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PubMed2004

Student-selected components in the undergraduate medical curriculum: a multi-institutional consensus on purpose.

Student-selected components (SSCs) are an established part of undergraduate medical curricula in the UK. Implementation has been against a background of differing educational approaches to curricular change, together with a lack of clarity about their purpose, relationship with the core curriculum and contribution to overall assessment. This has resulted in a diversity of programmes with perceived differing importance between medical schools. This paper documents the approach used by a consortium of medical schools with diverse curricula to develop consensus on the educational purpose and learning outcomes of SSCs. Agreement on common purposes and outcomes was achieved, and consensus documents are reported. These may be valuable for other medical schools implementing any form of student-selected project work. This work will now be the starting point for further work on producing recommendations for assessment of SSCs, which will be applicable across different medical schools.

Choice Behavior↗

PubMed2004

Multi-professional education in diabetes.

Multi-professional education (MPE) is a forward-looking educational strategy that is both innovative and clinically needed. The primary goal of this program was to assess the potential of MPE in diabetes care. Objectives included knowledge increase in type 2 diabetes care and examining the effect of uni-professional versus multi-professional small groups on learning outcomes. A total of 61 baccalaureate nursing students, four pharmacy students and 56 family practice residents participated in a half-day program. Participants were randomly assigned to multi-versus uni-professional groups. A questionnaire assessing knowledge, attitudes and perceived role responsibilities was anonymously completed in a pre-test/post-test manner. The program was delivered in two sessions that combined larger and small group activities. Quantitative data were analyzed using repeated measures Anova/Manova, Wilcoxon signed rank and Pearson chi-square tests. Participants and educators showed interest in multi-professional education. While no change in knowledge was found, moderate changes in attitudes (with a lessening of attitudinal differences) and significant changes in perceptions of role (from uni-professional responsibility to shared responsibilities) were noted. Nurses in uni-professional groups demonstrated the greatest attitudinal and role perception changes. The contribution of the patient as teacher was prominent. Further exploration and rigorous analysis of the utility of MPE in diverse settings is warranted.

Adult↗

PubMed2001

Design and validation of instruments to measure knowledge.

BACKGROUND: Measuring health care providers' learning after they have participated in educational interventions that use experimental designs requires valid, reliable, and practical instruments. METHODS: A literature review was conducted. In addition, experience gained from designing and validating instruments for measuring the effect of an educational intervention informed this process. RESULTS: The eight main steps for designing, validating, and testing the reliability of instruments for measuring learning outcomes are presented. The key considerations and rationale for this process are discussed. Methods for critiquing and adapting existent instruments and creating new ones are offered. CONCLUSIONS: This study may help other investigators in developing valid, reliable, and practical instruments for measuring the outcomes of educational activities.

Clinical Competence↗

PubMed2003

Computer assisted learning in medicine: a long-term evaluation of the 'Practical Training Programme Dermatology 2000'.

In recent years, numerous computer assisted learning (CAL) programmes based on new teaching methods, as for example the principles of cognitive apprenticeship and problem based learning, have euphorically been developed for various medical fields. However, many of these programmes failed due to either low acceptance, economic inefficiency, or, most seriously, problems with the implementation and evaluation in medical curricula. In 1999, the practical training course 'Dermatology 2000', an interactive multimedia programme for dermatological education, was developed and completely integrated into the regular dermatological curriculum of five German medical schools. The formative evaluation of an implemented relational database revealed contemporary information about the programme's quantity of use. So far, 3050 students have participated in 6557 lessons. The evaluation of two online questionnaires showed a high learner acceptance regarding the programme's instructional design, ergonomics, and didactical presentation and, after completion of Dermatology 2000, an increased interest in medical education software. A comparison of the objective learning outcome illustrated that Dermatology 2000 students (n = 31) not only outperformed non-participants (n = 7) but also showed a (10%) lower rate of errors in a conventional knowledge test. Additionally, single-case studies demonstrated the increased ability of participating students to apply the acquired knowledge to diagnostic problems. We conclude that the implementation of CAL in present medical curricula can contribute to reformations of medical education. The instructional design of Dermatology 2000 is well accepted and suitable to provide both theoretic biomedical knowledge and clinical skills.

Computer-Assisted Instruction↗

PubMed2000

Introducing cancer nutrition to medical students: effectiveness of computer-based instruction.

