Early Clinical Exposure Research Articles

早期臨床体験 (early clinical exposure) について

早期臨床体験 (early clinical exposure) について

Establishing a Medical Humanities Program in Israel: Challenges and Solutions

In the 2007–8 academic year, the Hebrew University – Hadassah Medical School established a three-year Medical Humanities program. We developed a spiral curriculum addressing three main concepts: moral reasoning, professionalism, and the social and cultural context of medicine, each of which is revisited during the entire period of studies on a higher level. The courses—encompassing topics applicable to medicine in general as well as subjects of special significance to physicians in Israel—are taught in a combination of frontal lectures, small group discussions, and early clinical exposure. Our interdisciplinary faculty includes physicians, nurses, social workers, psychologists, lawyers and members of the Faculty of Humanities. We believe that teaching the medical humanities enables graduating physicians to utilize the latest scientific and technological knowledge more empathetically and humanely, reminding them that medicine is not confined to mere tending to the sick, but includes an ethical philosophy common to all physicians who remain true to their art.

Impact of a Program of Early Clinical Exposure on Medical Students' Residency Choices of Primary Care and Surgical Fields

Impact of a Program of Early Clinical Exposure on Medical Students' Residency Choices of Primary Care and Surgical Fields

New York University School of Medicine

New York University School of Medicine

Stanford University School of Medicine

Stanford University School of Medicine

University of South Florida College of Medicine

University of South Florida College of Medicine

Reflecting on Reflections: Enhancement of Medical Education Curriculum With Structured Field Notes and Guided Feedback

The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.

Semiologia integrada: uma experiência curricular de aproximação antecipada e integrada à prática médica

Para evitar a fragmentação e a estereotipia e favorecer uma aproximação antecipada da pratica médica, foi introduzido o curso de Semiologia Integrada no programa do segundo ano do curso médico da Unifesp. Este curso inclui a realização de anamneses no hospital, seguidas de discussões que contam com a participação conjunta dos professores de Psicologia Médica e de professores de diferentes áreas da Semiologia (Clínica Médica, Pediatria, Ginecologia, Obstetrícia e Geriatria). Foi dada atenção especial para apresentar ao estudante de Medicina um modelo que integrasse os aspectos biológicos, psicológicos e sociais do adoecer. Este artigo apresenta o projeto e as observações preliminares, que sugerem um importante potencial integrador tanto para os alunos quanto para os professores. São necessárias avaliações futuras para comprovar essas observações.

Early clinical exposure in medical curricula across Europe: An overview

Background: Many faculties of medicine now include programmes using early clinical exposure (ECE) to introduce medical students to important topics in medicine. Objective: To sketch the landscape of ECE in Europe, describing existing courses. Methods: A survey questionnaire was developed by the Basic Medical Education Committee of the European Academy of Teachers in General Practice (EURACT). This survey used the key informant interviews method, with EURACT Council members serving as key informants by filling in the questionnaire and gathering descriptive data on ECE programmes in their own countries. Results: We asked representatives of 32 EURACT member countries to complete the questionnaire in 2006. We received responses from 21 countries, and the programmes of 40 medical schools from 16 countries were included in the study. Thirty-two medical schools implemented ECE starting in the first year. The duration of ECE programmes ranged from 2 weeks to 2 years. The length of each session varied from 2 hours to a full day. Primary care played an important role in ECE. ECE programmes were implemented with a wide range of objectives.Conclusion: ECE is a new and rewarding trend in European medical schools, and general practice/family medicine (GP/FM) departments are widely involved in these teaching activities. This could help establish GP/FM departments in some countries that still do not have them in their medical schools.

APEP - Anesthesiology Preceptorship Enrichment Program: A curriculum for first and second year medical students…an early look

The purpose of this educational innovation was to create a program for first and second year medical students (MS1s and MS2s) that would: (1) Provide students with early clinical exposure to the subspecialty field of anesthesiology, (2) Expose MS1s and MS2s to dedicated anesthesiologists serving as preceptors, (3) Enrich the students' basic science knowledge in a practical way using an integrated curriculum with clinical correlates and (4) Convey an accurate depiction of anesthesiology as a possible career choice. The Anesthesiology Preceptorship Enrichment Program (APEP) was designed for MS1s and MS2s as a seven month curriculum for each level, integrated with basic science course content. APEP students shadowed faculty from the Department of Anesthesiology (APEP preceptors). Guided by handouts, preceptors reviewed basic science concepts with clinical correlates. APEP encounters from October 2006-April 2007, October 2007-April 2008, and October 2008-April 2009 were documented and students completed a questionnaire about their experience. After three years, APEP has become a successful program, as evidenced by the increasing numbers of interested incoming students, active students and returning students. According to the end of program questionnaire, 38-68% of the APEP students used the APEP handouts to guide discussions with their preceptor, enhance intra-operative teaching, and/or refer to while studying for basic science course exams. According to the questionnaire, 71-80% of the APEP students were more interested in the field of anesthesiology after participating in APEP, 10-16% were neither more or less interested, and 4-19% were less interested. Early clinical exposure to anesthesiology with APEP was viewed as a very positive experience, increasing interest in anesthesiology at the MS1 and MS2 level. The APEP handouts were deemed a useful aid for discussion and created opportunities for teaching clinical correlates of basic science knowledge.

