Final Clinical Year Research Articles

Henry Jeffray Weston

Henry Jeffray Weston—known by family, friends, and colleagues as “Jeff”—was born on 9 September 1926 in New Plymouth, New Zealand, where his father was a newspaper proprietor. He studied medicine...

Undergraduate medical education in Germany.

The purpose of this article is to give international readers an overview of the organisation, structure and curriculum, together with important advances and problems, of undergraduate medical education in Germany. Interest in medical education in Germany has been relatively low but has gained momentum with the new "Regulation of the Licensing of Doctors" which came into effect in 2003. Medical education had required substantial reform, particularly with respect to improving the links between theoretical and clinical teaching and the extension of interdisciplinary and topic-related instruction. It takes six years and three months to complete the curriculum and training is divided into three sections: basic science (2 years), clinical science (3 years) and final clinical year. While the reorganisation of graduate medical education required by the new "Regulation of the Licensing of Doctors" has stimulated multiple excellent teaching projects, there is evidence that some of the stipulated changes have not been implemented. Indeed, whether the medical schools have complied with this regulation and its overall success remains to be assessed systematically. Mandatory external accreditation and periodic reaccreditation of medical faculties need to be established in Germany.

Veterinarians and Public Practice at the Virginia–Maryland Regional College of Veterinary Medicine: Building on a Tradition of Expertise and Partnership

The Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM), a regional veterinary college for Maryland and Virginia, has a long and unique tradition of encouraging careers in public and corporate veterinary medicine. The VMRCVM is home to the Center for Public and Corporate Veterinary Medicine (CPCVM), and each year approximately 10% of the veterinary students choose the public/corporate veterinary medicine track. The faculty of the CPCVM, and their many partners from the veterinary public practice community, teach in the veterinary curriculum and provide opportunities for students locally, nationally, and internationally during summers and the final clinical year. Graduates of the program work for government organizations, including the US Department of Agriculture, the Food and Drug Administration, and the Centers for Disease Control and Prevention, as well as in research, in industry, and for non-governmental organizations. Recent activities include securing opportunities for students, providing career counseling for graduate veterinarians interested in making a career transition, delivering continuing education, and offering a preparatory course for veterinarians sitting the board examination for the American College of Veterinary Preventive Medicine. As the VMRCVM moves forward in recognition of the changing needs of the veterinary profession, it draws on its tradition of partnership and capitalizes on the excellence of its existing program. Future plans for the CPCVM include possible expansion in the fields of public health, public policy, international veterinary medicine, organizational leadership, and the One Health initiative. Quality assurance and evaluation of the program is ongoing, with recognition that novel evaluation approaches will be useful and informative.

Student Occupational Exposure Incidence: Perception Versus Reality

Reports of clinical injuries made to a dental school Office of Occupational Health and Safety at the time of their occurrence were compared to self-reports on a survey for dental students in five classes at various times over their educational careers. The majority of injuries were from needlesticks and mishaps with hand instruments. Underreporting at the time of injury was approximately one-third in the first clinical year and one-half in the final clinical year of the three-year program. Students reported a greater perceived likelihood of injury later in their education than at the beginning but a decreased fear of such injuries. Female students reported more needlesticks and a greater fear of injury than did male students. It is hypothesized that a personal interpretation of the meaning of clinical injuries influences reporting behavior.

Microteaching and standardized students support faculty development for clinical teaching.

If faculty development programs are to have impact, we believe they should be made up of several self-reinforcing workshops that provide opportunities for behavior review, practice, reflection, and reinforcement within a context of interdisciplinary perspectives. A program was developed that supports these four activities and includes clinical faculty from medicine, dentistry, nursing, and pharmacy. At the University of Illinois at Chicago we have focused our efforts to improve clinical teaching through a program of two parallel courses. One course focuses on the "one-minute teacher" approach to clinical teaching. We call this course "Teaching-on-the-Fly," reflecting what many of our faculty attendees have suggested they do. The second course is "Feedback Strategies." The two courses are identical in format, which is a series of three three-to-four-hour small-group workshops of not more than eight participants. The first two workshops in each series are titled "Teaching-on-the-Fly I and II" and "Feedback Strategies I and II," respectively. Workshop I is separated from Workshop II by two weeks. During this hiatus faculty are urged to practice the skills learned and to reflect on what worked and what did not work in Workshop I. Six months following both series' Workshop II, "Advanced Teaching-on-the-Fly" and "Advanced Feedback Strategies" workshops are held. Each workshop begins with videotaping of two separate teaching encounters in which each participant interacts with standardized students. Standardized student and clinical faculty interactions are meant to mimic typical teaching and feedback situations. Teaching encounters are limited to five minutes, maximizing the similarity to the stress and frenetic quality of many of today's clinical settings. In Workshop II and in the advanced workshops the standardized students offer one positive comment to the faculty immediately following their encounter. Students are taught how to give this feedback. Immediately after videotaping, faculty adjourn to a small-group discussion. Workshops consist of reflective discussions during the review of each participant's videotape, brief lectures, and responsive comments and instruction by the workshop leaders. Participants are asked to reflect on each workshop and to bring examples of problems and opportunities gained to succeeding workshops in the series. Several theories support these clinical teaching workshops. (1) Outcomes research in continuing medical education suggests the need for ongoing reinforcement, which we do structurally through the three-session model. (2) We use a classical microteaching approach to develop insight and self-awareness. Each videotaped encounter is reviewed, stopped at key points, and discussed by the entire group. These discussions commonly open up after the workshop leaders ask questions such as, "What were you thinking there?" or "What were you trying to do?" or "What would you ask next?" (3) We emphasize the importance of knowing-in-action and the related reflection that guides action in practice. (4) The quality of the workshops is enhanced using standardized students, whom we carefully train and use repeatedly. At least two students have worked with us from their first years through their final clinical years. We are currently examining the program's impact through videotape review.

