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Writing a scientific paper as part of the medical curriculum.

The curriculum at the Medical School, University of Tromsø reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979-89) from Tromsø 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.

Curriculum↗

An innovative examination ending the medical curriculum.

There has been increasing interest in curriculum innovation in many medical schools. The pedagogic principles for learning and for assessment should be congruent. Changing the curriculum and pedagogic principles for medical education implies that the examinations should also be adapted to the new principles. At the Faculty of Health Sciences, Linköping University, we use a student-oriented programme with problem-based learning, early patient contact, multiprofessional integrated education, and integration between basic science and clinical medicine and between traditional medical subjects. We also encourage the students to adopt a scientific attitude from the very beginning. To assess the students at the conclusion of the medical curriculum, we have developed a new form for the final examination containing measurements of clinical ability based on a videotaped patient consultation, an assessment of the student's performance and presentation of a scientific project, the student's analysis of a published scientific paper and an extensive oral examination based on the students' own scientific papers. Our experience, including results from questionnaires to students and teachers, is that the method is suitable for a final examination and assesses qualities that we previously were not able to assess.

Adult↗

Educational supervisors evaluate the preparedness of graduates from a reformed UK curriculum to work as pre-registration house officers (PRHOs): a qualitative study.

INTRODUCTION: In 1996 the University of Liverpool introduced an integrated problem-based learning (PBL) medical curriculum incorporating the recommendations of Tomorrow's Doctors. This paper investigates whether the PRHO (pre-registration house officer) educational supervisors who supervise Liverpool graduates believe that the reformed curriculum is producing house officers who have the competencies outlined by the General Medical Council. METHODS: Forty-one interviews were arranged with a sample of educational supervisors in the Mersey Deanery area to ascertain their views on the competencies of Liverpool PRHOs. The interviews were tape-recorded, transcribed and analysed. RESULTS: The supervisors felt that the PRHOs had been well prepared to work as PRHOs, and compared with traditional graduates they were actually better prepared for the job of PRHO. They saw the PRHOs as competent communicators with improved clinical skills, who had good attitudes, were aware of limitations, were team workers, good at history-taking and examination and had different approaches to finding information. There was a very confusing picture regarding basic knowledge, with some consultants expressing concerns, despite saying they had adequate knowledge to work as PRHOs. It emerged that there was little consensus about the knowledge base of the traditional or PBL graduates or what knowledge level was needed at this stage. DISCUSSION: Educational supervisors believe that the reformed curriculum in Liverpool is producing competent PRHOs who have been better prepared for the role of PRHO than previous graduates. It could be that uncertainty over knowledge base may be the price paid for reducing the factual burden and improving preparedness for professional practice.

Cohort Studies↗

The development of an innovative education curriculum for 11-16 yr old children with type 1 diabetes mellitus (T1DM).

BACKGROUND: Evidence-based, structured education is recommended for all people with diabetes; tailored to meet their personal needs and learning styles. Adult courses exist in the UK but are of limited value for children. The aim of this study was to adapt the adult Dose Adjustment For Normal Eating (DAFNE) course to design a skills training course, for children aged 11-16 yr, focusing on self-management skills within an intensive insulin regime. To ensure that the course format meets the developmental, intellectual and social needs of children and adolescents and is delivered using educationally sound techniques. METHODS: Relevant professionals and potential users of the course were involved in curriculum design and content in the following ways: (i) The views of 95 pediatric diabetes specialist nurses were sought through a postal survey; (ii) Focus group discussions were conducted with children with type 1 diabetes mellitus (T1DM) and their families to contribute to content and design; and (iii) Secondary school teachers worked with experienced pediatric diabetes staff advising on educational content and teaching format. RESULTS: The developed curriculum uses a progressive modular-based structure to improve self-management in a variety of medical and social situations. It has clear learning objectives and is based on the format of UK schools curricula. Additional support is provided through dedicated parent sessions, involvement of friends and the provision of a school resource pack. CONCLUSION: Collaborative working between health professionals, school teachers and families has resulted in an age-appropriate curriculum, which employs validated educational techniques. This will be refined following pilot courses before formal evaluation in a multicentre randomized controlled trial.

