Biomedical subjects

W D Dauphinee

Publications and source records attributed to W D Dauphinee.

27 records · Page 2Linked to original sources

PubMed1985

The clinical learning environments in medicine, paediatrics and surgery clerkships.

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.

Clinical Clerkship↗

PubMed1984

The clinical and pathological course of hepatitis B liver disease in renal transplant recipients.

A prospective study of the clinical and pathological sequelae of hepatitis B disease in 22 immunosuppressed renal transplant patients is reported. All patients had allografts that functioned for more than 1 year, and all were hepatitis B surface antigen (HBsAg)-positive following transplantation. None of the 18 patients who had serial HBsAg tests converted to HBsAg negative. Serial liver biopsies were performed in 19 patients and one liver biopsy was available in the remaining three patients. Follow-up ranged from 12 to 93 months. Seven patients ultimately developed cirrhosis, 6 developed chronic active hepatitis, 5 developed chronic persistent hepatitis, and in 4 the presence of HB virus in hepatocytes was the sole morphologic alteration. The initial liver biopsy was not an accurate predictor of ultimate severity of liver disease because 5 of the 12 patients with virus only or chronic persistent hepatitis subsequently developed chronic active hepatitis or cirrhosis. Clinical liver dysfunction occurred in 8 patients, all of whom had chronic active hepatitis or cirrhosis. Three patients died with hepatic failure and 2 with hepatoma. The risk of death from liver disease in HBsAg-positive renal transplant patients was 5% per patient-year. For comparison, 10 HBsAg-positive patients whose renal failure had been treated by hemodialysis were also studied over a comparable period. Biochemical evidence of persistent liver dysfunction recurred in 1 patient only; 4 patients converted to the HBsAg-negative state; and no patient has died from complications of liver disease. We conclude that in the immunosuppressed renal transplant patient HB infection often results in the development of chronic active hepatitis, leading to cirrhosis and death from hepatoma and hepatic failure.

Adolescent↗

PubMed1984

Return to basic sciences after clinical experience in undergraduate medical training.

As part of the restructured undergraduate medical curriculum at McGill Medical School, a return to basic sciences was introduced in the students' final year. This follows the completion of the formal portion of their undergraduate clinical education. This paper describes this unique return to the basic science programme including the rationale behind the change and the effects of this programme on student learning, and student attitudes towards the programme. Final-year medical students in 1978 and 1981 were tested on educational and attitudinal variables. Data were collected using achievement tests, questionnaires and interviews. The findings of the study indicated that the major objectives of the programme, which were to facilitate student learning in greater depth and to integrate basic sciences with clinical knowledge, were achieved. The programme was enthusiastically received by the students in 1978 and also in 1981, indicating the outcome of the return to the basic science programme to be more than a 'Hawthorne effect' as suspected in 1978. The concept of a return to basic science is recommended for consideration by medical faculties.

Anatomy↗

PubMed1984

The reliability and validity of in-training evaluation reports in obstetrics and gynecology.

In a specific Obstetrics and Gynecological program, the program and certifying ITERs were evaluated for their measurement qualities. The internal consistency of the ITERs is supported. The tendency for high inter-item correlations suggest overall judgment of candidates may be influencing individual item rankings--particularly on the Program ITER. Unfamiliarity of faculty with appropriate behaviors may be one of the reasons for this effect based on the faculty's inability to select correct behavior for each item. Very limited inter-form consistency is noted and random associations of items often correlate higher than parallel items. The stability of the Program ITER is supported, but there is little support for criterion validity based on the criterion variables available. It is concluded that more clearly defined behaviors must be identified for each ITER item and faculty must be trained in their use. The use of the same ITER for all specialities may be a major reason for this inconsistency. Lastly, more studies of validity are advised.

Canada↗

PubMed1983

Early career choice: an unsuccessful program.

During the 1960s, early educational specialization and increasingly elective curricula were promoted as instructional advances. More recently, early educational specialization has been suggested as a solution to high educational costs and knowledge overload. In 1973 the McGill University Faculty of Medicine introduced a program of early specialization ("streaming") in the senior clerkship. The streams were: medicine, surgery, psychiatry, and family medicine. The streams emphasized their own clinical areas but not to the exclusion of other subjects. After three years, streaming was disbanded as students chose the medicine stream with increasing frequency. Streaming may have contributed to poorer class performance on licensing examinations. Responses of the students to questionnaires revealed that streaming did not lead to an early career choice and that the students did not use electives to fill in perceived gaps. The students often chose streams independent of career plans. Thus, it was concluded that early specialization did not hold promise as a solution to the issues of educational costs or knowledge overload.

Achievement↗

PubMed1981