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PubMed1990

Residency performance of graduates from a problem-based and a conventional curriculum.

Performance of 130 graduates in residency from a community-oriented, problem-based medical curriculum, and from a parallel, conventional track, were compared on eight dimensions: knowledge, communication with patients, independent learning ability, teamwork, patient education, critical thinking ability, attention to health care costs, and self-assessment. Ratings were obtained from three evaluators: a doctor-supervisor, a nurse and the resident him/herself. The study was undertaken to identify differences between graduates from the two curricular tracks. Differences were observed in the areas of health care costs (supervisors) and communication with patients (residents), and a trend was observed in patient education (supervisors) and knowledge (nurses), The outcomes of the study are discussed in light of the literature on residency performance, and in terms of the educational experiences that characterize the two medical curricula.

Clinical Competence↗

PubMed1991

Problem-based curriculum: outcome evaluation.

The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) in Bahrain is, in its innovativeness, unique in the region in that a problem-based strategy is used in the planning and implementation of the curriculum. The first batch of graduates have completed their internship programme in the different countries of the region. This paper presents an evaluative study of the outcome of the programme in relation to the institutional goals. Assessment of the intern's performance in clinical competence, interpersonal relations, self-directed learning, and their relative standing vis-à-vis graduates from other schools was done by supervisors. The findings of the study confirm the relative merits of the problem-based curricular strategy in medical education.

Bahrain↗

PubMed1991

Teaching medicine as a human experience: a patient-doctor relationship course for faculty and first-year medical students.

We developed a required, longitudinal course for first-year medical students that addressed the patient-doctor relationship. Our course linked understanding patients' experiences and perspectives on illness with listening to, talking with, and establishing a rapport with patients while obtaining their medical histories. Learning was enhanced by use of an interdisciplinary faculty and by small-group continuity and faculty mentoring. Our curriculum adapted problem-based, self-directed educational methods to convey medical humanism. We focused on bedside interviewing as the means for exploring patients' social, emotional, and ethical concerns.

Attitude of Health Personnel↗

PubMed1992

Problem-based curriculum and its value to Indian medical schools: description of the curriculum.

The decade of the 80's has seen the implementation of the problem-based curriculum (PC) (also called "parallel" or "student-centred" curriculum) in several medical schools in the United States. This new educational technique emphasizes active student participation and a hands-on learning process supplemented by judicious intervention by the faculty teachers. The students (often volunteers) are usually selected for their motivation rather than for highest intelligence or class ranking. For a period of two years, they meet twice or thrice-weekly in group sessions to explore problem cases developed by faculty for that special purpose. We describe the parallel curriculum here in some detail and suggest that medical educators in India give serious consideration to implementation of such a curriculum or its modification in their institutions. Medical graduates will benefit from the hands-on emphasis of this curriculum as well as the development of a disciplined approach in the handling of clinical problems. PC diminishes the stress levels associated with the traditional curriculum and lets the students play an active role in their education. PC will make them better prepared to face challenges during their clinical years and subsequent careers and should offset some of the weaknesses in the current educational system.

Curriculum↗

PubMed1991

Development of faculty consultants in a problem-based third year community medicine clerkship.

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.

Behavioral Sciences↗

PubMed1994

Uniform experience and assessment during a multisite surgical clerkship.

Major changes in health care delivery and the increased number of clerkship sites used for teaching by many medical schools has resulted in significant implications for medical education. Methods have become necessary to achieve and maintain a comparable clinical experience and a uniform assessment process at each teaching site. Following a review of existing practices, a new core curriculum, a problem-based approach and the Objective Structured Clinical Examination (OSCE) were introduced into this department. Over 1200 students have passed through this revised surgical clerkship over the past 8 years. The introduction of the OSCE has helped to direct student learning, provide an objective assessment to complement the ward grade, and enabled an audit of teaching and learning to be carried out. In one group of 103 students no significant correlation was found between the OSCE and ward grades. Performance at different hospitals was similar and those carrying out their clerkship later in the academic year benefited from their previous other attachments. The OSCE has enabled immediate feedback to be given to learners as well as providing teachers with an opportunity to see for themselves the outcome of their tuition. A clinical performance record card has now been introduced to improve the monitoring of students' clinical experience.

Clinical Clerkship↗

PubMed1989

Self-assessment in problem-based groups.

Medical students in a tutorial program rated themselves in Year 1 and again in Year 2 on Knowledge, Reasoning, Communication and Interpersonal Skills. Student and tutor ratings were similar in Year 1 but different in Year 2. Both self- and tutor ratings increased from Year 1 to Year 2 but self-ratings were independent of achievement while tutor ratings were related to achievement. Possible reasons for these results were discussed with reference to the learning goals of the tutorials.

