Small Group Seminars Research Articles

Prevention of weight gain in young adults through a seminar-based intervention program

Prevention would be the ideal public health strategy to face the current obesity epidemic. Adoption of healthy lifestyles during the first years of college or university could prevent the onset of weight gain associated with this period of acquired independence and eventually decrease the incidence of obesity. Randomized-controlled trial over a period of 2 years. The subjects received an educational/behavioral intervention (small group seminars) designed to help maintain a healthy lifestyle or no specific intervention (control group). One-hundred and fifteen non-obese freshmen in a Faculty of Medicine. Anthropometric measurements, physical activity level, fitness level, food intake and lipid profile were recorded at predetermined intervals. The control group gained weight, whereas the intervention group lost a slight amount of weight over 2 years. The difference between the two groups was 1.3 kg at the end of the follow-up, the trend of weight gain differing between the two groups during the 2-year intervention period (P=0.04). There was no detectable difference in fitness, physical activity level or total caloric intake between the two groups during follow-up. However, plasma triglyceride levels increased in the control group and decreased in the intervention group (P=0.04). In this randomized-controlled trial, a small-group seminar educational/behavioral intervention successfully prevents weight gain in normal weight young healthy university students. Such small absolute changes in body composition and lipid profile, if maintained over a prolonged period, could result in significant long-term health benefits for the general population.

Long‐term effects of an educational intervention on self‐medication and appropriate drug use in single‐sex secondary public schools, Quito, Ecuador

*Self-medication is extensively practised in both developed and less-developed countries, sometimes inappropriately. *Educational intervention in secondary schools has been proven to be useful. *Most educational interventions in adolescent populations have focused on the reduction of addictive substance abuse. *Educational intervention can improve knowledge about self-medication and reduce misconceptions about diarrhoea, common cold and vitamins in an adolescent population. *A specific lecture followed by small working-group seminars produces better results than a general lecture alone in terms of 'knowledge' and 'attitude'. *The positive effects of the intervention are detectable even 1 year later. Yearly reinforcing interventions while in secondary school would allow long-lasting effects. Improving knowledge about rational drug use at an early age may be a good way to increase the population's awareness of health, medicines and self-medication. We set out to evaluate the short- and long-term effects of an educational intervention to promote rational drug use and self-medication in secondary school students. A non-randomized, controlled clinical trial. The participants were 367 female students (10-13 years old) from two secondary public schools of the metropolitan district of Quito (Ecuador). The educational campaign had two components [a specific lecture (intervention and control schools) and subsequent small working group seminars (intervention school)] providing short and clear messages of five topics related to rational drug use. The main outcome measures were an increase in 'knowledge' short term (1 month) and long term (up to 1 year) after intervention and the relative risk (RR) reduction in misconceptions or wrong ideas about medicine use. The intervention group showed a significant increase in knowledge both short and long term and in comparison with the control group, mainly regarding oral rehydration salts preparation (+59.4%; P < 0.001), lack of multivitamin energizer action (+57.4%; P < 0.001), healthy growth effects (+53.3%; P < 0.001) and the perception that medicines' promotional activities do not teach how to take care of health (+54.0%; P < 0.001). A RR reduction in misconceptions about drugs was found short term and long term. The intervention group was less predisposed to consume antidiarrhoeals [RR = 0.75, 95% confidence interval (CI) 0.62, 0.92], cough suppressants (0.44, 95% CI 0.35, 0.55) and other medicines for the common cold (0.56, 95% CI 0.45, 0.70). Misconceptions concerning the benefits of multivitamin preparations were reduced in 73%; additionally, the intervention group showed a decrease in their consumption (43.9% basal; 25.3% short term and 25.6% long term; P < 0.001). It is possible to achieve a favourable modification of attitudes to appropriate use of medicines in a teenage population and this modification lasts at least 1 year. Continuous reinforcing interventions would allow better and long-lasting effects and could help to fill the gap in health education of the general population.

