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1. CURRICULUM DESCRIPTION. Twenty years ago, our faculty organized several lessons in a physiology course to inform students about computers. Recently, new courses in informatics were established. In their first year, students take a compulsory course (15 hours=h) of basic computer science (computers databases, networking, and basic non-medical computer software). A special elective course in medical informatics (30h) can be taken in the 4th year (about 20% of students pass tis course). This course includes the following lessons: computers in medicine (2h), scientific information (4h), classification in medicine (2h- including ICD, SNOMED etc.), computer support of clinical decision (2h-calculation principles with demonstration), artificial intelligence (2h), statistical software (2h), hospital information systems (2h), software for practitioners (2h), biosignal and image analysis (4th), computers in pharmacology (2h), computer simulation (2h), support of metabolic care (2h-consultations, risk calculations), and laboratory information systems (2h). The same course, though slightly differences, is used for paramedical students (occupational therapy, health education, and nursing). Medical technology was established in a three year curriculum courses in the 1st year include common courses in electronic devices (60 h), computers and programming (120 h), biophysics (90 h), biomechanics (30 h), and different medical courses (500 h). For the 2nd and 3rd year, 75% of the courses (700 h per year) are technical e.g., medical devices, information systems, signal and picture analysis, laboratory technique, and data protection. 2. CONCLUSION AND PERSPECTIVES. Students of medicine, and some paramedical studies, are able to use computer in their profession after having taken these courses. Bachelors of medical technology find application in biomedical research, hospitals, and medical technology firms.
A substantial over-estimate of medical care consumption cost was found when estimates from self-report data from an epidemiological study were compared to actual cost data extracted from administrative records. Even though the few subjects who were actually provided with two or more services in the two-week self-report period substantially under-reported their medical care consumption, a large net over-estimate of medical care consumption was produced by the self-report data. This finding has important implications for use of self-report data from surveys such as the Australian Bureau of Statistics (ABS) National Health Survey for estimating health service consumption. By combining epidemiological survey data from the Australian Vietnam Veterans Health Study (AVVHS), with data on actual medical care for which the Health Insurance Commission (HIC) or the Department of Veterans' Affairs (DVA) paid benefits, we were able to directly compare self-reported medical care consumption with actual medical care utilisation. The comparison revealed that veterans' self-reports were a valid measure of relative medical care consumption because those who reported care over the past two weeks were much more likely to have been recent consumers than those who did not. This relationship became even stronger if the comparison of self-report was extended to data on benefits paid beyond the two-week self-report period. However, the HIC and DVA data confirmed only 51% of veterans self-reporting medical care consumption during the past two weeks actually received a service.
The Food and Drug Administration (FDA) is classifying the medical washer and medical washer-disinfector intended for general medical purposes to clean and dry surgical instruments, decontaminate or disinfect anesthesia equipment, hollowware, and other medical devices into class II (special controls). FDA is also identifying the guidance document entitled "Class II Special Controls Guidance Document: Medical Washers and Medical Washer-Disinfectors" (the guidance) as the special control that, in addition to general controls, the agency believes will reasonably ensure the safety and effectiveness of the device. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (the FDAMA).
Two undergraduate medical students at the University of Bristol commented on their experiences of learning medical statistics. In general, medical students' focus is on acquiring skills needed to practice clinical medicine, and great care must be taken to explain why disciplines such as statistics and epidemiology are relevant to this. Use of real examples and an emphasis on the need for evidence has meant that medical students are increasingly aware of the pressure on clinicians to justify their treatment decisions, and the associated need to be able to understand and critically appraise medical research. It was felt that medical statistics courses should focus on critical appraisal skills rather than on the ability to analyse data, which can be acquired by particular students when they need to do this. Medical statistics should be taught early in the curriculum, but there is a need to reinforce such skills throughout the course. Teaching and assessment methods should recognize that what is being taught is a practical skill of clinical relevance. This means that problem based small groups, data interpretation exercises and objective structured clinical examinations will be more productive than traditional teaching and examination methods.