Preliminary Evidence for a General Competency Hypothesis

Although predoctoral dental education is generally taught and evaluated by disciplines, there is no evidence bearing on whether the competencies necessary to begin independent practice are learned and practiced as a general set of skills, understanding, and values or as groups of discipline-specific skills, understanding, and values, which together constitute graduation competency. There is some support in the literature for each view In this preliminary investigation, 64,000 faculty ratings of student clinical competency were analyzed in a Year x Quarter x Discipline x Model design. The dependent variable was predictive validity of graduation quarter competency ratings using R-values from four prediction models. Results of a multiple repeated measures ANOVA show that models based on technical skills other than the one being predicted, clinical judgment and patient management, and the combination of these two models all predict graduation competency in each of four disciplines better than do ratings in the disciplines being predicted. As the time gap between predictive and predicted competence decreases, predictions become more accurate, but an asymptote is reached by the middle of the final clinical year. By using general models to evaluate students rather than discipline-specific ones, students needing intervention and remediation and those who could benefit from enrichment experiences can be identified as accurately at the beginning of their clinical careers as they can near the graduation deadline. This study provides preliminary support for a general competency hypothesis and suggests that research is necessary to better understand how students and dentists learn and practice rather than how they are taught.

Developing a database to describe the practice patterns of adult nurse practitioner students.

To describe the practice patterns of adult nurse practitioner students using a database composed of core health data elements and standardized nursing language. Descriptive study of 3,733 patient visits documented by 19 adult nurse practitioner students in the academic year 1996-1997. A database was designed for documenting the full scope of practice of adult nurse practitioner students by use of core health data elements and the standardized nursing languages of NANDA and NIC. Nurse practitioner students used the database to document every clinical encounter during their final clinical year of study. Most visits occurred in ambulatory care settings in a midwestern American city. Based on the American Medical Association's Evaluation/Management coding system, data indicated that 50% of visits were classified as problem focused, while 31.9% were expanded, 10% were detailed, and 8.1% were comprehensive. The most frequently occurring NANDA diagnoses were pain, health-seeking behavior, altered health maintenance, and knowledge deficit. The most frequently reported nursing intervention classifications (NIC) were patient education, drug management, information management, and risk management. Using standardized nursing language to describe clinical encounters made visible the complex clinical decision-making patterns of adult nurse practitioner students. Systematic use of a database designed for documenting the full scope of practice of nurse practitioner students showed the applicability of standardized nursing language to advanced practice nursing contexts.

Knowledge, attitudes and preventive efforts of Malaysian medical students regarding exposure to environmental tobacco and cigarette smoking

A longitudinal study was conducted to determine changes in knowledge, attitudes and preventive efforts of Malaysian medical students concerning cigarette smoking and environmental exposure to tobacco smoke from their first pre-clinical year in medical school until their final clinical year. There were significant improvements in knowledge about cigarette smoking and in knowledge, attitudes and efforts concerning environmental exposure to tobacco smoke. Overall attitudes concerning cigarette smoking did not change over this period. The same pattern was found for male non-smokers. Women improved on all five scales; male smokers improved on none over the 3-year period.Male non-smokers had better scores on these scales than male smokers in both beginning and ending years. Women excelled in comparison to male non-smokers on smoking attitudes in the pre-clinical year and on all scales except preventive efforts in the final clinical year.Although medical students experienced no changes in the amount of pressures not to smoke from family and friends, there was a significant increase in the amount of prohibition on smoking from their teachers. Male non-smokers alone accounted for this increase.Women experienced more pressure than men not to smoke from their teachers in both years, but the male smokers and non-smokers did not differ in teacher pressure for either year.

