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PubMed1994

The efficacy of intensive biopsychosocial teaching programs for residents: a review of the literature and guidelines for teaching.

OBJECTIVE: To review research evaluations of intensive biopsychosocial training programs for nonpsychiatry residents, and determine whether this research showed sufficient rigor and consistent beneficial impact to allow initial research-based teaching guidelines. DATA SOURCES: An English-language literature search used MEDLINE (1966-93), Psychological Abstracts (1967-93), and Educational Resource Information Clearinghouse (1966-93) as well as bibliographic reviews from prominent peer-reviewed articles and consultation with an expert. STUDY SELECTION: From among several hundred articles about biopsychosocial training, only 12 studies met the selection criteria: at least 100 contact hours of training for nonpsychiatry residents and an evaluation of efficacy. DATA EXTRACTION: The three authors independently assessed these 12 studies and made a consensus decision based on explicit criteria. Successful and unsuccessful programs were distinguished from among those classified as quasi-experimental or experimental to identify programs of sufficient rigor to meet the study objective; success was defined as learning beyond knowledge and residents' acceptance of teaching. DATA SYNTHESIS: Four successful quasi-experimental or experimental programs showed the following uniquely beneficial features: 1) protected time for residents; 2) teaching that was required, structured, multidimensional, and balanced between learner-centered and teacher-centered approaches; 3) teaching methods that used normal as well as psychosocially disturbed patients, nonpsychiatrist teachers, and special teaching techniques; and 4) inclusion in the curriculum of interviewing, interpersonal skills, doctor-patient relationship, and patient education. Two unsuccessful quasi-experimental or experimental programs were unidimensional and unstructured, and used predominant or isolated teacher-centered approaches. Features found in both successful and unsuccessful programs were experiential teaching, psychiatrist and other mental health professional teachers, use of disturbed patients, training to manage patients' psychosocial problems, teaching directed toward knowledge acquisition, teaching about treatment, and university affiliation. CONCLUSIONS: Four rigorously studied, successful programs showed a common pattern of intensive biopsychosocial teaching that produced, in aggregate, improvement in residents' knowledge, attitudes, skills, and self-awareness. Although there is need for more definitive research, these data are sufficiently compelling and consistent to provide initial, research-based teaching guidelines.

Curriculum↗
PubMed2000

Basic clinical skills: don't leave teaching to the teaching hospitals.

OBJECTIVE: To compare student perception of teaching in general practice (GP), district general hospitals (DGHs) and teaching hospitals (THs) and their examination results. SETTING: The medical school at Queen's University, Belfast. SUBJECTS AND METHODS: A total of 161 medical and 34 dental students completed an objective structured clinical examination and questionnaire at the end of their second semester of basic skills teaching. They scored the course for teaching style, educational value and enjoyment. Teaching attributes of the tutors were similarly recorded. Students were also asked to quantify how time was used and to comment on the course. INTERVENTIONS: A new programme for teaching first- and second-year students basic clinical skills in the community. RESULTS: Teaching in GP and DGHs was reported to be more educational and enjoyable than in the TH. In GP most time was spent being lectured, in DGHs most time was spent with the patient, and in THs, waiting for the tutor. General practitioners and doctors in DGHs were more likely to model positive teaching attitudes such as showing interest in students and providing feedback. The most common complaints related to insufficient time spent with patients in GP and poor tutor preparation in THs. All teaching sites achieved similar examination results. CONCLUSION: Clinical skills can be taught to medical students early in their curriculum using GP tutors. Student preference was strongly for being taught by GPs rather than in THs. Simple steps such as prior preparation and the locating of a suitable patient could markedly improve student experience both in GP and in hospitals.

Clinical Competence↗
PubMed2002

Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state.

