Medical Education Experience Research Articles

Learner Satisfaction With Web-Based Learning as an Adjunct to Clinical Experience in Burn Surgery

Web-based learning provides an effective adjunct to clinical experience in medical education. However, few efforts have assessed learner satisfaction with web-based medical education experiences. American Burn Association and Advanced Burn Life Support (ABLS)-Now is a self-directed web-based curriculum designed to teach clinicians how to assess and stabilize patients with serious burns during the critical hours after injury. The purpose of this study is to evaluate time spent by learners taking the course, to demonstrate successful completion of an exam by these clinicians after the course, and to describe learner satisfaction with ABLS-Now. This preliminary descriptive study analyzed exam scores and voluntary course evaluations of medical students and interns to assess effectiveness of and satisfaction with the web-based ABLS-Now curriculum. Eighteen students and interns completed the web-based ABLS-Now curriculum and follow-up survey. The mean exam score was 88%. Learner scores strongly correlated with time spent completing the course (r2 = .66, P = .01). Learner satisfaction was very high. Learners expressed an interest in using similar web-based tools to learn about other topics in surgery. For novice clinicians, ABLS-Now seems to be an effective way to provide basic burn care education at a time when other educational opportunities have been reduced by work hour restrictions. Learners found the modules easy to use, relevant, and interesting. They indicated an interest in future use of web-based learning to supplement clinical experiences. Web-based learning represents an effective and well-received addition to clinical education in surgery for residents and medical students.

Breaking New Ground: The Story of Dagmar Berne

In 1885 a young country girl enrolled in medicine at Sydney University. She was the first woman in Australia to enroll in a medical school. The medical school at this time was heavily influenced by academics who had graduated from the University of Edinburgh. At one point in her medical education she experienced difficulties with her examinations, the reasons for which are a point for debate. Under the mentorship of a famous British female medical practitioner who was visiting Australia at the time, she continued her studies in the United Kingdom. Here she was successful and returned to practice in New South Wales in 1895. Her experience of medical education was not without suffering. This young woman became part of an international group of women who at the time were trying to break into a field dominated by men.

Breaking New Ground: The Story of Dagmar Berne

In 1885 a young country girl enrolled in medicine at Sydney University. She was the first woman in Australia to enroll in a medical school. The medical school at this time was heavily influenced by academics who had graduated from the University of Edinburgh. At one point in her medical education she experienced difficulties with her examinations, the reasons for which are a point for debate. Under the mentorship of a famous British female medical practitioner who was visiting Australia at the time, she continued her studies in the United Kingdom. Here she was successful and returned to practice in New South Wales in 1895. Her experience of medical education was not without suffering. This young woman became part of an international group of women who at the time were trying to break into a field dominated by men.

Medical informatics education at medical faculty of sarajevo university - 15 years experience.

CONFLICT OF INTEREST: NONE DECLAREDIn Bosnia and Herzegovina, Medical informatics has been a separate subject for the last 15 years with regard to Medical curriculum at the biomedical faculties in the country (1,2). Education in the field of Medical informatics is based on the concept which is used in developed countries, according to the recommendations of the working groups EDU – Education of Medical Informatics, of the European Federation for Medical Informatics (EFMI) and International Medical Informatics Association (IMIA). Theoretical and practical teaching and training performance as a whole is performed by use of the computer equipment, and the final knowledge check of the students is also performed using the Data Base Management System MS Access specifically designed to cover full teaching and training material by using question sets in the data base which encircled nearly 1500 question combinations. The distance learning is logical step that can further improve this method of education. In this paper, authors present 15 years of experience of Medical informatics education at biomedical faculties in Bosnia and Herzegovina. Medical Informatics, as an obligatory subject, was introduced to the biomedical faculties in Sarajevo (medical, dental and pharmaceutical as well as the High medical school) in 1992 and 1993. Students have practical computer exercises for a period of 7 weeks. Students had training in Excel, Word etc. During the semester, the students perform specific operation such as creation of data carrier for manipulation with medical information. The information was analyzed by statistical program such as Excel. From 2002 years Medical Informatics is divided in two parts in order to facilitate data processing and other procedure that are necessary to perform at time when student’s knowledge of medicine is sufficient for practicing specific tasks that include management the data about patient, anamnesis and similar parameters cause we noticed that students without such knowledge cannot figure out the whole picture without difficulties. The Theoretical part of examination is done using the multiple choice answer form provided by special software with randomly selected questions for each student. Such way of practical and theoretical path of final exam make possible to perform such procedures such as electronic registration for exam and distance testing. Possibilities of introduction of distance learning in medical curriculum are the title of project which has been realizing at Cathedra for medical Informatics, Medical faculty since year 2002. Our undergraduate and postgraduate students are satisfied with contents and organization of the teaching process.

