Final Clinical Year Research Articles

Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia.

Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.

Student perspectives of preparedness characteristics for clinical learning within a fully distributed veterinary teaching model.

The transition into the clinical environment is challenging and associated with significant stress and anxiety. This study aimed to examine the perspectives of students on the characteristics important for preparedness for clinical learning and the influence of gender, age, and graduate status on those perspectives. This descriptive, questionnaire-based study of 62 characteristics categorised into six themes was conducted within the Surrey School of Veterinary Medicine completed by 139 students commencing their final clinical year. The Friedman test and post-hoc Wilcoxon signed rank sum test explored for differences in ranking across the themes. Ordinal logistic regression and Mann-Whitney U pairwise comparisons were utilised to investigate for effects of gender, age, and graduate status on theme ranking. There was a significant difference (P <0.05) between medians for themes of preparedness characteristics with comparisons revealing willingness and communication and interaction as the most highly rated characteristics. Knowledge and understanding were viewed as the least important characteristic. Regression and pairwise Mann-Whitney U comparisons confirmed no significant effects (P >0.05) of gender, age or graduate status on student rating of preparedness characteristics. Integrating learning opportunities of those preparedness characteristics in the pre-clinical curriculum may improve students’ preparedness for the clinical environment.

Survey of Institutional Teaching Approaches to Clinical-Year Clinical Pathology Instruction and Comparison with Prior Survey Results.

Teaching approaches to veterinary clinical pathology in the final (clinical) year of veterinary school are often different than those for other specialties. Anecdotally, many schools teach these rotations separately from the routine diagnostic service, but minimal published data are available on this topic or on approaches to teaching and assessment in these rotations. An online survey of 69 veterinary institutions around the world was conducted in 2019. A total of 30 completed surveys were received from 10 countries; 22 completed responses were from North American institutions (73.3%). Survey question categories included information on basic rotations, including microscopy format, personnel involved in instruction, and assessment methods; information on advanced rotations; and challenges and successes with clinical pathology instruction. Data were analyzed and, when appropriate, compared with results from a similar survey conducted in 1997. Formats and content varied greatly among institutions. Several shifts in teaching strategies and rotation format over time were found since the 1997 survey, including increased use of projection microscopy and decreased use of multiheaded microscopy in 2019. More teaching by medical technologists and residents, less teaching by faculty, and a significant increase in the number of students per rotation were seen in 2019 compared with 1997. Several free-text comments referred to challenges related to increasing class size. These data and the comparison with the prior survey highlight common challenges and potential solutions to final-year clinical pathology instruction. Creation of specific, measurable objectives for clinical pathology competence may aid future development and refinement of clinical pathology teaching.

Mental well-being in Sri Lankan medical students: a cross-sectional study

ABSTRACT Preventing burnout and promoting positive mental health among medical students is important. Relevant research is lacking on positive mental health in medical students, particularly in low- and middle-income countries. We conducted a cross-sectional survey of Sri Lankan students enrolled in a five-year medical program. Measures included the Mental Health Continuum-Short Form, Kessler 10 Psychological Distress Scale, and Oldenburg Burnout Inventory. We investigated relationships between year in program, mental health indicators, and academic performance. Three hundred twenty-seven students participated (35% response rate). Most students had moderate positive mental health (64.8%) and severe psychological distress (40.4%). Final year students reported more psychological distress and burnout than first year students. Female students had higher burnout scores than males. In multivariable models, fourth and fifth year students evidenced lower positive mental health than first year students. Mental health indicators were unassociated with academic performance. Overall, distress rates were higher than those reported among students in other countries. Higher burnout and distress may be driven by increased responsibilities in the final clinical years of training. Bolstering positive mental health through positive emotions, meaning, and social connection may minimize burnout and distress, although extracurricular activities require time. Interventions to reduce medical student distress in Sri Lanka are needed.

Validation of the Arabic Version of the Epworth Sleepiness Scale among the Yemeni Medical Students.