PURPOSE: The possible benefit that hospital teaching status may confer in the care of patients with cardiovascular disease is unknown. Our purpose was to determine the effect of hospital teaching status on in-hospital mortality, use of invasive procedures, length of stay, and charges in patients with myocardial infarction, heart failure, or stroke. SUBJECTS AND METHODS: We analyzed a New York State hospital administrative database containing information on 388 964 consecutive patients who had been admitted with heart failure (n = 173 799), myocardial infarction (n = 121 209), or stroke (n = 93 956) from 1993 to 1995. We classified the 248 participating acute care hospitals by teaching status (major, minor, nonteaching). The primary outcomes were standardized in-hospital mortality ratios, defined as the ratio of observed to predicted mortality. RESULTS: Standardized in-hospital mortality ratios were significantly lower in major teaching hospitals (0.976 for heart failure, 0.945 for myocardial infarction, 0.958 for stroke) than in nonteaching hospitals (1.01 for heart failure, 1.01 for myocardial infarction, 0.995 for stroke). Standardized in-hospital mortality ratios were significantly higher for patients with stroke (1.06) but not heart failure (1.0) or myocardial infarction (1.06) in minor teaching hospitals than in nonteaching hospitals. Compared with nonteaching hospitals, use of invasive cardiac procedures and adjusted hospital charges were significantly greater in major and minor teaching hospitals for all three conditions. The adjusted length of stay was also shorter for myocardial infarction in major teaching hospitals and longer for stroke in minor teaching hospitals. CONCLUSION: Major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke in New York State.

Aged↗
PubMed2000

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards.

RATIONALE AND OBJECTIVES: The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS: Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS: Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION: Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.

Clinical Clerkship↗
PubMed1990

Preregistration house officers in the four Thames regions: II. Comparison of education and workload in teaching and non-teaching hospitals.

OBJECTIVE: To detect differences in the education and workload of preregistration house officers working in teaching and non-teaching hospitals. DESIGN: A postal questionnaire. SETTING: Teaching and non-teaching hospitals in the four Thames regions. PARTICIPANTS: 1064 Preregistration house officers. RESULTS: Response rate was 61% for teaching hospitals and 73% for non-teaching hospitals. House officers in teaching hospitals had significantly fewer inpatients under their care (house physicians 16.9 v 22.9, house surgeons 17.9 v 20.3) and admitted fewer emergency patients per week (house physicians 7.7 v 12.7, house surgeons 6.5 v 9.8). More house officers in teaching hospitals reported that they had too few patients to provide adequate clinical experience. More of their time was consumed by administrative activities devoid of educational value. CONCLUSION: Preregistration house officer posts at teaching hospitals provide less clinical activity and are perceived as less educationally satisfactory by their holders than those elsewhere.

Accreditation↗
PubMed2001

Teaching senior nurses how to teach communication skills in oncology.

Many nurses acknowledge that their nursing practice is hampered by inadequate teaching about communication skills during their nursing education. Ineffective communication has negative effects on patient care and causes stress when nurses interact with each other, with medical colleagues, with patients and their relatives. Many senior nurses teach junior staff about communication and feel uncertain about their competence to do so despite recognition of its importance. This article reports data from a training initiative endorsed by the Royal College of Nursing in the United Kingdom (UK) aimed at helping senior nurses to identify their personal strengths and weaknesses when communicating, learn new teaching methods and encourage new teaching initiatives. A residential 2-day course, based on learner-centered methods was employed. One hundred and twenty nine nurses from UK cancer centers worked on personal communication problems via group discussions, video demonstrations, small group teaching exercises and role-plays with professional actors. Post-course, participants reported significantly greater confidence in handling 14 common communication problem areas in cancer (p < .0001) and in 8 different areas of teaching. Participants were very enthusiastic about the course overall and especially valued the training approach and teaching materials provided. Three months post-course 91% reported changing their own teaching practice and 85% had initiated new communication skills teaching.

Attitude of Health Personnel↗
PubMedDate not supplied

[Teaching assessment in recruitment of university teaching staff].

When a university teacher is recruited, should his capacity for teaching as well as his scientific maturity be evaluated? If this is the case, how must this assessment be carried out? With regard to the first question, despite the fact that present-day official requirements seem unclear and confusing, for some years now declarations from the Consensus Conference of the World Federation for Medical Education (WFME) leave no doubt that assessment of teaching capacity should constitute a basic requisite for the appointment of teachers and their future career. The fifth declaration of WFME is quite clear about the need to train teachers to be educators and not only experts in their various disciplines, to ratify teaching capacities on par with capacities shown in biomedical research and medical practice. The WFME's recommendations, on the other hand, provide no useful elements for formulating the criteria by which to assess candidates' teaching capacities. The tables given therefore refer not to official documents, but to studies worked out by experts. In the first table regarding criteria for global assessment of candidates, it is easy to observe that teaching capacity is strongly penalized with respect to professional maturity. In the second grid, which is specific for teaching capacities, more precise criteria are suggested to characterize a teaching profile in various ways, such as finishing and updating experience in ateliers, familiarity with teaching instruments, use of articulated teaching methods and the possibility of assessment by students through questionnaires.