BACKGROUND: Computer-based instruction has been introduced at the University of North Carolina at Chapel Hill to augment its nutrition course for first-year medical students. Seven program modules have been completed; 2 more are planned. Each module explains the biochemistry and physiology of nutrition through interactive lessons, exercises, and a video case study. OBJECTIVE: The goal of this study was to evaluate the instructional efficacy and acceptability of the nutrition and cancer module when used by first-year medical students. DESIGN: The module was used by 163 first-year medical students at the university's medical school as an obligatory component of the nutrition course. Before and after using the module, students were asked to answer multiple-choice questions concerning their knowledge and attitudes; each question had 5 possible answers. RESULTS: On average, students spent approximately 3 h studying the lessons. The percentage of correct responses to 20 knowledge questions increased from 22% before the module was used to 86% immediately after its use. When a randomly selected subsample of 25% of the students took the same test 3 mo later, they answered 62% of the questions correctly. The increase in the percentage of students who felt prepared to provide advice regarding nutrition's role in cancer prevention (from 5.7% to 66.9%) suggested a successful subjective learning experience. Neither the students' initial level of interest in cancer nutrition nor their acceptance of computer-based instruction was related to learning outcome. CONCLUSIONS: The tested module is a useful and effective aid for teaching nutritional principles of cancer prevention. The evaluation strategy helped identify areas for instructional improvement.

Attitude↗

PubMed2006

Undergraduate musculoskeletal examination teaching by trained patient educators--a comparison with doctor-led teaching.

BACKGROUND: To compare the core hand and knee examination skills gained by undergraduates taught either by trained patient educators (PEs) or by doctors. METHODS: A total of 50 final year medical students were randomized to receive training from PEs or doctors. Group A were taught hand examination by a PE with rheumatoid arthritis, and knee examination by a PE with osteoarthritis. Group B was taught hand and knee examination by a consultant rheumatologist plus an untrained patient with appropriate signs. All students were taught an established core skills set in small group workshops. Students then undertook two validated objective structured clinical examination (OSCE) stations with two blinded assessors. Pre- and post-teaching questionnaires established the students' self-reported levels of skills (SRS) and a student evaluation of teaching (SET). The study was analysed as an equivalence trial. A mean difference in OSCE scores of 10% was assumed to be of educational significance. RESULTS: Although the SET scores of both groups were high, the doctor-led group received higher scores. Aside from this, the two student groups did not differ significantly. There were no significant differences in mean hand OSCE (mean difference = 0.88, P = 0.28, 95% CI = -0.73 to 2.49) or knee OSCE (mean difference = 0.28, P = 0.7, 95% CI = -1.19 to 1.75) scores. Both the upper and lower confidence intervals for each mean difference fell within the 10% range (-2.8 to 2.8 for the hand, and -2.5 to 2.5 for the knee) and equivalence was assumed. CONCLUSIONS: Adequately trained PEs can deliver clearly structured undergraduate skills, teaching with equivalent learning outcomes to those of rheumatology consultants. PEs are a valuable development to augment musculoskeletal education in the face of expanding student numbers.

Adult↗

PubMed1976

Comparison of the psychiatry learning system and traditional teaching of psychiatry.

Pressures of time, changing curricula, and increased enrollment in medical schools require the development of more efficient teaching methods to replace or supplement the traditional lecture format. The faculty of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina has developed an individualized course in basic psychiatry which can replace approximately 50 hours of lectures ordinarily delivered to students during the rotation on clinical psychiatry. The individualized course, referred to as the Psychiatry Learning System (PLS), was received by half the class during the year 1973-74, and the lecture course was delivered to the other half. These two groups were compared on several learning outcomes, including attainment of theoretical knowledge about psychiatry, observational skills, interviewing ability, and problem-solving ability. Overall performance ratings by clinical supervisors were also obtained. The PLS group scored no worse on any of the measures but statistically better on half of them than did the lecture group.

Education, Medical, Undergraduate↗

PubMed1990

Using a sociomatrix to evaluate the effectiveness of small-group teaching to residents.

This article describes a 1988 pilot study in a family medicine residency program of the use of a sociomatrix to assess small-group teaching. A multidisciplinary team developed a sociomatrix coding sheet, which was used by a family physician-psychiatrist to classify behaviors seen on videotaped small-group teaching sessions, which were held at the conclusion of patient care activities. Although the sociomatrix appears to have the potential to relate specific leader behaviors to residents' feedback regarding subjective learning outcomes, the number of observations was too small to permit clear conclusions regarding optimal teaching behaviors and styles.

Family Practice↗

PubMedDate not supplied

NINE: newspapers in nursing education.

Newspapers in education are not new, but the use of newspapers in nursing education (NINE) is just being initiated, because of the recognition that few students are informed about world events. The use of newspapers in the classroom can foster nurse leaders who are well informed and have appropriate communication skills (reading, writing, critical thinking) that prepare them for lifelong learning. The author describes the development and implementation of the newspaper approach in nursing education, based on Knowles' theory of adult learning. Outcomes of this approach are reported.