The study was conducted with the aim to assess the psychometric measures of an adapted Arabic version of the Epworth Sleepiness Scale (ESS) among medical students at Sana'a University, Yemen. The cross-sectional study targeted 360 students (males: 176; females: 184) from the preclinical 3rd year (N: 197) and the final clinical year (N: 163). Participants self-filled an Arabic and slightly modified version of the 8-item Epworth Sleepiness Scale. Exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were conducted on two equal subsets of the sample (N: 180 each). The PCA yielded a two-dimension model subsequently confirmed by factor analysis. The first dimension was grouped on three items while the second dimension had five items reflecting the respondents' propensity to sleep during “interactive situations” and “sitting and lying,” respectively. The model had an acceptable goodness of fit measures for the overall ESS (CMINDF = 2.362, CFI = 0.91, IFI = 0.92) and acceptable reliability indicators (factor 1 α = 0.65, factor 2 α = 0.62). However, due to weak variance explanation (0.07) of item 6 (sitting and talking) in factor 1, analysis was repeated excluding this item. The 7-item model was also two-dimensional, valid, and reliable. The reliability indicators were acceptable with α = 0.65 for factor 1 (4 items of interactive situations) and 0.62 for factor 2 (3 items of sitting) and overall α = 0.68. Overall, the ESS is a useful tool. Factor analysis produced a two-factor model of 7 items with good validity and reasonable reliability that can be used in diagnosing daytime sleepiness among young Yemeni adults.

Exploring fourth-year students' perceptions of the hidden curriculum of a doctor of veterinary medicine program through written reflections

Introduction: Hidden curriculum (HC) is embedded into interactions and learning opportunities involved with a formal curriculum. The curriculum of US-based Doctor of Veterinary Medicine (DVM) Programs is still understudied. We explored how fourth-year students perceive the HC during their final clinical year in a US-based DVM program. Methods: We used a thematic analysis approach that involved iterative steps of coding and re-coding to explore fourth-year DVM students' perceptions of the HC. We analyzed 182 students' written reflections to a brief reading on HC in veterinary medicine and collected reflections from three cohorts of students during their clinical (4th) year. Results: The three features of the HC (individual development process [IDP], teaching–learning environment [TLE], and communication approaches) were well represented from the coding analysis of fourth-year student reflections. From the three larger features of HC, a total of twenty sub features emerged. The sub features were reported as different frequencies, with the IDP and TLE sub features being reported the most. The different features and sub features of HC are interdependent and further illustrate the complexities of HC. Moreover, findings show that HC is made up of various elements that create a unique HC of DVM programs. Conclusion: Student perceptions of the HC in veterinary settings are diverse and portray many interrelated themes that come together to form a unique HC culture that is supplementary to the formal curriculum of a DVM setting.

Virtual Grand Rounds: A Curricular Model for Translating Evidence-Based Practice From the Classroom to the Clinic

Background and Purpose. The physical therapy profession supports educating physical therapist graduates to use evidence-based practice (EBP) skills in the clinical environment. Educational interventions to teach EBP include a variety of formats, but most focus on changing student and clinician knowledge and skills rather than changing actual clinician behavior. The literature suggests that for clinician behavior to change, educational interventions must be integrated into clinical practice. To describe the restructuring of the ATSU research and EBP curriculum including the development of a course, Virtual Grand Rounds (VGR), that focused on EBP skills and took place during clinical experiences. Method/Model Description and Evaluation. The curriculum and VGR course were designed for students to learn EBP skills, develop tolerance for uncertainty, implement EBP within time demands of the clinic, and use workplace supports. All physical therapy students completed both the Evidence-Based Practice Beliefs (EBPB) scale and the Evidence-Based Practice Implementation (EBPI) scale at program entry and at the end of years 1, 2, and 3 (graduation). Outcomes. A total of 727 EBPB and 719 EBPI surveys were completed and analyzed. Using an analysis of variance with Scheffe post hoc analyses, significant differences (P &lt; .05) were found between the EBPB and EBPI scores for each year of data collection with the exception of a nonsignificant change between year 1 and year 2 (P = .998 and P = .702). The overall EBPI score at graduation indicated that during the final clinical year, students performed each EBP skill somewhere between 1 and 5 times during the clinical experience. Changes in individual question scores indicated increases in students' skills, knowledge, and application throughout all years. Discussion and Conclusion. Evidence-based practice implementation increased throughout the 3 years and was at the highest following the final clinical year when students participated in the newly developed VGR. By situating practice of EBP within the time constraints of the clinical environment, the setting where EBP takes place, students are equipped to move away from the reliance on clinical expertise to evidence-based physical therapy. The development of the VGR course described in this article shifts EBP from an academic exercise in the classroom to an activity imbedded in real clinical practice. Other programs may find this integrated course helpful in removing barriers to EBP and developing graduates equipped to integrate EBP in the clinical environment.