Evaluation Studies as Topic↗
PubMed2006

See one, do one, teach one--exploring the core teaching beliefs of medical school faculty.

This paper explores the core teaching beliefs of medical school faculty and establishes whether these beliefs differ among basic science, clinical, and instruction specialist faculty. One hundred and twenty-five medical school teachers who were members of professional organizations dedicated to the improvement of medical school teaching completed a Q-sort of 56 statements reflecting their core teaching beliefs. The statements described beliefs about motivation, knowledge and skill acquisition, retention, feedback, transfer, teacher characteristics, and teaching strategies. Q-sorts were completed by 37 basic scientists (30% of respondents), 59 clinicians (47%) and 29 instruction specialists (23%) working in medical schools. Fifty-two participants were classroom teachers (42%), 66 were classroom and clinical teachers (53%), and seven reported that they do not teach (6%). The Q-sort results indicate how medical school faculty members differ in their core beliefs about teaching and learning. Thirty-two respondents (26%) focused on the student as a person first. Eight (6%) were content oriented. Thirty-four (27%) were performance oriented; their focus was on having students learn and apply knowledge and skills to accomplish clinical tasks. Fifty-one respondents (41%) were found to have a blend of these viewpoints. Respondents' type of training or type of teaching did not provide a reliable indication of core teaching beliefs classification.

Culture↗
PubMed2002

The effectiveness of teaching strategies for creativity in a nursing concepts teaching protocol on the creative thinking of two-year RN-BSN students.

Because of changes in the medical environment, nurses must maintain the ability of divergent thinking to solve the health problems of patients. However, many nurses whose work in clinical practice has become routine have lost the ability of creativity. To cultivate nurses creativity should be a goal of nursing education. The purpose of this study is to evaluate a nursing concepts teaching protocol by utilizing teaching strategies directed toward creativity to promote creativity in two-year RN-BSN students. This study design is a time series and one group experiment utilizing multiple instances of treatment. Teaching strategies for creativity were applied to a teaching unit and 52 two-year RN-BSN students were tested for creativity before the end of each semester. This study was conducted from March, 1999 to May, 2000, but only 30 students completed all tests and reached a 58% return rate. Torrance s (1974) definitions of creativity includ fluency, flexibility, and uniqueness were followed and the instrument, a questionnaire on Creativity in the application of the Nursing Process Tool (CNPT), was designed based on Emerson (1988). The content validity of Chinese-version CNPT was.79. The inter-coder reliability between two researchers was.84 following a coding guide that ten nursing education experts had established. The results indicated that 30 two-year RN-BSN students had improved fluency and flexibility. The improvements reached a significant level after the third semester. Only uniqueness declined. It is suggested that nursing faculty apply teaching strategies uniqueness more often in a teaching protocol of nursing concepts. By utilizing teaching strategies of creativity in a teaching protocol of nursing concepts, it is expected that two-year RN-BSN students can acquire characteristics of creativity for problem-solving skills in clinical settings.

Adult↗
PubMed1997

Teaching residents to teach. An instructional program for training pediatric residents to precept third-year medical students in the ambulatory clinic.

OBJECTIVE: To provide second- and third-year pediatric residents with practical teaching skills for precepting third-year medical students in the outpatient clinic. DESIGN: Educational intervention with 3-month follow-up of participants. SETTING: University teaching hospital. PARTICIPANTS: Second- and third-year pediatric residents. INTERVENTION: A curriculum for a half-day workshop to provide residents with 6 key clinical teaching skills. Residents participated in the workshop and then were observed by trained faculty as they precepted third-year medical students in the pediatric clinic. MAIN OUTCOME MEASURE: Direct observation of resident-student precepting encounters, noting the presence or absence of their use of clinical teaching skills taught in the workshop. RESULTS: Twenty-one of 23 pediatric residents participated in the workshop. Observation of 56 resident teaching encounters before and after the workshop showed that the residents improved their clinical teaching skills. Residents valued the workshop, and many suggested it should also be considered for faculty development. CONCLUSIONS: Residents can be taught clinical teaching skills in a half-day workshop. These skills also are applicable in various clinical venues. With the increasing interest in using community-based primary care physicians for student and resident education, this curriculum is well suited for training practicing clinicians to teach in their own practice sites.