Adolescent↗

Ruralising the undergraduate medical curriculum through consultation with key stake holders.

This paper describes the approach taken at the University of Queensland to broaden the scope of curriculum design to involve rural general practitioners, medical students and rural health care consumers. A form of nominal group process in serial telephone teleconferences was used, with a group of rural general practitioners, to develop and pilot curriculum content, learning strategies and assessment methods. Medical students assisted in the evaluation of the curriculum and representatives of rural organisations were consulted about the value of hosting medical students in rural communities. The three groups made significant contributions to the project. The results will be trialed for the entire year 6 cohort (240 students) in 1995 and will form the basis of the planned rural practice term in the new graduate course.

Community Participation↗

Radiology curriculum for medical students: clinicians' perspectives.

This study was conducted to establish clinicians' perspectives of a set of radiology curriculum topics for medical student teaching, which were held to be important by radiologists. A questionnaire was sent to clinicians in all specialties. Forty-six clinicians (51.1%) out of 90 returned the questionnaires. All curriculum topics were scored above an average of 4 (agree). The five highest ranking curriculum topics in order of importance were: developing a system for viewing chest radiographs (5.59), developing a system for viewing abdominal radiographs (5.56), developing a system for viewing bone and joint radiographs (5.33), distinguishing normal structures from abnormal in chest and abdominal radiographs (5.33) and identifying gross bone or joint abnormalities in skeletal radiographs (5.22). Correlative analysis between speciality groups showed surgical and medical specialities were significantly different in their responses of two learning outcomes: basic knowledge about the contrast media benefits and risks (P= 0.01) and ability to select the most appropriate and the most cost-effective methods of radiological investigations for clinical situations (P= 0.03). Acute specialities were not significantly different from the other two groups for these two learning outcomes. There was no statistically significant difference for other learning outcomes between the three speciality groups.

Curriculum↗

Evaluating and enhancing a women's health curriculum in an internal medicine residency program.

OBJECTIVE: Resident education in women's health is required but is often underemphasized. Our aim was to identify women's health topics with the most relevance to our graduates' practices and to determine how well they were prepared to address women's health issues. DESIGN: Postgraduate survey. SETTING: University-affiliated internal medicine residency program. PARTICIPANTS: Program graduates in general internal medicine practice. METHODS: A survey was drafted listing the 65 topics described in a published residency curriculum in women's health. Respondents indicated the extent to which each item was relevant to their practice and the adequacy of instruction received on a Likert-type scale of 1 (not relevant/inadequate) to 5 (highly relevant/adequate). RESULTS: The response rate was 86%. Many of the items were highly relevant to our graduates' practices. Learning needs were found in all areas as none of the topics were rated as "adequately" taught during residency. Many areas in the curriculum had low relevance scores. Few differences were seen in the perceived relevance of women's health problems or the adequacy of instruction received based on gender, practice type and setting, or amount of ambulatory training during residency. CONCLUSIONS: Use of this survey has allowed us to tailor and prioritize learning issues in women's health to meet the needs of our graduates. Increased time in ambulatory rotations alone may not be sufficient to prepare residents to provide comprehensive care in this field. Further study of the effectiveness of a dedicated curriculum in women's heath is needed.

Chicago↗

Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview?

OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes.

Attitude to Health↗

The PRIME curriculum. Clinical research training during residency.