German Language Adaptation of the Kalamazoo Communication Skills Assessment Form (KCSAF): A Multi-Method Study of Two Cohorts of Medical Students

Abstract. This work investigates the German version of the Kalamazoo Communication Skills Assessment Form (KCSAFd) for three assessment methods: students' self-assessment (KCSAFd-self), assessment by standardised patients (KCSAFd-sPat) and video-assessment by trained raters (KCSAFd-video). Videotaped simulated patient consultations of N = 163 medical students from the first ( n = 97) and the final clinical years ( n = 66) were rated using the KCSAFd. Investigating the psychometric properties of the instrument, we found a two factor-construct with interpersonal and conversational competence. All methods showed good internal consistency and acceptable model fit values. Additionally, we found plausible relationships between the three methods and meaningful differences between the two groups of students.

Medical student perceptions of their knowledge and skills in pharmacology in their first and final clinical years.

This article was migrated. The article was marked as recommended. Medical student perceptions of their knowledge and skills in pharmacology in their first and final clinical years were investigated. An online survey investigated qualitative and quantitative data. Resources that the students relied on to support their knowledge in this area included pharmacists and the Australian Medicines Handbook. Suggested areas for curriculum review include having more formal teaching in this area and having more prescribing practice.

Barriers to practicing General Practice in rural areas - Results of a qualitative pre-post-survey about medical students during their final clinical year.

Objective: At the end of the Practical Year (PY), medical students decide on a specialization. Individual motivational factors and barriers play a central role in the choice of the subsequent subject area and the place of establishment (city/country). The aim of this study was to document the barriers of PY students within the General Practice (GP) tertiary elective over time. Methodology: Two guided interviews were conducted with each participant (N=19) as part of qualitative process monitoring – a pre-interview at the start and a post-interview after completion of the PY. Evaluation of the interviews was based on Grounded Theory. Results: 13 barriers could be deduced from the 38 interviews. The most frequently cited barriers were “expected workload”, “recreational opportunities”, “work-life balance” and “compatibility with family”. 13 of the participants were firmly committed to continuing GP training, 12 of whom aspired to opening a practice in a rural area. Another three were considering GP training, three had decided against it after the PY. After the PY, some of the previously anticipated individual barriers were now perceived in a more differentiated manner as a result of practical experience. The barriers “work-life-balance”, “compatibility with family”, “recreational opportunities” and “infrastructure” had been largely eliminated. Conclusion: The PY General Practice Tertiary itself appears to have a positive impact on the individual barriers expressed before the PY. Targeted experience with a PY in General Practice at the end of study seems to be a solution to increase the attractiveness of the subject.

Influences on students\u2019 empathy in medical education: an exploratory interview study with medical students in their third and last year

BackgroundEmpathy is beneficial for patients and physicians. It facilitates treatment and improves physical and psychosocial outcomes. The therapeutic relevance of empathy emphasizes the need to help medical students develop their empathic abilities. Our study aimed to identify factors which promote or hinder the development and expression of empathy in medical students during the course of their studies.MethodsWe interviewed 24 medical students (six male and six female students in their 6th semester as well as six male and six female students in their final clinical year) using semi-structured interviews. The interviews were recorded, transcribed verbatim and analyzed using Braun & Clarke’s thematic analysis.ResultsWe identified four main themes influencing the development and expression of empathy. 1) Course of studies: hands-on-experience, role models, science and theory, and emphasis on the importance of empathy; 2) students: insecurities and lack of routine, increasing professionalism, previous work experiences, professional distance, mood, maturity, and personal level of empathy; 3) patients: “easy” and “difficult” patients including their state of health; and 4) surrounding conditions: time pressure/stress, work environment, and job dissatisfaction.ConclusionsThe development and use of empathy could be promoted by increasing: hands-on-experiences, possibilities to experience the patient’s point of view and offering patient contact early in the curriculum. Students need support in reflecting on their actions, behavior and experiences with patients. Instructors need time and opportunities to reflect on their own communication with and treatment of patients, on their teaching behavior, and on their function as role models for treating patients empathically and preventing stress. Practical experiences should be made less stressful for students. The current changes implemented in some medical school curriculums (e.g., in Germany) seem to go in the right direction by integrating patient contact early on in the curriculum and focusing more on teaching adequate communication and interaction behaviors.