Achievement↗

PubMed1989

[Evaluation of medical education at the McMaster University, Canada, based on the case method concept].

Students of three different levels and the chairman of the MD-Program evaluated the educational system of McMaster University, Canada, using the six criteria of the case method as defined by Renschler. This analysis provided a very differentiated evaluation of the McMaster curriculum, demonstrating a systematic progress of learning methods from the second to the last phase. The instrument showed differences in the ratings of the demonstrative lectures between the chairman and the students. Free access to patients and responsibility, gradually growing during the 3-year program, are important features of the educational system. The problem-based system provides a unique integration of acquiring theoretical knowledge in the basic sciences through clinical problem solving which was highly rated in all analysed phases. Ratings given by the interviewed students for evaluation of documented work were lower than expected by the chairman and the authors. The results are discussed in relationship to the McMaster Philosophy and to the conditions of studying medicine in America and in Germany.

Attitude of Health Personnel↗

PubMed1991

Continuing medical education and career choice among graduates of problem-based and traditional curricula.

A survey was conducted among graduates of two Canadian medical schools who have been in practice for more than 9 years. The purpose of the study was to test the hypothesis that graduates of a problem-based curriculum differ from graduates of a traditional curriculum in their attitude to and participation in continuing medical education (CME) activities. Differences were noted in the rate of participation in certain CME activities (attendance at national and international conferences and meetings) between specialists and family doctors in both groups of alumni. However, the data indicate that the differences in learning-teaching methods employed in the course of the undergraduate medical curriculum do not exert a decisive influence upon the learning habits of the graduates.

Attitude of Health Personnel↗

PubMed1989

A first-year problem-based curriculum in health promotion and disease prevention.

This paper describes Harvard Medical School's integration of a curriculum on health promotion and disease prevention into the first year of its New Pathway to General Medical Education. The goals of the curriculum were to develop in each student (1) the knowledge and skills necessary to evaluate critically the major issues in prevention and (2) an attitude that acknowledges the pertinence of prevention in virtually every clinical encounter. The case method was used for all teaching in the curriculum, as it is throughout the New Pathway. Students worked together in small groups, addressing the issues raised by each case under the direction of faculty preceptors. The component was taught by clinicians as part of a two-year course in which students learned clinical skills and addressed topics from the social sciences and medical humanities. In addition, issues in health promotion and disease prevention were integrated into the cases used to teach the other components of the New Pathway curriculum.

Boston↗

PubMed1977

"Blood and guts": one component of an integrated program in biologic sciences as applied to medicine.

The 3-year medical school program at McMaster University encourages an approach to learning a physician can apply throughout his or her career. The program has four phases and provides early exposure to relevant clinical material. In phase 3, the basic science phase, the structure and function of organ systems in health and disease are studied. Understanding the mechanisms of disease in order to be able to relate clinical symptoms and signs to physiologic and pathologic processes is emphasized. The four 10-week units deal with groups of organ systems. The "blood and guts" unit teaches the student hematology and gastroenterology through a variety of problem-based methods. Specialists in the relevant scientific disciplines influence selection and construction of the problems presented. The students are evaluated by the faculty tutor on their accomplishment of specific objectives related to their competence in solving biomedical problems.

Curriculum↗

PubMed1988

Evaluation of students' approaches to studying in a problem-based physical therapy curriculum.

The purpose of this study was to investigate the approaches to studying of first- and second-year students in a problem-based physical therapy program. The Short Inventory of Approaches to Studying was administered to 112 first-year students (66 female, 46 male) and 100 second-year students (62 female, 38 male). Ninety-nine first-year students and 88 second-year students responded to the inventory, representing a return rate of 88%. The results of both groups were compared. Further comparisons were made with reported normative inventory scores and with inventory results reported of first-year students in a medical problem-based school. All comparisons were made using two-tailed t tests. The inventory scores proved similar in both year groups of physical therapy students and were more desirable than the normative values. The first-year physical therapy students' scores were similar to those of the first-year medical students reported to be desirable. It was concluded that the physical therapy students possess desirable approaches to studying.

Curriculum↗

PubMed1991

What do medical students know about childhood asthma?

