Traditional Curriculum Students Research Articles

A Multifaceted Educational Design Approach to Critical Care Rotation Improves Learner Confidence and Knowledge.

Purpose: We developed a pilot elective to enhance the critical care training experience for medical students through integration of didactic, simulation, and experiential learning with the goal to increase student confidence in caring for patients with critical illness and advance knowledge and competencies within core critical care topics. Approach: We created and piloted a 4-week critical care elective for fourth-year medical students pairing clinical experience with didactic and simulation-based training. Students completed two 2-week intensive care unit (ICU) rotations in both medical and surgical ICUs. Students received 6 half-days of didactics focusing on: respiratory failure, ventilator management, shock, acid/base, and discussions at the end of life. Didactic sessions were coupled with simulation-based training to reinforce content through application and provide opportunity to build procedural skills. Medical knowledge was assessed via multiple-choice questions delivered before and after course completion. Course grades were determined through clinical evaluations by faculty/residents, written examination, and simulation assessment. Pre- and postknowledge assessment performance was compared between students enrolled in the pilot and traditional curricula. The traditional curriculum involved clinical experience without formal didactics or simulation opportunities, and course grades were determined by evaluations only. Outcomes: No students received passing scores of 70% on the precourse medical assessment in either curriculum group. The mean score on the postcourse knowledge assessment for the novel-curriculum students (N = 13) was 21.8/30 (72.8%), compared with the 17/30 (56%) for the students in the traditional curriculum (N = 6). No students in the traditional curriculum received a passing score on the postcourse assessment. Before the course, few students felt “comfortable” or “very comfortable” managing common ICU conditions (acute respiratory distress syndrome, 0%; undifferentiated shock, acute hypercarbic respiratory failure, and identifying need for mechanical ventilation, 33%; acute hypoxemic respiratory failure and cardiogenic shock, 50%; septic and hypovolemic shock, 83%). At completion, there was an improvement in the reported level of comfort; 100% of students reported feeling “comfortable” or “very comfortable” with all topics, save for cardiogenic shock at 83%. Comfortability levels remained high on subsequent evaluation 12 months post-course (6 months into trainee’s intern year). Discussion: A limitation of traditional critical care curricula is that it lacks structure designed to ensure exposure to core critical care topics. It relies on the randomness of patient’s disease states present during a given rotation. Incorporating scheduled didactics ensures consistent exposure to these topics regardless of the patient cases on service. A limitation of this study is the small sample size of both the novel-curriculum group and the percentage of traditional curriculum students undergoing written assessment. Despite the small sample size (N = 13), this pilot demonstrates feasibility of consistent delivery of core content via didactics and simulation coupled with experiential learning. Our results may suggest benefit in this multimodal approach compared with experiential learning alone; however, further research is needed. Traditional assessment relies solely on clinical impression which is biased and often fails to capture an actionable level of detail. Lack of objective measures of assessment impedes identification of areas for improvement at the trainee level as well as within a curriculum. The use of multiple methods of assessment allows for mitigation of bias and overcomes some of the limitations of a single method alone. 1 Simulation assessment allows for greater practical assessment of procedural competency than written assessment. Significance: With this novel pilot curriculum incorporating multiple educational strategies, students improved their confidence and knowledge in core critical care topics. By harnessing didactic and simulation training to complement the clinical experience, consistent delivery of core content is assured. Furthermore, evaluation is strengthened through use of knowledge assessment questions and simulation-based assessment as compared with traditional evaluations which are largely subjective. More research is needed to understand the impact when scaled to a larger group.

Iraqi Medical Student's Perceptions of Learning Environment Following Surgical Curriculum Change.

Background:There are three undergraduate medical school curricula types - ‘traditional’, ‘integrated’, and ‘problem-based learning’ (PBL). Traditional curricula involve teaching basic medical science in the early years in an atomistic and often didactic way, predominantly through lectures. In later years, students move on to learning clinical skills and applying their medical knowledge in clinical settings. Meanwhile, the philosophy of integrated curricula is that students learn best by understanding medical science in relation to whole systems and by linking knowledge with practice. Integrated curricula take a more holistic approach and bring together elements of medical science rather than teaching them in isolation.Objective:The study aimed to measure and compare perceptions of the learning environment between two cohorts of medical students at a medical school in Iraq. The intention was to explore differences in perceptions between those following a traditional surgical curriculum and those following an innovative, integrated curriculum and thereby add to the body of evidence looking at the impact of the two surgical curriculum models on the learning environment.Methods:The Dundee Ready Educational Environment Measure (DREEM) was used to measure students’ perceptions of their learning environment. The unpaired t-test was used to compare the mean scores of two cohorts of medical students.Results:The global mean score for the students following the integrated curriculum was higher than the global mean scores for the group studying the traditional curriculum. This difference is statistically significant. The mean scores for the integrated curriculum students are higher than those of the traditional curriculum students for all sub-sets of the measure. The difference is statistically significant for one sub-set, ‘Students’ Perceptions of Learning,’ and the difference is close to being statistically significant for the ‘Students’ Perception of Teachers’ sub-set.Conclusion:The results reflect those from other international studies and add to the body of evidence that suggests that innovative, integrated curricula are a critical factor in promoting a more positive learning environment than that generated within a traditional curriculum model.