Experience and confidence of final year veterinary students in performing desexing surgeries

AIMS: To describe the level of experience and confidence of veterinary students in performing canine and feline desexing procedures at the end of their final clinical year.METHOD: A cross-sectional survey was conducted with veterinary students at Massey University in November 2017 after completion of their final clinical year. The questions included career plans after graduation, number of assisted and unassisted desexing procedures performed, approximate time to complete desexing surgeries, level of confidence with different aspects of desexing surgeries, what aspects of their desexing surgery training were most helpful, and what could be done to improve training in desexing surgical skills in veterinary school.RESULTS: The survey was completed by 70/95 (74%) students in their final clinical year. Among respondents, 55/70 (70%) had performed >2 unassisted feline neuters before graduation. However 38/70 (54%) students had never performed an unassisted feline spay, 31/70 (44%) had never performed an unassisted canine neuter, and 44/70 (63%) students had never performed an unassisted canine spay. The median reported times to complete a feline neuter, feline spay, canine neuter, and canine spay were 9, 40, 30 and 60 minutes, respectively. The median level of confidence for these procedures were 9, 6, 7 and 5 (on a scale from 1=least confident to 10=most confident), respectively. The reported time to complete procedures and the confidence in performing procedures did not change markedly with increasing total number of procedures performed. Students were most concerned about their ability to perform the desexing procedures in a reasonable amount of time and to prevent post-operative bleeding from occurring. Students were least concerned with their ability to manage post-operative pain in patients and to select the appropriate suture material. Free-text comments revealed that 62/70 (89%) students wanted more hands-on surgical experience prior to graduation.CONCLUSION AND CLINICAL RELEVENCE: Many students are currently completing veterinary school with limited experience and low confidence with performing routine canine and feline desexing procedures. Further research is needed to identify the most effective ways for addressing this issue within the constraints of the veterinary curriculum and teaching hospital resources.

PTH-132 Medical Students’ Perception of Nutrition Education at An Undergraduate Level and The Role of The Clinicians They Shadow

Introduction Medical schools have neglected nutrition training in undergraduate courses, resulting in medical students being unsure of its importance1 and doctors not confident in managing nutrition-related problems.2 The aim of this study was to explore medical students’ views and experiences of nutrition training at different stages of their training and to evaluate the impact of the views of the clinicians they shadowed. Methods A cross-sectional email survey of all medical students in the first (T) and final (F) clinical years at St. George’s University of London was conducted. Clinicians at St. George’s hospital were surveyed with a 10 item questionnaire. Data were analysed using SPSS version 21.0 and the significance determined using a 2 tailed Fischer’s exact test. Results The overall student response rate was 106/549 (19.3%) with no significant difference between the 2 year groups. 86/~500 clinicians responded. 75% of students agreed that ‘having a strong understanding of nutrition is an important aspect of a doctor’s job’. Of those that disagreed, 57% cited as a reason that ‘other members of the healthcare team deal with nutrition problems’. 71% of students agreed that ‘nutrition should be included in the undergraduate medical curriculum’. The only students to disagree were from F year (12% vs 0%, p = 0.016) and 36% of them cited as a reason that their ‘medical school timetable is too full’. Only 11% of students had had the importance of nutrition highlighted to them by a senior clinician ‘regularly’. This group were more likely to ‘strongly agree’ with the statements above than those who had not (24% vs 3%, P = 0.02 and 21% vs 6%, P = 0.039). However, only 17% of clinicians frequently emphasised the importance of nutrition problems and only 7% frequently emphasised the importance of nutrition screening tools to students. The most commonly cited reason for clinicians not emphasising these was ‘it does not occur to me’ Only 50% of clinicians said they were confident managing nutrition related problems and for the majority (63.4%) of confident clinicians, it took greater than one year as a doctor to achieve this confidence. Conclusion It appears that whilst senior clinicians do have an impact on how students perceive the importance of nutrition, they do not emphasise it enough and; this may be due to themselves viewing it as a low priority or a lack of confidence. The greater likelihood of F year students disagreeing with nutrition’s inclusion in the curriculum may result from increased time spent on clinical placements compared with T year students, allowing their perception of nutrition to be negatively influenced by the clinicians they shadowed. References 1 Tripisciano F, Neild P. Proceedings of the Nutrition Society. 2010;69(0CE2). 2 Nightingale JM, et al. Clin Nutr. 1999;18(1):23–27. Disclosure of Interest None Declared

Preparation courses for medical clerkships and the final clinical internship in medical education - The Magdeburg Curriculum for Healthcare Competence.