A questionnaire designed to measure knowledge about childhood asthma was completed by 216 of the 311 (69%) undergraduate medical students at the University of Newcastle. First year students had a mean score of 16.2 (maximum possible score was 31) which was similar to the background community score of 13.0 obtained in a group of parents with no close contact with asthma. Knowledge about asthma increased over each of the 5 years of the medical course. Final-year students had a mean score of 28.7 (range: 25-31) which was similar to a group of parents thought by their paediatricians to have a high level of knowledge about asthma (mean: 25.3, range: 18-31). The progression of knowledge over the 5 years of the course provided interesting information about the learning process. Although second year students completed the questionnaire after a term devoted to coursework in respiratory medicine, only 26% were able to name two preventive agents and 21% named three agents useful during acute attacks of asthma. Third year students gave correct responses in 39 and 45% of cases, respectively, and the correct response rates rose to 78 and 97% in the fifth year. This was probably because the theoretical knowledge needed to be acquired and tested against a clinical scenario before it could be used. The study demonstrated an increase in knowledge about asthma throughout the problem-based medical course. In addition to providing information about the educational process, it provided information about the questionnaire which was able to measure a range of knowledge and not just extremes of asthma knowledge.

Asthma↗

PubMed1990

Charting the winds of change: evaluating innovative medical curricula.

The increased interest, in North America and around the world, in problem-based and community-oriented medical curricula has sparked interest in the evaluation of these innovative programs. In January 1989, the Josiah Macy Jr. Foundation sponsored a conference to consider designs for evaluation studies and the potential distinctive outcomes of the innovative curricula that might be foci of these studies. After defining an "innovative curriculum," the participants identified seven characteristics of "important evaluation studies," particularly endorsing studies that compare curricula as whole entities. The participants then identified 26 areas where differences between graduates of innovative and traditional curricula might be expected, and five equally important areas where differences are not expected. Distinctive outcomes of innovative curricula were anticipated in areas such as interpersonal skills, continuing learning, and professional satisfaction. Overall, these recommendations are offered to stimulate creative evaluations of the growing number of innovative programs in medical education.

Clinical Clerkship↗

PubMed1986

Skills development by medical students and the influence of prior experience: a study using evaluation by students and self-assessment.

Research was carried out into the effectiveness of an innovative, problem-based introductory course which was designed to help medical students, within a traditional curriculum, to bridge the gap between theoretical study during the first 4 years and inservice training during the next 2 years. Comparison of exit and entry self-assessment ratings of students showed a marked rise for history-taking and physical examination and a smaller rise for diagnosis and patient management. Cross-study of these self-assessment ratings and the background variable of past medical training showed that prior active experience within the health care system appeared to have a favourable influence on both history-taking and more intellectual skills, notably diagnosis and patient management. History-taking, however, could be taught as effectively during the introductory course. This was not so for the more intellectual skills. The results of this research plead for early active experience within the health care system during the medical curriculum, in order to give the students more insight into the clinical relevance of their theoretical studies. Evaluation by the students of the teaching formats used to reach the learning objectives was favourable, especially of those formats related to concrete practical skills such as live simulated (programmed) patients. It was rather unfavourable to self-study facilities which provide more theoretical knowledge.

Clinical Competence↗

PubMed1979

The beginning doctor: a problem-based course for first year medical and dental students.

A problem-based course designated as 'Beginning Doctor' was given to 136 first year medical and dental students. The students were divided into small groups and under guidance of a tutor studied largely unfamiliar clinical problems presented to them as written résumés. They determined what further information they required, obtained the information on their own and described it to the oters in plenary sessions. The tutors acted as facilitators of student learning rather than as sources of information. Contrary to the widely held assumption that students in these parts of the world are passive learners, incapable of taking direct responsibility for their own learning, the staff was pleasantly surprised to see the enthusiasm and the competence with which the students tackled the problems and easily adopted the self-learning mode.

Clinical Competence↗

PubMed1994

A rating scale for tutor evaluation in a problem-based curriculum: validity and reliability.

An instrument has been developed to assess tutor performance in problem-based tutorial groups. This tutor evaluation questionnaire consists of 13 statements reflecting the tutor's behaviour. The statements are based on a description of the tasks set for the tutor. This study reports results on the validity and reliability of the instrument. Confirmatory factor analysis showed that a three-factor model fitted the data reasonably well. The three factors are: (1) guiding students through the learning process, (2) content knowledge input, and (3) commitment to the group's learning. Generalizability studies indicated that the rating scales provide reliable information with student responses of existing tutorial group sizes. It is concluded that the tutor evaluation questionnaire is a fairly valid and reliable instrument that can be used in staff development programmes.

Curriculum↗

PubMed1989

A problem-based clinical course in general internal medicine.

General internal medicine instruction in an unsuccessful lecture-based course was replaced by a clinical problem-based 'junior clerkship'. Hospital and ambulatory-clinic instruction was centered around major common medical problems. Tutors willingly adopted a problem-based teaching approach and participated eagerly in a multi-component evaluation. Students and instructors responded favourably to questionnaires regarding the use of a problem list, the content and face validity of the course and the usefulness of the evaluations as learning experiences.

Curriculum↗