Knowledge, attitudes and management of alcohol problems in general practice in rural South Africa

Background: There has been increasing emphasis on the role of primary health care in the prevention and management of alcoholrelated harm. The aim of this study was to determine attitudes to and management of alcohol problems in general practice in rural South Africa. Methods: A total of 61 general practitioners (GPs) were interviewed with the aid of a structured questionnaire (response rate 50%) in two rural districts. Results: The results indicate that 51% of the GPs felt that alcohol is an important issue in general practice. GPs were able to discriminate accurately between cases of problem drinking and alcohol dependence. GPs who reported high levels of alcoholrelated education and training were more prepared to counsel problem drinkers, expressed more therapeutic commitment in their role and reported more appropriate management of these patients than did GPs with lower levels of Continuing Medical Education (CME) experience. Alcohol problems are recognised as an important problem in general practice, and improved training could increase the identification and management of alcohol problems in primary care. GPs rated the most critical barriers to alcohol interventions as competency training, role endorsement, not being adequately reimbursed, health policy not supporting prevention and their own alcohol problem. Conclusion: Alcohol problems are recognised as an important problem in general practice, and improved training, adequate reimbursement and health policy support could increase the identification and management of alcohol problems in primary care. This article has been peer reviewed. Full text available at www.safpj.co.za

Genetics education in medical school: a qualitative study exploring educational experiences and needs

Background: Genetic discoveries increasingly have an impact on clinical medicine. Primary care providers (PCPs) need to be prepared to address patients’ concerns about their genetic risks.Aims: To explore family medicine residents’ experiences with genetics in medical school and residency training and to understand their educational needs in genetics.Methods: Four focus groups were held with 33 family medicine residents at the University of Toronto, which represented graduates of 9 different Canadian medical schools. Groups were audio-taped, transcribed and analysed independently by 4 reviewers using content analysis. Recurrent themes were identified.Results: Participants described their experiences with genetics in medical school as almost entirely related to rare disorders, so genetics was not perceived to be clinically relevant. There was little awareness of the complex ethical and psychosocial issues that accompany genetics. However, participants felt that genetics would become significant in medical care in the future and PCPs would play an important role. They expressed a need for more knowledge of genetics to fulfill this role and practical teaching in genetics by clinicians.Conclusions: Medical school educational experiences may not be preparing future PCPs to address genetic issues with patients. A change and a broadening of the teaching of genetics are required to fulfill this need.

Experience - the best teacher?

Manique Wijesinghe and colleagues consider the role of early practical experience in medical education

Twelve tips for preparing residents as teachers

Background: Residents are frequently identified by medical students as their most frequent and memorable teachers; residents also teach their peers, junior and senior colleagues, other health professionals, and their patients. Many will teach in their future practice. Developing the skills to become a teacher is an important part of postgraduate education, and warrants a systematic, planned approach that may include many complementary learning opportunities.Aims: Our purpose is to describe one such approach: a 4-week elective experience in medical education offered to postgraduate learners.Method: The paper describes the background and goals for the elective, and the various steps in planning, implementing, and evaluating such a course, drawing on the literature and mining our own experience for examples. Specifically, we address the following: needs assessment; the determination and selection of content, sequence, and teaching and learning methods; the experiential learning opportunities offered; and the emphasis on the participants’ developing self-awareness of themselves as teachers, and as part of a community of teachers.Results: The program implementation, program evaluation, and response to feedback received are described.Conclusion: A 4-week elective experience in medical education was positively received by participants.