Acceptability and perceived effectiveness of web-based self-instruction in clinical orthodontics

For a predoctoral course in advanced clinical orthodontics, we evaluated the acceptability to students (how well did you like it?) and the perceived effectiveness (how well did it help you learn?) of Web-based self-instruction plus small-group seminars. On a 10-point Likert scale, median scores for acceptability and effectiveness of the self-instructional modules and seminars were nine. More than half the students rated the modules as excellent, and two-thirds rated the seminars as excellent. No students rated either the modules or the seminars as poor. With the use of structured seminar outlines, there were no significant differences in seminar scores among the seminar leaders. Compared with their predecessors who had a traditional lecture course, students who had the new self-instructional course were less likely to report either the positive or negative extremes in confidence about their ability to recognize treatment alternatives for orthodontic problems. The results indicate that Web-based self-instruction plus small-group seminars coordinated by a course leader is at least as effective as traditional lectures. This approach offers a possible way to share faculty among orthodontic departments for both pre- and postdoctoral education, as a way to help overcome faculty shortages.

Teaching and Assessing Professionalism in Medicine

Professionalism is the single most important of the clinical competencies. Lack of professional behavior, in turn, is the single most common cause for disciplinary action against third and fourth-year medical students, residents, fellows, and clinical practitioners. Desirable professional attributes include humility, honesty, responsibility, reliability, and accountability. The ability to preserve an appropriate balance between patient care responsibilities and personal commitments also is an important feature of professional behavior. Altruism, respectfulness, loyalty, compassion, sensitivity, and tactfulness are other desirable professional attributes. In addition, professionalism requires a heightened sense of intellectual curiosity, insight into personal strengths and weaknesses, maturity, and commitment to clinical excellence and self-directed learning. Professionalism can be taught and assessed through lectures, small-group seminars, role-playing exercises, directed reading, and one-on-one observation and counseling. However, the most effective way of teaching professionalism is for instructors to model appropriate behavior and to impose a consistent policy of zero tolerance for unprofessional behavior.

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study

BackgroundLittle data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.MethodsThroughout the academic year 2001–2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating.ResultsThere was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064).ConclusionThe results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.

Teaching interdisciplinary geriatrics team care.

Addressing the current fragmentation and lack of coordination of health care requires that health professionals be skilled and motivated towards interdisciplinary team care. The objectives of our program are to (1) enhance attitudes towards team health care and (2) improve group interaction skills among interdisciplinary health care learners. We nested an educational intervention focusing on skills and attitudes in interdisciplinary team care within a one-month rotation in an interdisciplinary geriatrics clinic. One day each week, a morning is devoted to small-group seminars, and learners participate as members of an interdisciplinary geriatrics clinical team in the afternoon. Learners are from four disciplines and include an internal medicine resident, a nurse practitioner, a social worker, and pharmacy students. During the small-group seminars, eight hours are spent focusing on team care through facilitated discussions with assigned readings that include (1) motivational information and personal stories regarding the fragmented nature of current health care and personal attitudes and experiences with team care (2 hours), (2) a review of selected effective group communication skills (e.g., querying another learner about reasoning behind a statement before responding with a counter-opinion) (one hour), (3) case studies with team care planning and debriefing on group process behaviors (four hours), and (4) exploration of the potential relevance of team care to learners' own career paths (1 hour). The remaining seminars are devoted to topics in clinical geriatrics and managed care, and to reviewing patient files for the afternoon clinic. In the interdisciplinary clinic, learners spend an additional 18 hours seeing patients with a team that includes faculty from each of the four disciplines. Patients are seen jointly, and care plans are developed and implemented collaboratively. The primary outcome measures are pre- and post-rotation attitudes regarding interdisciplinary team care. Concurrent controls who do not participate in the program are also assessed. Additional measures include faculty observation of communication behaviors, review of written interdisciplinary care plans, and learner perceptions of the value of the rotation. After a one-year planning and pilot period, the educational program is now in its third month of operation. Previous team-care training programs for health professionals have demonstrated difficulty in fostering effective attitudes and skills. During the planning and pilot year, we identified barriers to success that included (1) negative baseline attitudes toward interdisciplinary team care, especially among medical residents, (2) unrecognized assumptions and behaviors by learners regarding authority and power relationships within the team, and (3) specific concerns by learners regarding the effectiveness and efficiency of health care teams. We hope to demonstrate success through a program that includes direct examination of learners' attitudes and their origins in a safe environment, immediate feedback regarding group behaviors, case-based learning, and direct role exposure to a well-functioning interdisciplinary team.