Education, Nursing, Baccalaureate↗

PubMedDate not supplied

Reflective journaling: developing an online journal for distance education.

Reflective journal writing can be a useful heuristic tool to foster critical thinking skills and develop reflective clinical practice in nursing. When combined with a distance education delivery format, the online journal helps to leverage the strengths of reflective learning with educational technology as well as provide a seamless record of learning outcomes across the curriculum. The authors discuss the incorporation of an online reflective journal into a distance education clinical course and provide guidelines for educators considering a similar approach.

Attitude of Health Personnel↗

PubMedDate not supplied

Student perspectives on transitioning to new technologies for distance learning.

This article reports on students' perceptions of their learning experiences when an existing distance-learning master's program transitions to new technologies and new instructional strategies. Unique elements addressed in this article include (1) findings when a program with extensive experience delivering distance education changes to new technologies and (2) findings when a multidimensional format is used to evaluate program delivery. The technology changes involved migrating from a satellite-based technician-supported videoconferencing system to a land-based faculty-operated videoconferencing system and the addition of class Web materials and asynchronous computer conferencing to course delivery. The multidimensional evaluation format examined student experiences within the context of specific interactions among instructional activities, technology applications, and desired learning outcomes. The evaluation process involved (1) open-ended and structured items in course surveys and (2) an end-of-year student focus group discussion. A formative evaluation approach was used; this article reports on efforts to address the problems identified. Findings include (1) program planners should not assume that prior institutional experiences with distance education facilitate a smooth transition to use of different technologies and (2) a formative multidimensional approach to program evaluation is critical for understanding student experiences with technology-mediated distance education.

Adaptation, Psychological↗

PubMedDate not supplied

Quality assurance processes for designing patient education web sites.

In the future, more nurses and other healthcare professionals will be providing patient education on the Internet. Having knowledge of processes that lead to quality patient education Web site design is essential. These quality assurance processes include determining the site's purpose, selecting the user population, establishing the expected clinical and learning outcomes, providing an educational framework, incorporating specific design principles, and multiple and ongoing site evaluation. Therefore, Web site development processes designed to undergird quality patient education are presented, and an example Web site is used to illustrate them.

Computer Security↗

PubMedDate not supplied

Flexible monitoring in the management of patient care processes: one year after the pilot study.

A pilot study at a large metropolitan hospital in Auckland identified a specific group of patients that can be safely monitored outside the Coronary Care Unit using Flexible Monitoring technology. This article describes the project management processes used to further develop the remote monitoring system into a hospital network of remote monitoring. The educational and staff support resources required throughout the project are described as are the strategies adopted to meet those needs including the utilization of online learning. Outcomes from the introduction of the system include improved electrokardiogram interpretation by nursing staff and improved ECG resource allocation.

Aged↗

PubMed1980

A critique of the 'objectives model of curriculum design' applied to the education and training of district nurses.

In 1976 the Panel of Assessors for Nurse Training published the 'Right on the Education and Training of District Nurses SRN/RGN'. This recommends an extended form of training based on an outline curriculum. The new scheme of training will be implemented in 1981, and responsibility for developing the detailed curriculum will rest with district nurse tutors and will be undertaken at local level. One method that might be used by district nurse tutors is the 'objectives model of curriculum design', which requires educators to (a) consider sources for the derivation of objectives; (b) identify and express objectives, preferably in behavioural terms; (c) utilize the objectives to identify skills, attitudes and learning experiences required to produce desired learning outcomes and (d) evaluate whether or not objectives have been achieved. It is generally acknowledged that this particular model, which has been tested and tried in the spheres of general and vocational education, has strengths and weaknesses. Some of these are identified in this paper and applied to the education and training of district nurses. District nurse tutors might, therefore, consider both the strengths and the weaknesses of this approach as they prepare to develop the outline curriculum.

Curriculum↗

PubMed2005

Specialist educational intervention for acute inpatient mental health nursing staff: service user views and effects on nursing quality.