The working of the 1832 Anatomy Act in Oxford and Manchester

Eighteenth-century demands for improved medical care, especially in surgery, required detailed dissection of the human body in medical education. The rapid rise in numbers of medical students ensured that the traditional sources of bodies for anatomization, the gallows and body-snatching, could not supply demand and became increasingly unacceptable. The 1832 Anatomy Act attempted to alleviate the problem of cadaver shortage by allowing licensed anatomists to claim bodies from workhouses. This article addresses the impact of the legislation on medical education in the 19th century in two contrasting localities, away from the traditional focus on the metropolitan centres, by examining the body supply to the school at Oxford University and the private schools of Manchester after the Act. These two areas provide the chance to examine the contrasting experience of medical education in a traditional centre for the education of physicians with a rising centre focused on the education of surgeons.

Free choice and career choice: clerkship electives in medical education

Medical education experiences, particularly in clinical years, are reported determinants of career choice. Less is known about features of clinical education experiences including length, discipline, setting and choice, which may serve as landmarks in career choice decisions. This study's purpose was to explore the benefits of a free choice clerkship elective, and more specifically, its role in clarifying career choice. Using framework and content analysis methodology, we analysed University of British Columbia, third-year medical student anonymised assignments regarding free choice and 2-week clerkship elective experiences. This clerkship was designed to provide students with clerkship experiences outside the conventional curricular model, while encouraging student choice of ambulatory and community settings. Assignment questions included: reasons for choosing elective; whether learning objectives were met; influence of elective on career choice; and unique elective experiences. Iterative review, coding, analysis and indexing of assignments were carried out to identify themes and corroborate findings. Emergent themes included: positive views of experience; transferable knowledge and skills; and influencer of future education and career choices. Although students were encouraged to choose clerkship experiences outside the conventional curricular model, most students chose the elective to clarify future career decisions. This qualitative descriptive study highlights the influence of highly regarded, free choice clerkship elective experiences in the career decision making process in medical education. Further examination of the details of clerkship elective experiences which influence career choice is recommended.

An AOA Critical Issue Should There Be a Minimal Surgical Experience for a Graduating Orthopaedic Surgery Resident?*

According to the Graduate Medical Education Directory, published by the American Medical Association, “the mission of the Accreditation Council for Graduate Medical Education is to improve health care in the United States by ensuring and improving the quality of graduate medical education experience for physicians in training. The Accreditation Council for Graduate Medical Education establishes national standards for graduate medical education by which it approves and continually assesses educational programs.”1 The Directory also states that “the Accreditation Council for Graduate Medical Education is a separately incorporated organization, responsible for the accreditation of approximately 8,000 allopathic graduate medical education programs. It has five member organizations: the American Board of Medical Specialties, American Hospital Association, American Medical Association, Association of American Medical Colleges, and Council of Medical Specialty Societies. Each member organization nominates four individuals to the Accreditation Council for Graduate Medical Education's Board of Directors. In addition, the Board of Directors includes three public representatives, a resident representative, and the chair of the Residency Review Committee Council. A representative for the federal government and the chair of the Residency Review Committee Resident Council also serve on the Board in a non-voting capacity.”1 The accreditation of graduate medical education programs is carried out by twenty-seven residency review committees. The orthopaedic surgery Residency Review Committee has ten members; nine are appointed for six-year terms each from three organizations (the American Board of Orthopaedic Surgery, the American Medical Association, and the American Academy of Orthopaedic Surgeons), and one resident is selected for a two-year term. Through the accreditation process, the objective of the Accreditation Council for Graduate Medical Education (ACGME) is to assure the public of the high-quality education and training of physicians for improving health care in the United States. It would be implicit in its mandate that, if physician education …

Does recruitment lead to retention? - Rural Clinical School training experiences and subsequent intern choices