Educational effectiveness of early clinical exposure with reflection

Educational effectiveness of early clinical exposure with reflection

Global Health Opportunities in Surgery: A Guide for Medical Students and Faculty

A four-week surgical rotation at the Clinica Universitaria Teleton in Chia, Colombia, was arranged for a U.S. student at the completion of the first year of medical school. The rotation resulted in a supervised intense early clinical exposure to surgery resulting in advancement in five of the six clinical competencies. International medical experiences can provide great benefit to U. S. medical students.

The academic environment: the students’ perspective

Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4-6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the 'students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The 'ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from 'class size', 'leisure time' and 'assessment procedures' to 'relations with peers and faculty', 'ethical climate' and 'extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between 'teaching' and 'learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement.

Unique Medical Education Programs at Nippon Medical School

In an attempt to improve the content of the educational programs offered by Nippon Medical School and to better prepare our students to work in the rapidly changing world of medicine, the school has recently revamped its teaching methodology. Particular emphasis has been placed on 1) simulator-based education involving the evaluation of students and residents in a new clinical simulation laboratory; 2) improving communication skills with the extensive help of simulated patients; 3) improving medical English education; 4) providing early clinical exposure with a one-week clinical nursing program for the first year students to increase student motivation at an early stage in their studies; 5) a new program called Novel Medical Science, which aims to introduce first-year students to the schools fundamental educational philosophy and thereby increase their motivation to become ideal physicians. The programs have been designed in line with 2006 guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology to allow flexibility for students to take part in education outside their own departments and year groups as part of the Ministry's program to encourage distinctive education at Japanese universities.

Attitude of medical students towards Early Clinical Exposure in learning endocrine physiology

BackgroundDifferent teaching-learning methods have been used in teaching endocrine physiology for the medical students, so as to increase their interest and enhance their learning. This paper describes the pros and cons of the various approaches used to reinforce didactic instruction in endocrine physiology and goes on to describe the value of adding an Early Clinical Exposure program (ECE) to didactic instruction in endocrine physiology, as well as student reactions to it as an alternative approach.DiscussionVarious methods have been used to reinforce didactic instruction in endocrine physiology such as case-stimulated learning, problem-based learning, patient-centred learning and multiple-format sessions. We devised a teaching-learning intervention in endocrine physiology, which comprised of traditional didactic lectures, supplemented with an ECE program consisting of case based lectures and a hospital visit to see patients. A focus group discussion was conducted with the medical students and, based on the themes that emerged from it, a questionnaire was developed and administered to further enquire into the attitude of all the students towards ECE in learning endocrine physiology.The students in their feedback commented that ECE increased their interest for the subject and motivated them to read more. They also felt that ECE enhanced their understanding of endocrine physiology, enabled them to remember the subject better, contributed to their knowledge of the subject and also helped them to integrate their knowledge. Many students said that ECE increased their sensitivity toward patient problems and needs. They expressed a desire and a need for ECE to be continued in teaching endocrine physiology for future groups of students and also be extended for teaching other systems as well. The majority of the students (96.4%) in their feedback gave an overall rating of the program as good to excellent on a 5 point Likert scale.SummaryThe ECE program was introduced as an alternative approach to reinforce didactic instruction in endocrine physiology for the first year medical students. The study demonstrated that students clearly enjoyed the experience and perceived that it was valuable. This method could potentially be used for other basic science topics as well.

Problem Based Learning, curriculum development and change process at Faculty of Medicine, Makerere University, Uganda.

The faculty of Medicine, (FOM) Makerere University Kampala was started in 1924 and has been running a traditional curriculum for 79 years. A few years back it embarked on changing its curriculum from traditional to Problem Based Learning (PBL) and Community Based Education and Service (COBES) as well as early clinical exposure. This curriculum has been implemented since the academic year 2003/2004. The study was done to describe the steps taken to change and implement the curriculum at the Faculty of Medicine, Makerere University Kampala. To describe the steps taken to change and implement the new curriculum at the Faculty of Medicine. The stages taken during the process were described and analysed. The following stages were recognized characterization of Uganda's health status, analysis of government policy, analysis of old curriculum, needs assessment, adoption of new model (SPICES), workshop/retreats for faculty sensitization, incremental development of programs by faculty, implementation of new curriculum. The FOM has successfully embarked on curriculum change. This has not been without challenges. However, challenges have been taken on and handled as they arose and this has led to the implementation of new curriculum. Problem based learning can be adopted even in a low resourced country like Uganda.