AIM: This paper reports a study to evaluate the impact of an innovative 18-day educational intervention for acute ward-based mental healthcare nursing staff on documented quality of nursing care and on service user views of that care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. It is claimed that specialist educational courses are needed to improve these services. However, whilst such courses may lead to positive learning outcomes for participants, the impact on the actual care of service users is unknown. METHOD: An uncontrolled before-and-after evaluation of three acute mental health wards from different United Kingdom National Health Service trusts was carried out. Quality of nursing care was evaluated by extracting documentary evidence from service user records, assessed by two independent researchers according to predefined quality criteria. The views of a purposive sample of mental health service users, currently receiving services from the three designated wards, were ascertained by semi-structured interview. RESULTS: Both documentary evidence and service user views revealed some important baseline deficiencies in the quality of care offered at the study sites. Following the educational intervention, statistically significant improvements were observed in the quality of care planning, initial assessments and the provision of therapeutic care. No statistically significant changes were observed in the quality of risk assessments, medication management or external agency involvement. CONCLUSIONS: Education can have an impact on nursing care but may not be sufficient alone to change mental healthcare practices on acute inpatient wards in the radical manner demanded by policymakers and service user lobby groups. Educational interventions need to be implemented in conjunction with organizational changes that are specifically designed to maximize the opportunities presented by a newly skilled and positive workforce.

Acute Disease↗

PubMed1995

Competence-based summative assessment of a student-directed course: involvement of key stakeholders.

The 5-week module in general practice for final-year students at the University of Sheffield is based on practice attachments and student-directed learning in small groups. This paper describes how the summative assessment process of the module was revised to incorporate the notion of competence-based assessment, and how general practitioner tutors, departmental tutors and students were involved in this revision. The question 'What are students expected to know and be able to do by the end of the module?' was answered in terms of a statement of the key purpose of the module and a list of intended learning outcomes. The question 'How can we find out if students have achieved these outcomes?' was addressed by developing check-lists of criteria for observed behaviours and for the written products of students' actions.

Clinical Competence↗

PubMed2005

A structured assessment of newly qualified medical graduates.

INTRODUCTION: While there is extensive published experience with the assessment of procedural skills in undergraduate students, this is limited in newly qualified medical graduates at the time of entry to the pre-registration (internship) year. The few studies that have been published suggest that these skills are frequently deficient when objectively tested. We therefore chose to assess the competence of a group of South African medical graduates on entry to their pre-registration year. METHODS: A total of 58 graduates of South African medical schools were assessed. Each subject participated in a 7-station objective structured clinical examination (OSCE); 6 of these assessed individual competence in phlebotomy, intramuscular injection, female pelvic examination, bladder catheterisation, tracheal intubation and prescription writing, while competence in cardiopulmonary resuscitation was assessed in a seventh station in randomly allocated teams of 3 candidates. Candidates' opinions of their own competence was sought by questionnaire. RESULTS: There was a wide variation in competence between subjects and across the range of tasks studied. Mean scores ranged from 85.4% for phlebotomy to 55.3% for prescription writing. The average score across all stations was 67.5%, and no student obtained an overall cut-off score of 85% or more, which was established using a modified Angoff method. Subjects' assessment of their own performance was unduly optimistic; most believed that they had demonstrated competence despite clear shortcomings in technique. Objective scores for subjects who had been exposed to a structured skills laboratory programme were not significantly higher than for those who had not, although their self-assessed performance was indeed higher. DISCUSSION: Most of the South African medical graduates who participated in this study were unable to satisfactorily perform technical procedures appropriate to the house officer on entry to the pre-registration year. This is in line with the conclusions of the few studies published in other countries. We suggest that the learning outcomes of undergraduate medical programmes should include an explicit statement of the competencies required for practice in the pre-registration year, and that these should be adequately taught and rigorously assessed before graduation.

Cardiopulmonary Resuscitation↗

PubMed1998

School screening in remote aboriginal communities--results of an evaluation.

As part of ongoing quality assurance, the effectiveness of the school screening program in meeting the health needs of Aboriginal children in a rural district in the Northern Territory Top End was evaluated. The major health problems of Aboriginal children were analysed for their suitability for screening programs. A prospective cross-sectional study used routinely collected field data from the school screening program in 1993. To ascertain follow-up, children who had failed screening tests had their clinic notes reviewed. A total of 774 children from 11 remote communities were screened. The results confirmed high level of disease, with rates for anaemia, malnutrition and trachoma reaching 39%, 22% and 26% respectively. Nearly one-third failed the hearing screening, urinalysis was abnormal in 19%, 3% failed visual acuity and 6% were considered to have abnormal heart auscultation. Many of the major health problems did not meet the recommended criteria for screening programs and others would be better dealt with by ongoing surveillance rather than a single screening. Some abnormalities found on screening were inadequately investigated and/or treated. This evaluation has demonstrated a limited role for school screening in identifying and meeting the health needs of Aboriginal children living in remote areas. In collaboration with the NT Department of Education, a school-age child health policy, including a new school-age child health surveillance program, is being developed. This promotes greater participation by communities, families and schools with the aim of improving the health and learning outcomes for all school-age children in the NT.

Adolescent↗