The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the School of Medicine, which provides a four-year graduate MB BS program. Students may elect to train in their 3rd and/or 4th year in one of three clinical divisions, namely Central, Southern (both based in Brisbane) or Rural which comprises teaching sites in south west Queensland and central Queensland region. Training must be of an equivalent nature throughout these three divisions, because students all sit the same examinations. Rigorous evaluation of the RCD teaching program underpins the goals of continuing improvement of both education and resources, and is also a key component of the reporting mechanisms linked to ongoing Commonwealth funding. Students' perception of their medical education at the RCD is the major focus of such evaluations in order to assist both educational improvement and required student recruitment. With this in mind, a questionnaire, the 'Year 4 Exit Survey' was developed to evaluate medical student perceptions of their 4th year experience at the RCD. Coupled to this was an analysis of internship choices to evaluate the important related issue of medical graduate retention. The increasing popularity of the RCD has prompted further investigation into the intern placement choice by these students. The provision of a positive medical education experience in a Rural Clinical School might be expected to influence this intern choice to favour a rural location. This preliminary report provides the results of the evaluations by one cohort of year 4 students and explores the relationship between rural undergraduate medical training experiences and subsequent recruitment and retention of junior medical personnel within local rural hospitals. The Year 4 Exit Survey contained 63 questions and was a combination of open-ended and forced answer items. The survey was divided into the following sections: demographics, career interests, experience of rural living, interest in rural medical practice, perceptions of rural communities, perceptions of the RCD, rating of their medical training, the impact of the RCD on their desire to practice medicine in a rural area, their opinions on the most and least valuable study experiences at either site and their suggestions on how that experience might be improved. A final question asked them their choice of internship location and the reasons why they were or were not staying at their present RCD site. Overall there was a high degree of student satisfaction with all aspects of their medical education. However there was a discrepancy between these findings and subsequent internship choices. Reasons for this discrepancy were associated with the students' adverse perceptions of their future workforce environment and professional support. Provision of positive rural training experiences and quality medical education has been shown to increase interest in rural medicine and encourage a desire to pursue a medical career in a rural area. However a quality undergraduate rural medical education does not guarantee immediate transition to rural internship. If the ultimate goal of improving the rural medical workforce is to be achieved, the present high levels of recruitment by the Rural Clinical Schools and their provision of a positive rural training experience must be matched by a supportive clinical workplace environment. Studies are needed to look more closely at the transition period between medical graduate and intern.

Follow the patient: process and outcome evaluation of medical students' educational experiences accompanying outpatients

To instill patient-centred attitudes in medical students, several medical schools in Japan have recently started to offer educational experiences in which medical students accompany outpatients throughout entire visits to hospitals. To evaluate the processes and outcomes of the educational experience of Year 5 medical students accompanying outpatients at Nagoya University Hospital. An integrated, multimethod approach was adopted using a written survey with open-ended questions for students, focus groups with students, and a written evaluation survey for patients. In all, 99 students completed the survey, 19 students participated in 3 focus groups, and 46 patients participated in the evaluation. Many students were sceptical about the objectives of the exercise. We were able to gain insight into student perceptions about facets of the exercise such as the ratio of students to patients and whether or not students should wear white coats. In particular, there was consensus among students about the importance of the debriefing session after the experience. Students achieved different learning outcomes depending on their particular individual experiences. In the student survey, 49% were satisfied with this experience, 6% were dissatisfied, and 43% were neither. In contrast, patients were highly satisfied with the experience (mean score 4.2 out of 5.0 on a Likert scale). Some students expressed concern about being a burden to patients, while many patients reported feeling emotionally supported by being accompanied by students. An integrated approach to programme evaluation, using quantitative and qualitative methods, was useful in the process and outcome evaluation of this new educational experience. The results have been taken into consideration for quality improvement of this curricular element.

Preparation for clinical practice: a survey of medical students’ and graduates’ perceptions of the effectiveness of their medical school curriculum

This paper describes the perceptions of students and graduates of the Hebrew University—Hadassah medical school in Israel regarding the effectiveness of their medical education in preparing them for work in the clinical setting. The six-year curriculum consists of three years of mainly lecture-based Basic Science courses, and three years of clinical education, consisting of clinical clerkship rotations of various lengths. An anonymous questionnaire containing 114 items was distributed to 294 students (in their clinical years) and 500 graduates of the faculty. A total of 371 respondents completed the questionnaire (response rate 49%). Overall 60% of the respondents were generally satisfied with the medical training they received. However, respondents indicated many deficiencies in the curriculum, and in their competences. More than half of the respondents felt that Basic Science courses lacked clinical relevance. Almost 40% of the respondents reported that students were not taught sufficient clinical skills in preparations for clinical practice. At least 50% of the respondents reported that they had not received adequate exposure to 26 out of the 36 important clinical activities and skills during clerkships. Only 33% of the respondents agreed that the fundamental knowledge, skills, attitudes and values that medical students should possess at the time of graduation were made explicitly clear to them. Perspectives of students and graduates were compared. In many questions significantly more graduates tended to rate their learning experience better than students. This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It also stresses the need to integrate better preclinical and clinical studies, and to change to active learning methods. This study demonstrates the necessity of gathering information from students and graduates to evaluate their medical education experience.