Clinical experience, performance in final examinations, and learning style in medical students: prospective study

Objective: To assess whether the clinical experience of undergraduate medical students relates to their performance in final examinations and whether learning styles relate either to final examination performance or to...

The role of the Skills Laboratory in the integrated curriculum of the Faculty of Medicine and Health Sciences, UAE University

The old curriculum of the Faculty of Medicine and Health Sciences (FMHS), which was recently revised, still applies to the 1989 student intake. It comprises 2 preparatory years, 3 medical years and 2 final clinical years. Clinical teaching is introduced from the first medical year. Clinical skills are first learned in the Skills Laboratory (SKL), using simulations, before application to real patients. The SKL role is primarily knowledge consolidation, motivation and integration. A formative objective structured clinical examination (OSCE) was recently introduced as a teaching tool. Weaknesses of clinical skills were identified. Tutors' feedback and guidance resulted in a significant improvement of students' performance and helped standardize procedures. It was concluded that the SKL is a useful clinical teaching setting, especially when clinical teaching is introduced early in the curriculum. It provides both horizontal and longitudinal integration through a motivating curriculum. The formative OSCE was a...

The changing clinical experience of British medical students

The UK National Health Service is undergoing fundamental reforms, which might have a detrimental effect on the training of doctors, not least with respect to the amount of clinical experience that medical students get. We compared the practical experience gained by two cohorts of students at medical schools throughout the UK, who had started their training in 1981 or 1986. The assessment was made by questionnaire at the end of their final clinical year. Experience of acute medical conditions, surgical operations, and practical procedures differed significantly between groups of medical schools, and showed a significant decline in the past five years. This decline in the clinical experience of medical students has coincided with the introduction of the health service reforms. We suspect that the university-based clinical education designed for a lifetime of change is in danger of being replaced by a dispersed clinical apprenticeship for current practice.

European Undergraduate Education in Oncology: A report of the EORTC Education Branch

By the year 2000 it is estimated that approximately two million Europeans per year will be afflicted by cancer and that the annual death rate will be of the order of one million. Despite the numerical extent of the problem, the high mortality and the very considerable morbidity associated with uncontrolled cancer, it is the general view of experts in the field that the teaching of oncology to undergraduates remains extremely unsatisfactory in many medical schools. In recent years there has been substantial progress in cancer research and in the management of cancer patients due to developments in diagnosis and treatment. It is clear that, with available knowledge and technology, screening programmes designed to detect cancers at an earlier stage and programmes of public education aimed at prevention could substantially contribute to a reduction of our present cancer problem. If the newly-qualified doctor is to be provided with the necessary knowledge and skills to participate as a nonspecialist in the prevention, early diagnosis and management of malignant disease, it is essential that attention is focused on the development of a satisfactory curriculum for undergraduate education. The problem of an integrated undergraduate oncology training programme in Europe was reviewed by a UICC Regional Conference in Oncology held in Cracow in 1972 (1) and subsequently by a UICC/WHO meeting in 1981 (2). The objective of the Education Branch of the EORTC is to identify requirements for cancer education in Europe at both the undergraduate and postgraduate level. The Education Branch, which was set up in 1986, has directed its attention initially to the problem of undergraduate oncology education and, as a basis for making recommendations, in 1987 carried out a survey by questioning 165 deans of medical schools in Europe. Of 124 responses received by July 1987, 94 were considered valid, since 30 were either double-registered from the same university or did not concern undergraduate education. The information obtained from 94 medical schools in 14 countries (UK, France, Netherlands, Italy, Germany, Spain, Denmark, Belgium, Portugal, Ireland, Switzerland, Greece, Iceland, Sweden) is summarized in Fig. 1. As shown, approximately 60% of the centres have a course in oncology and a chair in oncology. In some institutions the courses were of a very short duration whereas optional in others. Only 41% of schools reported that they had a curriculum in oncology. Less than 50% had a pre-degree training period (that is a specific allocation of time for oncology in the final clinical year). Only one-third of the schools had an examination in oncology. It is of interest to examine the schools’ preferences for the future evolution of undergraduate education in ontology. Of the universities without corresponding facilities, 86% indicated that they would like a specific course in oncology, 81 % a chair in oncology, and 70 % a curriculum in oncology. A common European curriculum would be favoured by 95 % of all universities (Fig. 2). A striking finding of the inquiry was the wide variation in educational practice between different universities in the same country (Table). Approximately only 50 % of the medical schools in the United Kingdom, Germany, Spain and Denmark, for example, had courses in oncology. There were also substantial differences between individual countries. Thus all 16 French medical schools responding to the inquiry reported a course in oncology, whereas none of the 12 Italian medical schools had such a course. However, the Italian Government has recently approved