Improving residents' interviewing skills by group videotape review.

Internal medicine residency training programs typically emphasize biomedical learning, but relatively few provide opportunities for residents to improve outpatient interviewing skills or to address challenging patient encounters. Even fewer programs provide resources to assess patient-resident relationship skills. To address these issues, we developed a curriculum that is designed to enhance patient-centered interviewing techniques in residents. At the UCSF-VA PRIME residency program, interns on ambulatory block attend three didactic sessions that introduce basic medical interviewing techniques, including elicitation of patient concerns and mutual agenda setting, biopsychosocial interviewing, and conflict resolution in the patient-physician relationship. These sessions are taught using role-play exercises and interactive, case-based discussions. Second- and third-year residents on ambulatory block participate in an ongoing small-group seminar in which they present videotapes of their interviews with patients. To make these tapes, residents arrange to see patients in a clinic room where a videotape recorder is mounted on the wall. Patients who consent to be videotaped complete a form stating that the tapes are to be used solely for educational purposes. Twice a year, each of our 16 residents selects one encounter that highlights personal learning goals related to interviewing and presents those learning goals with associated videotape clips in a 90-minute seminar. Each seminar is devoted to two residents, who facilitate a discussion of the effectiveness of the interview and solicit feedback about potential methods for improvement. When the seminars were originally developed, we anticipated that this innovative combination of traditional individual videotape review with small-group learning would encourage self-directed learning. Indeed, over the last three years, residents have become more confident with their interviewing capabilities and less self-conscious about showing their own videotaped interviews. As a result, the seminars have unexpectedly evolved into a highly sophisticated series of learning modules, in which residents seek their most challenging patient encounters to videotape and show to the group. Residents have presented complicated scenarios involving critical patient-physician conflicts, somatizing patients, cross-cultural communication difficulties, overzealous family members, patients with substance abuse, and bad-news interviews. These dilemmas represent fundamental management challenges that are difficult to discuss in a more didactic format, and the immediate case-based nature of the interviews makes these often-emotional issues come alive. The group videotape reviews also give residents opportunities to reflect on their own interviewing encounters, to observe other interviewing styles and techniques, and to provide support to their fellow residents after particularly emotional interviews. An ancillary benefit of these exercises is that we have now developed a library of challenging interviews, which are easily accessible for further teaching seminars. Our residents consider this learning experience to be one of the most positive of their residency and valuable for their professional development. Residents report that this small-group seminar series has markedly improved their communication with patients, and they now clamor for the opportunity to present interviewing dilemmas. We believe that similar curricula can be readily instituted at other residency programs.

Mixing it up: integrating evidence-based medicine and patient care.

To teach internal medicine residents to use evidence-based medicine (EBM) in their interactions with patients by creating curricula that integrate EBM into clinical topics in internal medicine. The last several years have brought the wide-spread inclusion of EBM in internal medicine training programs in the United States. However, EBM is often taught as an independent topic and is poorly integrated into the clinical teaching of trainees. Most EBM education occurs in a journal-club format, focusing on question development, searching, and critical appraisal. The challenge of discussing the evidence with patients is rarely addressed. We set out to integrate EBM teaching into new curricula in women's health, addiction medicine, and topics in anticoagulation. During the first of two ambulatory blocks of the year, residents participate in an EBM seminar series in which they present cases, generate questions, and critically appraise the evidence. Second-year residents present articles on therapy or diagnosis and third-year residents present articles on diagnosis, meta-analysis, or decision and economic analysis. Both the women's health curriculum and the anticoagulation curriculum are presented during the second ambulatory block of the year as four half-day small-group seminars. The women's health curriculum is presented to the second-year residents and the anticoagulation curriculum is presented to the third-year residents. Both curricula are case-based and emphasize essential skills in patient care, including interview techniques, sensitivity to psychosocial issues, and skills in evidence-based patient care. Teaching EBM is not identified to the residents as a goal of these curricula; instead EBM, psychosocial medicine, and communication skills are woven into the content material and taught in the context of the broader subject matter. Learners are expected to integrate these concepts into actual practice. The curricula utilize clinical vignettes and role-plays to link EBM concepts such as number needed to treat or decision analysis to real-patient decisions. Residents are also asked to apply the evidence in their own patient encounters for further discussion at later sessions. Simpler concepts of therapy and diagnosis are covered during the second year in women's health and the more complex concepts of meta-analysis; decision analysis, and economic analysis are covered during the third year in anti-coagulation. The women's health curriculum was introduced in the spring of 2000; the anticoagulation curriculum was introduced in the spring of 2001. Both have been well received and seem to have impacted the ability of our housestaff to incorporate EBM into patient care. Currently under development in this series is a curriculum in addiction medicine for interns that will use a similar approach to provide an overview of EBM topics and their integration into the flow of patient care. We feel that these educational programs have helped EBM to bridge the gap between the classroom and the exam room.