AIM: The Primary Medical Education (PRIME) program is an outpatient-based, internal medicine residency track nested within the University of California, San Francisco (UCSF) categorical medicine program. Primary Medical Education is based at the San Francisco Veteran's Affairs Medical Center (VAMC), 1 of 3 teaching hospitals at UCSF. The program accepts 8 UCSF medicine residents annually, who differentiate into PRIME after internship. In 2000, we implemented a novel research methods curriculum with the dual purposes of teaching basic epidemiology skills and providing mentored opportunities for clinical research projects during residency. SETTING: Single academic internal medicine program. PROGRAM DESCRIPTION: The PRIME curriculum utilizes didactic lecture, frequent journal clubs, work-in-progress sessions, and active mentoring to enable residents to "try out" a clinical research project during residency. PROGRAM EVALUATION: Among 32 residents in 4 years, 22 residents have produced 20 papers in peer-reviewed journals, 1 paper under review, and 2 book chapters. Their clinical evaluations are equivalent to other UCSF medicine residents. DISCUSSION: While learning skills in evidence-based medicine, residents can conduct high-quality research. Utilizing a collaboration of General Internal Medicine researchers and educators, our curriculum affords residents the opportunity to "try-out" clinical research as a potential future career choice.

Authorship↗

Description of a research-based health activism curriculum for medical students.

INTRODUCTION: Few curricula train medical students to engage in health system reform. AIM: To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S. health system. SETTING: Montefiore Medical Center, the University Hospital of the Albert Einstein College of Medicine, Bronx, NY. PROGRAM DESCRIPTION: We designed a 1-month curriculum in research-based health activism to develop physician activists. The annual curriculum includes a student project and 4 course sections;health policy, research methods, advocacy, and physician activists as role models; taught by core faculty and volunteers from academic institutions, government, and nongovernmental organizations. PROGRAM EVALUATION: From 2002 to 2005, 47 students from across the country have participated. Students reported improved capabilities to generate a research question, design a research proposal,and create an advocacy plan. DISCUSSION: Our curriculum demonstrates a model for training physician activists to engage in health systems reform.

Curriculum↗

Management of the clinical curriculum in which students direct rather than perform the laboratory stages of restorations.

At the University of Iowa, senior dental students direct rather than perform laboratory construction of clinical prosthodontic work. This report highlights the fundamentals of a successful curriculum based on this concept. One critical component of the curriculum involves teaching the process of self-evaluation of laboratory work as well as the evaluation of work received from a commercial laboratory. Instructors teach students how to evaluate a product in the sophomore preclinical curriculum. A computerized evaluation form, developed by the prosthodontic faculty, allows assessment of the students' laboratory work in addition to self-evaluation. To incorporate patient care into the appraisal process, a modified preclinical evaluation framework is used during the junior clinical clerkship. This expanded framework takes into consideration patient treatment factors such as degree of difficulty, diagnosis and treatment planning, use of infection control, and students' understanding of patients' comprehensive treatment plan. In the senior clinic, the students' ability to direct the construction of a prosthesis is enhanced by the unique diversity of faculty within the Department of Family Dentistry at the University of Iowa. This department unites private practice dentists with academicians and general practitioners with specialists.

Communication↗

A case-based emergency medicine curriculum for senior medical students.

OBJECTIVE: To determine the effects of a case-based, core content-oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students. METHODS: All senior medical students rotating through the Milwaukee County EM elective during the 1992-1993 academic year were assigned specific chapter readings from a case-oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. All students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five-point Likert scale. RESULTS: Seventy-five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 +/- 7.1%; final examination score 76.2 +/- 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of -1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale. CONCLUSIONS: A case-based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.

Analysis of Variance↗

British Society for Oral and Maxillofacial Pathology, UK: minimum curriculum in oral pathology.

This paper describes a minimum curriculum in oral pathology for undergraduate dental education in the United Kingdom prepared by the Teachers Group of The British Society of Oral and Maxillofacial Pathology. Curricular development in UK dental schools is overseen by the General Dental Council (GDC), the Quality Assurance Agency for Higher Education (QAA) and the European Union. These organisations define the framework for education and learning outcomes but provide little or no detailed guidance on syllabus or curriculum. This recommended minimum curriculum has been drawn up by a consensus process involving teachers of oral pathology from all 13 UK and one Irish dental schools and is cross-referenced to the GDC and QAA published requirements for undergraduate dental education.

Curriculum↗

Evaluation of student and faculty perceptions of the PBL curriculum at two dental schools from a student perspective: a cross-sectional survey.

Problem-based learning (PBL) research has primarily highlighted issues related to medical education and less evaluation has been reported from the field of dental education. Furthermore, literature reports tend to focus mainly on PBL from a pedagogic and curriculum constructional view and up to this date, studies from a student perspective are lacking. The aim of this study was to approach the evaluation of student and staff perceptions of PBL curricula from a student perspective at two separate schools: the Faculty of Odontology at the University of Malmö, Sweden and the dental school of the University of Southern California, School of Dentistry (USCSD), Los Angeles, CA, USA. The study was initiated and conducted by two of the authors, at the time senior students at the Faculty of Odontology in Malmö, Sweden. The study was comprised of a literature search, a 2 week field trip to USCSD, USA, survey distribution to students and faculty in both schools, analysis of the data and a written report for oral defence. The results from the survey were intended to provide feedback on student and faculty perceptions regarding the PBL curriculum. The results indicate a general student and faculty satisfaction with the PBL curriculum. Perhaps, surprisingly their perceptions did not differ significantly despite differences in geography, culture and implementation of PBL pedagogy.

Attitude of Health Personnel↗

Effect of curriculum change on student anxiety and diagnostic reasoning.

Curriculum revision was undertaken to address student anxiety and diagnostic reasoning ability. A quasi-experimental study was conducted with the revised curriculum as the intervention. Subjects were convenience samples of senior baccalaureate students (N = 38) the year before and after the intervention. Spielberger's State/Trait Anxiety Inventory revealed significantly less state anxiety in the intervention group, with no difference in trait anxiety. Gordon's Diagnostic Reasoning Test indicated no significant difference in knowledge of nursing diagnosis language or concepts, but a difference in the inferential ability of the intervention group on one vignette. After the curriculum change, students were less anxious and somewhat improved in their ability to infer nursing diagnoses.

Anxiety↗

Relevant curriculum planning in health education: a methodology.

Procedures proposed to present a methodology for planning relevant health education curriculum included having students write out questions they felt their peers had about health in the specific content areas of community health, consumer health, diseases, drugs, alcohol, and tobacco, ecology, family life, nutrition, mental health, personal health and safety and first aid. A sample survey was presented where 80 junior high school students wrote a total of 981 questions and 74 senior high school students wrote 786 questions. Implications for the health education curriculum would be as follows: (1) Curriculum can be made relevant if the specific content covered is directly related to problems of daily living: (2) Provide needed cognitive information to meet real or potential problems of students; and (3) Provide guidance for the health educator in planning the kind and the amount of emphasis within the total health education program.

Adolescent↗

The Minnesota smoking prevention program: a seventh-grade health curriculum supplement.

A seventh-grade program based on social psychological theories attempted to prevent non-smokers from starting to smoke. Two competing strategies, a Short-Term Influences Curriculum and a Long-Term Influences Curriculum were compared. Within these broad strategies, several other variables were also tested: the use of same age peer opinion leaders or health educators as teachers, the use of media supplements and the elicitation of a public commitment not to become a regular smoker. Program effectiveness was evaluated using self-report measures confirmed by saliva thiocyanate analyses. The treatment groups were compared to a standard curriculum comparison group.

Adolescent↗

Changing the course: a school nutrition and cancer education curriculum developed by the American Cancer Society and the National Cancer Institute.

Increasing evidence exists linking eating patterns and risk of several major chronic diseases, including cancer. The focus of the "Changing the Course" curriculum is to provide students with the knowledge, skills, and attitudes to enable them to adopt cancer risk reducing eating behaviors. A behavioral approach is used, involving acquisition of pertinent background information, evaluation of personal intake patterns, decision-making skills, goal-setting, and evaluation of success in achieving goals. The curriculum involves about 20 hours of action-oriented core instruction, five hours of optional activities, and 10-15 hours of home assignments. Educational strategies involve independent activities such as individual food records, cooperative or team activities and quizzes, and out-of-classroom assignments such as inventorying fruits and vegetables at home. Pilot-tested in four states, the curriculum will be revised based on pilot evaluation data and disseminated nationwide through American Cancer Society divisions and volunteers.

Adolescent↗