Many observers of medicine have expressed concerns that new doctors are not as well prepared as they should be to meet society's expectations of them. To assist medical schools in their efforts to respond to these concerns, in January 1996 the Association of American Medical Colleges (AAMC) established the Medical School Objectives Project (MSOP). The goal for the first phase of the project--which has been completed and is reported in this article--was to develop a consensus within the medical education community on the attributes that medical students should possess at the time of graduation, and to set forth learning objectives that can guide each medical school as it establishes objectives for its own program. Later reports will focus on the implementation phase of the MSOP. In this report, each of the four attributes agreed upon by a wide spectrum of medical educators is stated and explained, and then the learning objectives associated with the school's instilling of that attribute are stated. The first of the four attributes is that physicians must be altruistic. There are seven learning objectives, including the objective that before graduation, the student can demonstrate compassionate treatment of patients and respect for their privacy and dignity. The second attribute is that physicians must be knowledgeable; one of the six learning objectives is that the student can demonstrate knowledge of the normal structure and function of the body and of each of its major organ systems. The third attribute is that physicians must be skillful; one of the eleven learning objectives is that the student have knowledge about relieving pain and ameliorating the suffering of patients. The last attribute is that physicians must be dutiful; one of the six learning objectives is that the student have knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies. The report ends by stating that (1) if a school's curriculum is shaped by the set of learning objectives presented in the report, the graduates will be well prepared to assume the limited patient care responsibilities expected of new residents and also will have begun to achieve the attributes needed to practice contemporary medicine; (2) schools should feel a sense of urgency in responding to the intent of the report; and (3) it is important to measure the outcomes of learning objectives, and better assessment methods should be developed, particularly ones to assess outcomes related to attitudes and values.
The development of the Best Evidence Medical Education (BEME) Collaboration is introduced in the context of other systematic review initiatives, specifically the Cochrane and Campbell collaborations. The commentary addresses two goals: to describe the current status of BEME and to situate BEME in the broader context of the medical education community's need to be accountable, to conduct research to understand educational processes and results, and the key role that medical educational research must play within the quality-improvement agenda. Lessons drawn from the evidence-based practice movement of the last ten years and the current experience with BEME suggest that, although BEME will inform some educational policies and practices, its initial success may be limited because of the paucity of studies that meet current standards for evidence and the great difficulty in conducting methodologically rigorous studies in the complex social interaction called education. Nonetheless, the need exists for medical education research to continue to address key issues in medical education using experimental designs, while at the same time anticipating the need for more situation-specific data to permit educators to monitor and benchmark their existing programs within a quality-improvement and accountability framework. The authors conclude that the very nature of being professional in today's social and fiscal context demands that medical educators provide evidence of effectiveness and efficiency of their programs while at the same time BEME and medical education research continue to grow and mature.
Future hospital accreditation could take into account the quality of medical files. The objectives of this study is to test a method for auditing and evaluating the quality of the handing of medical files. We conducted a retrospective regional audit based on the frame of reference the National Agency for Medical Development and Evaluation, by using a sample of cases, stratified by establishment. In our region, the global budgets of 47 public and private hospitals participating in the public hospital service, are adjusted while keeping in mind the medicalised activity data (PMSI). This audit was proposed to the doctors of the Department of Medical Information on the occasion of the regulatory PMSI quality control. A total of 467 questionnaires were given by 39 of the 47 sollicited hospitals (83%). The methodological aspects (questionnaire, cooperative approach...) are discussed. The make-up of medical files can alos be improved by raising the percentage of the presence of important data or documents such as the reason for admission (74.1%), the surgery report (83.2%), and the hospitalisation report (66.6%). A system for classifying the paraclinical results is shared and systematic throughout the service or hospital in only 73.2% of cases. The quality of the handing of medical files seems problematic in our hospitals and actions for improving the quality should be undertaken as a priority.
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