Comparison of computer-assisted instruction and seminar instruction to acquire psychomotor and cognitive knowledge of epistaxis management

Epistaxis is a common problem faced by primary care physicians. Typically, first-hand experience with this problem is not obtained in medical school. A computer learning module was developed to address practical management of epistaxis. It was evaluated by use of third-year clerks and compared with an interactive seminar based on the same material. Fifty-eight students doing their required otolaryngology rotations were randomly separated into 3 groups: (1) doing a preinstruction test, (2) using the computer module, and (3) participating in a small-group seminar. All participants were tested with a short written test and a practical test that involved performing anterior nasal pack placement in a model patient. Percentage scores for the 2 groups were compared by use of t tests, and there was no significant difference between the written, practical, or combined scores at a level where P = 0.05. This study shows that basic patient management and a simple procedure can be taught as effectively with a computer module as with a small-group interactive seminar. (Otolaryngol Head Neck Surg 1999;121:430-4.)

Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: a critical review of curricula.

To systematically review the published literature on graduate medical education (GME) curricula in clinical epidemiology, critical appraisal, and evidence-based medicine (EBM). The author searched the Medline and Educational Resources Information Center (ERIC) databases from 1973 through 1998, and also searched the references of the captured papers. The author reviewed all peer-reviewed reports of GME curricula (with or without effectiveness studies) in critical appraisal, clinical epidemiology, or evidence-based medicine, extracting objectives, formats, and evaluations (including effectiveness, process, and satisfaction). For effectiveness evaluations, he also identified the outcomes, outcome measures, methodologic characteristics, and results. The search produced 18 reports. The most common objective of the curricula described in the reports was improving critical skills; the most common format was resident-directed small-group seminar. The most common outcome-evaluation measure was a multiple-choice examination. Only seven of the reports evaluated the curricula's effectiveness, and only four met a minimum methodologic standard of a pretest-posttest controlled trial. The impacts on critical appraisal skills of the curricula in those four reports ranged from no effect to a 23% net absolute increase in test scores. These reports provide useful guides for medical educators, but many suffered from incomplete descriptions and inadequate evaluations of their curricula. The curricula themselves often focused on critical appraisal to the exclusion of other EBM skills and had limited effectiveness. In addition to increased methodologic rigor, future studies should focus on more meaningful outcome evaluations. Curricula should use residents' actual clinical experiences and teach EBM skills in real time in existing clinical and educational venues.

Interactive Teaching, Medical Students, and Substance Abuse

The authors present an innovative approach for providing freshman and sophomore medical students with their initial exposure to the problems of alcohol and other drug abuse. Students in small interactive group seminars teach each other about the major areas of substance abuse: treatment, prevention/education, research, and law enforcement. They are aided by group moderators, by resource professionals, and by recovery teachers as they make field trips, attend 12-step meetings, and get background material. They utilize audiovisuals, role-plays, and programmed patients in a report/debate format. Effects of this seminar on their attitudes have been measured and are presented.

Task Force: A Senior Seminar for Undergraduate Majors in International Studies

Task Force is a small group seminar required of all seniors in the Henry M. Jackson School's International Studies Program at the University of Washington. Five or more seminars are offered in the winter quarter, and each focuses on a current policy issue. In recent years, Task Forces have dealt with such topics as strategic arms control, apartheid, United States policy towards Central America, the future of NATO, and United States trade with Japan. The following is an abridged version of the handbook which serves as a general guide for Task Force students, instructors, and evaluators.The International Studies Program at the Jackson School introduces undergraduate students to world affairs through traditional and multidisciplinary coursework. Its curriculum draws on economics, geography, history, political science, sociology, languages and literature, religious studies, and many other disciplines. The program also recognizes that the study of international affairs is rooted in policy issues and processes. It is this notion which underlies the concept of Task Force.The organization and operation of Task Force were inspired by the Policy Conference of Princeton University's Woodrow Wilson School of Public and International Affairs. The Policy Conference, which was initiated in 1930, consists of 25-30 people and operates much like a Presidential Commission or other investigative group. Its members explore a policy problem through research and discussions with experts; they debate the merits of policy proposals and arrive at a set of policy recommendations.