Background/Goals: Supporting medical students entering their internships – the clinical clerkship and the internship “final clinical year” (Praktisches Jahr, PJ) – the seminars “Ready for Clerkship” and “Ready for PJ” were held for the first time in 2014 and continued successfully in 2015. These seminars are part of the “Magdeburg Curriculum for Healthcare Competence” (Magdeburger Curriculum zur Versorgungskompetenz, MCV). The concept comprises three main issues: “Understanding interdisciplinary clinical procedures”, “Interprofessional collaboration”, and “Individual cases and their reference to the system.” The aim of the seminar series is to prepare students as medical trainees for their role in the practice-oriented clinical clerkship and PJ, respectively.Methods: Quality assurance evaluations and didactic research are integral parts of the seminars. In preparation for the “Ready for PJ” seminar a needs assessment was conducted. The seminars were rated by the participants using an anonymized questionnaire consisting of a 5-choice Likert scale (ranging from 1=fully agree to 5=fully disagree) and spaces for comments that was generated by the evaluation software Evasys.Results: The results are presented for the preparatory seminars “Ready for Clerkship” and “Fit für PJ” held in 2014 and 2015. Overall, the students regarded the facultative courses as very good preparation for the clerkship as well as for the PJ. The three-dimensional main curricular concept of the MCV was recognized in the evaluation as a valuable educational approach. Interprofessional collaboration, taught by instructors focussing in teamwork between disciplines, was scored positively and highly valued.Conclusions: The “Magdeburg Curriculum for Healthcare Competence” (MCV) integrates clerkship and PJ in a framing educational concept and allows students a better appreciation of their role in patient care and the tasks that they will face. The MCV concept can be utilized in other practice-oriented phases (nursing internship, bed-side teaching, block internships).

Factors affecting the specialty choice of medical students at king Abdulaziz University in Jeddah, Saudi Arabia

Background: Little is known about the factors that influence the choice of medical specialty by male and female senior medical students at King Abdulaziz University in Jeddah so this study was conducted to investigate these factors . Methods: In this cross sectional study, data was collected through a questionnaire that was adapted to the Saudi culture from. It was distributed to three hundred male and female medical students in their sixth year and the response rate was 79.6%. Data analysis was carried out by using the Statistical Package for the Social Science (SPSS) version during the years 2013-2014. The percentages and the significances of the most and the least factors that influence the choice of medical specialties by the sample of the study were computed. Results: Study showed that 91 out of 121 senior male students and 88 senior female students out of 118 agreed that joining medical school was their first interest. Results illustrated that helping patients is the most considerable reason to choose medicine by the majority of the students (93% of senior male students and 91% of senior female students) whereas family enforcement was the least influential reason to choose medicine (28% of senior male students and 23% of senior female students). Internal medicine was chosen by the majority of the sample of the study as their first interest after graduating from medical school (43 male and female senior students). While only one male medical student chose community medicine . Conclusions: Medicine was the first choice for the majority of both male and female medical students who entered university. Internal medicine was the most desirable specialty following graduation. Most of the graduates have no plan in pursuing a career in general practice. It is advocated to establish a career advising committee at KAU. The committee should focus on medical students during their final clinical years. The lack of physicians in some specialties and its effect on the community should be addressed.

Identifying the influence of gender on motivation and engagement levels in student physiotherapists

Background: There is an increasing focus in higher education on the role of learner characteristics and their influence on academic performance. Educators are interested in how students engage with learning activities as they progress through the curriculum. A previous study highlighted gender effects in academic performance in student physiotherapists, despite comparable entry scores.Aims: The aim of this study was to determine variation in student motivation and engagement, across the four year levels of the physiotherapy program at The University of Notre Dame Australia while considering gender and age.Methods: A cross-sectional design was adopted surveying 233 students utilising the Motivation and Engagement Scale – University/College (MES-UC), to review motivational thoughts and behaviours influencing learning.Results: Results identified gender effects with males having on average significantly lower scores for planning, task management and persistence; and higher scores for disengagement from their studies. Females displayed higher average scores for anxiety particularly in their first year and final clinical year. Results were consistent with gender effects noted in academic performance throughout the program for previous student cohorts.Conclusions: The application of the MES-UC early in course would highlight to educators the areas where intervention can be targeted. Early individualized intervention is recommended to address learner characteristics influencing performance.