Clinical skills training in a resource constrained medical school

Context and setting Uganda is one of the world’s least developed countries. Makerere Medical School has neither an equipped skills laboratory nor designated trained personnel for teaching clinical skills. Makerere lacks the funds to construct and equip a skills laboratory and train the trainers. Training of clinical skills to medical students has been implemented traditionally during the clinical clerkships in Uganda. In 2003–04 a problem-based learning (PBL), student-centred medical undergraduate curriculum was introduced with the stated goal of early clinical exposure and training of clinical skills. Why the idea was necessary Early introduction of clinical skills was viewed to be beneficial, as these skills may take a significant time to develop. Moreover, early introduction of these skills would probably facilitate the integration of clinical and basic science knowledge. The objectives of the training were to develop competency in communication and history taking, as well as procurement of vital signs. What was done? A clinical skills training curriculum was developed through a number of meetings, and consultation workshops with institutional leaders and faculty. At these forums, consensus was reached regarding the objectives, format and content of the curriculum in order to match and maintain relevance between PBL cases and the skills training curriculum. Initial implementation of the clinical skills training took place during the 2nd semester of 2004. Students in the 1st and 2nd years received 2 clinical skills training sessions of 2 hour each over a period of 15 weeks; 1st-year skills in interpersonal communication and vital signs were taught using mini-lectures, demonstrations and role play, and 2nd-year skills covered interpersonal communication and general history-taking procedures. Teachers demonstrated skills to students, who in turn performed the procedure on their peers. A ratio of 1 teacher to 15 students was maintained. In order to determine the students’ perceptions of the programme, a questionnaire using a 5-point Likert scale was administered to 32 randomly selected 1st-year students from a population of 100. The teachers’ opinion on how to improve the curriculum and their enjoyment of the training were also elicited. Student assessment was not performed in this pilot programme, which was used to obtain data for assessment criteria. Evaluation of the results and impact All students and teachers indicated that they had enjoyed the training sessions. All the students surveyed agreed that the clinical skills programme was tailored to their knowledge level, that session objectives were clear and that teachers demonstrated the skills adequately. Students indicated concern about timely feedback, lack of equipment for learning and time for supervised practice. Faculty recommended improvement of the facilities and recruitment of more faculty to teach the course. This project demonstrated that early training in clinical skills is feasible in resource-limited environments. Moreover, training space may be upgraded as a result of the pilot.

Louisiana State University Health Sciences Center in Shreveport.

Louisiana State University Health Sciences Center in Shreveport.

Sometimes we do get it right! Early clinical contact is a rewarding experience.

Like many other medical education bodies, the Health Professions Council of South Africa has advocated changes in the education and training of medical practitioners. The suggested reform includes early clinical exposure in a range of settings. Early in the design of Curriculum 2001, a problem-based learning programme, health care visits in Year 1 were considered essential. Since the student population was diverse in many aspects, including age, it was necessary to evaluate whether students were prepared for the early exposure. Data on the impact of the health care visits were collected directly through a survey administered towards the end of the academic year and indirectly from student comments regarding their most rewarding experiences during the year. Responses to survey items indicated that students were generally prepared for their health care visits and gave them insights into the activities of a medical practitioner. Sixty-nine per cent of students indicated that aspects of their health care visits, particularly the labour ward and an ambulance duty where many had hands-on experience, were their most rewarding experiences. The decision of curriculum organisers to introduce students to patients in Year 1 of the new PBL curriculum was well received. Despite their young age, many students believed that they were psychologically prepared for this exposure. For many, it was the highlight of their academic year, often reinforcing their original desire to study medicine and allowing them to experience the real world of medicine.

Early clinical exposure to geriatric medicine in second-year medical school students--the McGill experience.

This study examined the effect of a curriculum change on early clinical exposure to geriatrics for second-year medical students at McGill University and its effects on learning and students' appreciation of geriatrics as a subspecialty. Second-year medical students (N = 200) were exposed to a change in the curriculum involving the integration of 10 weekly sessions into one integrated week in geriatric medicine. Students participating in 10 weekly sessions were Group 1 and students participating in one integrated week were Group 2. Students rated their rotation using two different scales. The students completed 12-item questionnaires during their feedback sessions at the end of the 10-week session experience or the integrated week. The first six items assessed the students' appreciation of their improvement of knowledge in the subject of geriatrics and aging. The second and third part of the survey (questions 7 and 8) included the students' opinions about the quality of the instruction (teaching feedback) and evaluation. Students in Group 2 found their rotation more effective as a learning experience and expressed greater satisfaction with interaction with the tutors, community settings, and multidisciplinary team sessions. Grades obtained on final examinations showed a better and more-effective acquisition of knowledge by Group 2. The integrated week is a more-effective learning tool in the early clinical experience for medical students in geriatric medicine than 10 weekly sessions as the first introductory experience to the field of geriatric medicine.