Adult↗
PubMed2005

Estimating the effects of informal radiology resident teaching on radiologist productivity: what is the cost of teaching?

RATIONALE AND OBJECTIVES: One mission of an academic radiology department is to teach. The greatest teaching effort is directed at radiology residents. As clinical work demands increase, informal, non-revenue-generating, teaching may suffer. We sought to determine the economic consequences of teaching. MATERIALS AND METHODS: With the use of a picture archiving and communications system, 6 radiology faculty members independently interpreted and dictated digitally acquired bone and chest radiographs for 1 hour alone and again 10-12 weeks later with a first-year resident. During the second session, the quality of teaching was graded by independent observers. The number of cases, relative value units (RVUs), and reimbursement for each session were calculated. RESULTS: The difference in number of cases dictated working alone (mean, 44.7) and with a first-year resident (mean, 23.5) was significant (P = 0.007). The difference between RVUs generated by faculty alone (mean, 9.0) and with a resident (mean, 4.5) also was significant (P = 0.006), and the difference in dollars billed when working alone (mean, $1558.45) and with a resident (mean, $777.65) was significant (P = 0.007). As teaching quality increased, the number of cases interpreted, dollars billed, and RVUs trended lower. CONCLUSION: Informal resident teaching significantly reduces clinical throughput, reducing examination volume, RVUs, and dollars billed by approximately half.

Bone and Bones↗
PubMed1998

Teaching portfolios: documenting teaching.

In recent years, teaching portfolios have been developed as a way teachers can document teaching scholarship and demonstrate their teaching accomplishments, skills, and strategies. Most medical schools reward good teaching, often with promotion on clinician-teacher tracks, thereby acknowledging the contributions made by clinical faculty who serve the academic mission as teachers. Teaching portfolios provide a means for teachers to demonstrate their teaching achievements and display their best work. This article gives recommendations for constructing a teaching portfolio and includes examples of what can be included.

Documentation↗
PubMed2002

Changing an existing OSCE to a teaching tool: the making of a teaching OSCE.

OBJECTIVE: The teaching OSCE (objective structured clinical examination) was developed from existing OSCE materials to provide direct observation and feedback to students on their doctor-patient relationship skills, students' abilities to do a focused history and physical examination, and to familiarize students with this type of examination. DESCRIPTION: Existing OSCE cases were modified to ten minutes and to focus on case scenarios using standardized patients. Faculty facilitators were trained in giving feedback and oriented to the new OSCE format. Clerkship students are told in advance the general topics of the Teaching OSCE stations, so they can prepare. Students are divided in three groups of six to eight students and each group is assigned a faculty facilitator. Each student performs a ten-minute OSCE station and is observed directly by the faculty facilitator and the remaining students in the group using a video monitor. The faculty facilitator then leads a 12-minute feedback session on focused history-taking skills, physical examination skills, and the doctor-patient relationship skills. Students selected at random by the faculty facilitator also give feedback to their peer. Teaching OSCEs take three hours and are held twice during the clerkship such that each student is actively observed twice and watches a total of ten to 14 additional interactions. Facilitators grade students on attendance, participation, and evidence of preparation. The actual interaction with the standardized patient is used entirely for formative purposes and is not graded. DISCUSSION: Our department has used OSCEs for six years to evaluate students at the end of the third-year family medicine clerkship. Even after continuous improvement, our OSCE did not meet higher standards of reliability and would need at least three hours of testing per student to meet those standards. The low number of students in the rotation and limited resources to increase the duration of the OSCE made it very difficult to construct a more reliable examination. At the same time, both faculty and students wanted more direct observation and feedback on performance with clinical scenarios. Using existing OSCE resources to change the OSCE to a teaching tool proved to be an efficient use of teaching resources while increasing our educational impact. Students report that they appreciate the opportunity to have constructive discussions of their strengths and weaknesses in clinical encounters, observe a variety of doctor-patient interaction styles, and practice for future OSCE-type examinations. Faculty members enjoy this active teaching format and find the process of students giving feedback to their peers educationally useful. The teaching OSCE has been extremely well rated in the end-of-rotation evaluations and will be continued in future clerkships.

Education, Medical, Undergraduate↗