in medical school, and suggests means for attaining computer competency prior to making application to medical school.

Computer Literacy↗
PubMed1996

The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education.

This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.

Clinical Competence↗
PubMed1996

Developing generalists for Kentucky.

Since 1985, nearly half of the graduates of the University of Kentucky College of Medicine have chosen generalist careers, even though its students received almost no outpatient ambulatory training in primary care before 1990. This study determined the factors influencing the choice of generalist specialties in the absence of ambulatory training experience. A questionnaire was mailed to the 516 graduates of the classes of 1964 through 1989 who had entered a generalist specialty. A three-way ANOVA with one repeated measure was used to determine whether there were statistically significant differences in the responses of practitioners in the three generalist specialties (family practice, general internal medicine, or general pediatrics). Sufficiently complete responses were received from 187 graduates (116 family practitioners, 40 general pediatricians, and 31 general internists). Many of the physicians who had spent formative years in rural areas were practicing in rural communities. Many respondents had already decided upon a generalist career before entering medical school. Clerkships in internal medicine and pediatrics were an important influence, as was mentor role modeling. For pediatricians, an elective ambulatory care experience was also important. Educational experiences exert meaningful influences on students interested in a generalist career. Formal ambulatory care training experiences, while not critical for the selection of a generalist career, may heighten or confirm interest. Efforts that encourage students from rural communities to enter medical school appear to produce rural physicians.

Analysis of Variance↗