The ACGME Residency Review Committee for Diagnostic Radiology: A Resident’s Perspective

In the continually evolving world of American health care, the Accreditation Council for Graduate Medical Education (ACGME) strives to be a leader in health policy, a guarantor of educational quality, and an advocate for resident physicians. The ACGME’s [1] mission statement is as follows: The mission of the ACGME is to improve the quality of health care in the United States by ensuring and improving the quality of graduate medical education experiences for physicians in training. The ACGME establishes national standards for graduate medical education by which it approves and continually assesses educational programs under its aegis.

Simulation Based Medical Education: an opportunity to learn from errors

Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals’ performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals’ performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals’ experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals’ attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals’ performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession—SBME educator—was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.

Effect of Medical Education and Life Experiences on the Cultural Competence of Physicians

Effect of Medical Education and Life Experiences on the Cultural Competence of Physicians

Medical Informatics Education in Bosnia and Herzegovina

Abstract:Medical informatics, as a separate medical discipline, is quickly developing in our country, both in Bosnia and Herzegovina. In our country, medical informatics has been a separate subject for the last ten years with regard to Medical curriculum at the biomedical faculties in Bosnia and Herzegovina. This is in accordance with the project of education related to the Bologna declaration and the project EURO MEDICINA. Last year, the Chair of Medical Informatics of the Medical Faculty in Sarajevo celebrated ten years of its existence.The research was performed using a separate questionnaire patterning data with defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students shows dominant satisfaction with the majority of the parameters that are important for the assessment of the quality and the tuition contents which were evaluated through use of the questionnaire. Education in the field of medical informatics is based on the concept which is used in developed countries, according to the recommendations of the working groups of the European and international association of medical informatics. Theoretical and practical teaching and training performance as a whole is performed by use of the computer equipment, and the final knowledge check of the students is also performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using question sets in the data base which encircled nearly 1500 question combinations. In this paper, the author presents ten years of experience of medical informatics education at biomedical faculties in Bosnia and Herzegovina.

Update for the neurology residents and fellows from the Neurology Residency Review Committee (NRRC).

The Accreditation Council for Graduate Medical Education (ACGME) has the mission of improving the quality of health care in the United States by ensuring and improving the quality of graduate medical education experience for physicians in training. The ACGME oversees 27 Residency Review Committees (RRC), including the Neurology Residency Review Committee (NRRC). Each RRC functions as the ACGME body that accredits specialty training programs. The Neurology RRC is comprised of seven members serving up to 6 years, two members each appointed by American Academy of Neurology, American Board of Professional Neuropsychology (ABPN), and the American Medical Association and a resident member serving 2 years. Two-thirds of the requirements for training programs are defined by the ACGME; the other third are specific to the specialty and defined by the RRC based on input from specialists in that field. The RRC and ACGME accomplish their goals by an in-depth review and subsequent accreditation of …

Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model

Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians’ need to consider culture in the delivery of effective services. To address these issues we investigated predictors of culturally competent actions among a sample of 134 practicing San Diego County physicians. They provided demographic information and completed questions assessing their cultural knowledge, cultural awareness, and culturally competent actions specific to Mexican Americans with diabetes. We then developed a structural cultural competence model. Results indicated that participation in diverse medical education settings and experience in community clinics predicted cultural knowledge. Participation in diverse educational settings, Latino ethnicity, bilingual skills, and cultural knowledge predicted cultural awareness. An internal medicine specialty predicted less cultural awareness. Culturally competent actions were only predicted by cultural awareness. Goodness-of-fit statistics supported the overall model's acceptability. The number of Mexican Americans physicians see in practice did not predict any tested cultural competence dimension. Our model supports a number of conclusions. First, knowledge of cultural factors per se and simple exposure to Mexican Americans in practice do not directly facilitate culturally competent care. Rather, such care is most strongly predicted by recognition that cultural factors and awareness of personal biases are important. Results further support medical education that does not solely focus on basic information about Mexican Americans but also explores provider biases and preconceptions. Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence.