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PubMed1991

A student-centered, problem-based surgery clerkship.

In the academic year 1989-90, the department of surgery at one college of medicine revised its third-year clerkship to focus on students' learning decision-making skills and critical thinking (cognitive skills) and acquiring knowledge about surgery. Learning to perform procedures and tasks (psychomotor skills) would be accomplished in the required fourth-year acting internships. Problem-based learning (PBL) was chosen as the clerkship's primary instructional method. Comprehensive student and program evaluation systems were established. The response by faculty and students has been very positive. Students believe that the new clerkship has helped them increase their abilities in resource use, time management, and retention of knowledge. Faculty have noted students' increased eagerness and enthusiasm for learning.

Clinical Clerkship↗
PubMed1990

The quarterly profile examination.

In sum, a school-wide examination such as the QPE can be used successfully. As a longitudinal, comprehensive testing system based on the objectives of the educational program, the QPE can satisfy internal and external requirements for assessment. Such an examination system could be an effective evaluation instrument for schools fostering problem-based and independent learning by students.

Education, Medical, Undergraduate↗
PubMed1989

The New Mexico experiment: educational innovation and institutional change.

Over the past ten years the University of New Mexico School of Medicine has conducted an educational experiment featuring learner-centered, problem-based, community-oriented learning. The experiment was introduced into an established institution by means of an innovative educational track running parallel to the more conventional curriculum. Students in the innovative track, compared with those in the conventional tract, tended to score lower on the National Board of Medical Examiners (NBME) Part I examination (basic sciences) and higher on NBME Part II (clinical sciences), received higher clinical grades on clinical clerkships, and experienced less distress. They were more likely than conventional-track students to retain their initial interest in or switch their preference to careers in family medicine. The parallel-track strategy for introducing curriculum reform succeeded in fostering institutional acceptance of continuing educational innovation. Generic steps in overcoming institutional barriers to change are identified.

Curriculum↗
PubMed1992

Increases in knowledge and use of information technology by entering medical students at McMaster University in successive annual surveys.

OBJECTIVE: To determine self-reported microcomputer and information technology competency, access, and usage by entering medical students and their perceptions of the need for training in additional applications. DESIGN: Cross-sectional surveys of successive classes. SETTING: McMaster University Faculty of Health Sciences Medical Undergraduate Program, which has a 33-month, problem-based, self-directed learning curriculum and a high applicant-to-student ratio. PARTICIPANTS: Medical school classes entering in 1987, 1988, and 1989. Response rates were 80%, 90%, and 86% respectively. MEASURES: A self-report questionnaire was sent to each student, with up to two follow-up letters to prompt a response. RESULTS: There was a progressive rise in reported information technology access and use for the three years. For the classes starting in 1987, '88, and '89 respectively, computer access was 29%, 49%, and 49% (P < 0.002 for linear trend), and, among those with computer access, modem access was 17%, 29% and 50% (P = 0.012). Self-service MEDLINE use on CD-ROM at the Health Sciences Library was 65%, 75%, and 89% respectively (P < 0.001) for all respondents within the first few months of starting medical school. Over 50% of each class stated they would take courses, if available, on clinical applications software, office management, online searching, filing, and CD-ROM searching. CONCLUSIONS: Half of the most recent entering students already had access to a personal computer and most wished to learn computer applications that would assist them with patient management, and with information access and organization. Medical schools need to address which applications they will teach or make available and how to bring all students to acceptable competency in their use.

Computer Literacy↗
PubMed1991

Self-assessment and learning through GOSCE (group objective structured clinical examination).

The objective structured clinical examination (OSCE) was modified to serve as a means of self-assessment and learning, rather than as an examination. The main modifications were to adapt it for use by small groups instead of individuals, and to provide a correct answer or other feedback at each station. The resulting group OSCE (GOSCE) was used as an introductory session in two residential refresher courses for general practitioners. The 300 participants rated it highly as a method of self-assessment and as an enjoyable social event. Four potential applications of the GOSCE are suggested: as an assessment instrument for formative and informal summative assessment, as a resource for learning about interpersonal and interprofessional relationships, and as a framework for problem-based short courses.

Education, Medical, Graduate↗
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↗
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↗
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↗
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↗
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↗