An overview of reform initiatives in medical education. 1906 through 1992.
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Biomedical subjects
Publications and source records attributed to F D Burg.
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Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.
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The Medical Knowledge Self-Assessment Program of the American College of Physicians is one of the largest continuing medical education programs in the United States. The scope and educational rationale for each of the components of the program are described. More than 32,000 physicians used one or more components during 1977 and 1978. Performance on the self-assessment examinations showed that, on the average, participants who submitted answer sheets scored in the range of 65% to 75% correct responses. Participants performed better in areas reflecting their special interests and, in general, performance appeared to improve for groups that were closer to the completion of formal training in internal medicine. Specific suggestions have been made as to how the program might be improved in future years.
A study was undertaken to test the effect of open- vs. closed-book testing conditions on performance on a graduate-level, multiple-choice examination in pediatrics. A group of practicing pediatricians and a group of medical students took the examination. For the practice group, no significant difference between mean scores was observed, and the correlation between scores under the two testing conditions was high. In the student group, however, the mean score was significantly higher under open-book conditions and the correlation between scores under the two testing conditions was positive but low. The mean score obtained by practitioners was significantly higher than the mean score obtained by students under both testing conditions. The effects of time limit and level of motivation were not explored in the present study.
A Practice-Related Educational Program has been developed to help the physician in primary practice meet the mounting pressures for continuing medical education. Based on analysis of his practice, the physician tests himself to identify areas of potential improvement. Learning resources appropriate to his educational needs are then made available to him at his home base. A follow-up test determines if the person's learning has been effective, and where further emphasis may be placed.
Over the past half decade, there has been an increment in forces moving the profession toward recertification and a decrement in the restraining forces. The whole process will be catalyzed by available funding through grants to implement continuing medical education, development of performance-, and competency-based assessment measures and recertification. Specialty boards serving relatively small numbers of candidates have serious difficulty funding certification, to say nothing of recertification. An adequate mechanism to implement recertification can emerge only from the profession itself, working through the American Board of Medical Specialties and specialty boards. The means to discharge this responsibility should, at the outset, come from public and private sources. Eventually the system may become self-supporting through evaluation and certification fees. The public interest will be best served when there are adequate mechanisms to assess continuing competence of all physicians. As a minimum, there must be a system to guard against incompetence through obsolescence of any of the practicing professionals.
This study compared the performance of medical students and practicing pediatricians taking a graduate-level examination in pediatrics under open-book vs closed-book conditions. Students performed significantly better under open-book conditions, but there was no significant difference for the practitioner group.
In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report which identifies the important components of competency needed in the practice of pediatrics. The development of the report involved a group process engaging ABP board members and examiners. The outcome has been (a) the delineation of a process for establishing definitions of competency in a medical discipline; (b) the development of a framework for specifying the abilities needed to perform the tasks required of pediatricians; (c) an elaboration of samples of pediatric subjects to which these abilities and tasks are relevant; and (d) the development of a basis for choice of methods to use for purposes of certification.
During 1973, a 10-patient, linear PMP examination was administered in both written and computerized form to 104 candidates for certification by the American Board of Pediatrics and to 122 individuals in their first month of graduate training in paediatrics. Both groups made significantly more errors of omission (failure to select appropriate actions) and fewer correct diagnoses on the computerized version of the test than on the written version. These results suggest that examinees 'retrace' (use clues from problems near the end of the case to make additional correct decisions on earlier problems) when the test is presented in written form and that computerization prevents this phenomenon. Additional analyses indicated that the reliability of the PMP examination was essentially the same for the written and computerized versions, that both forms distinguished about equally well between first-year residents and candidates, and that both forms had about the same magnitude of correlation with the American Board of Pediatrics oral examination. Finally, correlation between both PMP forms and the American Board of Pediatrics multiple-choice examination suggested that the PMP, in either mode of presentation, measures characteristics that are not tapped by the multiple-choice test. Thus, computerization of the PMP provides a means for controlling a variable (retracing) which may be considered extraneous to the desired measurement, but it does not appear to alter the reliability of the test or to modify its relations with other measures.
The authors discuss the development and proceedings of a highly structured conference at which 17 representatives from diverse non-medical groups and 14 medical educators from one medical school identified objectives needing greater emphasis in the medical curriculum. The conference emulated industry's use of consumer advisory panels. Using the nominal group technique, a group process used in business, the non-medical group developed independently a priority list of areas in which physicians might be better educated to serve society. The medical educators then joined the non-medical group to discuss and clarify the concerns given highest priority. The authors describe subsequent initiatives by the medical school to address aspects of the general concerns raised by the non-medical group. The conference represents an approach to seeking input from non-traditional sources in the development of the medical curriculum.
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