Initiatives to Improve Feedback Culture in the Final Year of a Veterinary Program

Despite the recognized importance of feedback in education, student satisfaction with the feedback process in medical and veterinary programs is often disappointing. We undertook various initiatives to try to improve the feedback culture in the final clinical year of the veterinary program at the University of Bristol, focusing on formative verbal feedback. The initiatives included E-mailed guidelines to staff and students, a faculty development workshop, and a reflective portfolio task for students. Following these initiatives, staff and students were surveyed regarding their perceptions of formative feedback in clinical rotations, and focus groups were held to further explore issues. The amount of feedback appeared to have increased, along with improved recognition of feedback by students and increased staff confidence and competence in the process. Other themes that emerged included inconsistencies in feedback among staff and between rotations; difficulties with giving verbal feedback to students, particularly when it relates to professionalism; the consequences of feedback for both staff and students; changes and challenges in students' feedback-seeking behavior; and the difficulties in providing accurate, personal end-of-rotation assessments. This project has helped improve the feedback culture within our clinics; the importance of sustaining and further developing the feedback culture is discussed in this article.

Superficial and deep learning approaches among medical students in an interdisciplinary integrated curriculum.

Students' learning approaches have a significant impact on the success of the educational experience, and a mismatch between instructional methods and the learning approach is very likely to create an obstacle to learning. Educational institutes' understanding of students' learning approaches allows those institutes to introduce changes in their curriculum content, instructional format, and assessment methods that will allow students to adopt deep learning techniques and critical thinking. The objective of this study was to determine and compare learning approaches among medical students following an interdisciplinary integrated curriculum. This was a cross-sectional study in which an electronic questionnaire using the Biggs two-factor Study Process Questionnaire (SPQ) with 20 questions was administered. Of a total of 402 students at the medical school, 214 (53.2%) completed the questionnaire. There was a significant difference in the mean score of superficial approach, motive and strategy between students in the six medical school years. However, no significant difference was observed in the mean score of deep approach, motive and strategy. The mean score for years 1 and 2 showed a significantly higher surface approach, surface motive and surface strategy when compared with students in years 4-6 in medical school. The superficial approach to learning was mostly preferred among first and second year medical students, and the least preferred among students in the final clinical years. These results may be useful in creating future teaching, learning and assessment strategies aiming to enhance a deep learning approach among medical students. Future studies are needed to investigate the reason for the preferred superficial approach among medical students in their early years of study.

Evaluation eines strukturierten Prüfungsvorbereitungsprogramms für das 2. Staatsexamen (M2) nach Neuer Ärztlicher Approbationsordnung: Eine quantitative Analyse

The implementation of the amendment to the German medical licensing regulations ("Approbationsordnung") in 2002 led to a reduction in the number of state examinations from four to two exams, with the date of the second state exam being shifted to the end of the final clinical year. Students now face a double burden: on the one hand, they need to get ready for their future job, and on the other hand, they need to prepare for the state exam. This is why the Medical Faculty of Heidelberg introduced a preparation programme for the second state exam. The focus of this study was to evaluate the acceptance of the different modules of this programme and to compare the results against each other. 39 students (15 male / 24 female; mean age 26.6 ± 1.9 years) took part in the exam preparation programme at the Medical University Hospital Heidelberg. Five different modules were implemented: an informational meeting, a key-feature written exam, case-based multiple-choice exams, a simulated practical examination and a simulated oral examination. Acceptance was measured using a six-point Likert scale (1=very good, 6=unsatisfactory and 1=I completely agree, 6=I completely disagree, respectively) The exam preparation programme as a whole was rated good: overall rating key-feature written exam 3.33 ± 1.17; case-based multiple-choice exams 2.61 ± 1.61; simulated practical exam 1.61 ± 0.54; simulated oral exam 1.55 ± 0.50. A comparison of the different modules demonstrated significantly better ratings for the practical and oral examinations than the case-based multiple-choice exams (p<0.001). The presented exam preparation programme is well accepted and facilitates the preparation for the second state exam, particularly with regard to the oral-practical examination.

Teaching Veterinary Obstetrics Using Three-Dimensional Animation Technology

In this three-year study, test scores for students taught veterinary obstetrics in a classroom setting with either traditional media (photographs, text, and two-dimensional graphical presentations) were compared with those for students taught by incorporating three-dimensional (3D) media (linear animations and interactive QuickTime Virtual Reality models) into the classroom lectures. Incorporation of the 3D animations and interactive models significantly increased students' scores on essay questions designed to assess their comprehension of the subject matter. This approach to education may help to better prepare students for dealing with obstetrical cases during their final clinical year and after graduation.