Science Teacher Education: A Program with a Theoretical and Pragmatic Rationale

Penick and Yager show how research and practice can be blended to produce a powerful preservice science teacher education program. The University of Iowa program includes intensive field ex periences at a variety of levels, small group seminars, and a series of oppor tunities for teacher self-evaluation. Orig inally developed with funding for a ten- year period from the National Science Foundation, this program is now fully self-supporting, visible within the uni versity, and successful in terms of stu dent performance.

Development and modification of a required family medicine clerkship.

A new required clinical clerkship in family medicine at Duke University School of Medicine is described in terms of planning, implementation, and modification in response to students' evaluations. Seventy-five percent of the eight-week course involves direct clinical experience both in academic practices and community sites, and 25 percent is spent in small group seminars and workshops. Evaluations by students have been highest for the clinical experience, the clinical competence of the faculty, the teaching effectiveness of the faculty and house staff, and the overall learning experience. The ratings have been lowest for seminars, workshops, and required written projects. Several modifications made in the clerkship over a three-year period have raised the students' ratings to near their ratings of the five traditional clerkships. The data demonstrate that family medicine can be taught effectively as a core clinical rotation and can broaden the general education of medical students.

Developing and assessing a training program in prehospital care of behavioral emergencies.

Did we achieve our training objectives? The written test suggested that significant learning did occur. However, these results should be viewed with caution. We attempted to do a three-month follow-up posttest, but our rate of return was too small to analyze. Also, the resuits of the field performance study indicate a significant improvement in only two skills: EMTs commenting on the patients' problems and saying goodbye to patients. Because of the large numbers of participants at the Boston workshop, it consisted primarily of lectunes and large-group discussions and minimal interaction between the trainees and faculty. Also, there were few opportunities to practice the skills discussed in the workshop. However, in Essex Junction, the smaller numbers helped to correct these deficiencies. Although this did not change the overall results of the test scores, it probably accounted for the higher posttest scores in Essex Junction. As a result of our findings, we revised the pilot course to emphasize a small-group seminar format with opportunities for practicing skills through role-playing exercises and small-group discussions. Our experience suggests that intensive training of this type can help prehospital caretakers provide more effective care to acutely distressed emergency patients.

Social science in medicine

Social science differs from the other basic medical sciences in that its perspective for understanding illness is not centered on processes within the individual. For this reason the relevance of social science knowledge to clinical practice is not obvious to many medical educators and students. Initial efforts at the University of North Carolina to develop a social science curriculum that is obviously relevant are described. Strategies include the use of small-group seminars taught by social-scientist/clinician teams and an organizing framework which links social science knowledge to clinical practice. Response to the curriculum from faculty and students has been encouraging.

Introduction to patient care

Basic science education of physicians has been almost exclusively in the biological fields. Although in recent years many schools have added behavioral sciences to the preclinical curriculum, there has been no agreement as to content or method in this area. An understanding of human behavior is essential for all physicians and is the goal of the course described here. This course, entitled "Introduction to Patient Care," utilizes readings, group presentations, site visits, small-group seminars, and specifically stated educational objectives to present the following topics: health problems of the United States, physicians and other healers, humanistic values--the sick role, and the doctor-patient relationship. The small-group seminars, with behavioral science and clinical faculty, help to guide the student's learning experience toward a scientific analysis of the art of medicine.

Land Use Projects and Small Group Seminars for Environmental Geology Courses

Land Use Projects and Small Group Seminars for Environmental Geology Courses

Small-group seminar for developing communication skills in chemistry majors

Description of a seminar that emphasizes reading, writing, discussion, formal oral presentation, criticism, and idea generation.

A suggested method for studying small group seminars in psychiatry.

A suggested method for studying small group seminars in psychiatry.