Self-Perceived Preparedness to Work Independently Among Graduating Dental Students in Saudi Arabia: Traditional Versus Integrated Curriculum

Objective: To investigate the perceived preparedness of graduating dental students to work independently and to compare these perceptions between Traditional and Integrated curriculums of dentistry in Saudi Arabia. Material and Methods: A pretested self-administered questionnaire was filled by 258 dental students from four dental institutions across the country. The questionnaire covered 10 domains consisting of sixty suitable questions. Students were asked to mark their responses at one of five levels of performance for each of the selected skills ranging from 0 (not yet learned) to 4 (can do it confidently). Mean scores for each subscale of the Questionnaire were calculated by individual items and for all comparison, p≤0.05 was considered statistically significant . Results: 253 graduating students were included in the final analysis, out of which 108 belongs to the Integrated curriculum group and 145 from Traditional curriculum. Overall scores of Traditional curriculum students (176 ± 4.8) were more compared to Integrated curriculum students (161 ± 3.2), which are statistically significant. Integrated curriculum students had more self-perceived skill scores in Orthodontics, Conservative/Operative Dentistry & Endodontics, Dental Public Health and Drug & Emergency management group of clinical skills. Overall, perceived preparedness to practice dentistry for all participants is 60.5% and traditional curriculum students expressed more preparedness (68%) than Integrated curriculum (53%) . Conclusion: Overall, preparedness to practice independently is unsatisfactory compared to other countries. The Ministry of Education (KSA) should take necessary actions to bridge the gap between training dentists and to be competent practitioners.

Do Medical Student Stress, Health, or Quality of Life Foretell Step 1 Scores? A Comparison of Students in Traditional and Revised Preclinical Curricula

Theory: We explored the theory that measures of medical students’ well-being and stress from different types of preclinical curricula are linked with performance on standardized assessment. Hypotheses: Self-reported stress and quality of life among sophomore medical students having different types of preclinical curricula will vary in their relationships to USMLE Step 1 scores. Method: Voluntary surveys in 2010 and 2011 compared self-reported stress, physical and mental health, and quality of life with Step 1 scores for beginning sophomore students in the final year of a traditional, discipline-based curriculum and the 1st year of a revised, systems-based curriculum with changed grading system. Wilcoxon rank sum tests and Spearman rank correlations were used to analyze data, significant at p <.05. Results: New curriculum students reported worse physical health, subjective feelings, leisure activities, social relationships and morale, and more depressive symptoms and life stress than traditional curriculum students. However, among curriculum-related stressors, few differences emerged; revised curriculum sophomores reported less stress working with real and standardized patients than traditional students. There were no class differences in respondents’ Step 1 scores. Among emotional and physical health measures, only feelings of morale correlated negatively with Step 1 performance. Revised curriculum students’ Step 1 scores correlated negatively with stress from difficulty of coursework. Conclusions: Although revised curriculum students reported worse quality of life, general stress, and health and less stress from patient interactions than traditional students, few measures were associated with performance differences on Step 1. Moreover, curriculum type did not appear to either hinder or help students’ Step 1 performance. To identify and help students at risk for academic problems, future assessments of correlates of Step 1 performance should be repeated after the new curriculum is well established, relating them also to performance on other standardized assessments of communication skills, professionalism, and later clinical evaluations in clerkships or internships.

Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students.

BackgroundAny curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students’ perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study.MethodsA cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test.ResultsThe mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for the male students.ConclusionThe current study adds to the advantages of the SBC indicating not only healthier EE for both genders but also healthier emotional well-being for female students only.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-192) contains supplementary material, which is available to authorized users.

Influence of curriculum type on student performance in the United States Medical Licensing Examination Step 1 and Step 2 exams: problem-based learning vs. lecture-based curriculum

Introduction The results of the United States Medical Licensing Examination Step 1 and 2 examinations are reported for students enrolled in a problem-based and traditional lecture-based curricula over a seven-year period at a single institution. There were no statistically significant differences in mean scores on either examination over the seven year period as a whole. There were statistically significant main effects noted by cohort year and curricular track for both the Step 1 and 2 examinations. These results support the general, long-term effectiveness of problem-based learning with respect to basic and clinical science knowledge acquisition. Context This paper reports the United States Medical Licensing Examination Step 1 and Step 2 results for students enrolled in a problem-based and traditional lecture-based learning curricula over the seven-year period (1992–98) in order to evaluate the adequacy of each curriculum in supporting students learning of the basic and clinical sciences. Methods Six hundred and eighty-nine students who took the United States Medical Licensing Examination Step 1 and 540 students who took Step 2 for the first time over the seven-year period were included in the analyses. T-test analyses were utilized to compare students’ Step 1 and Step 2 performance by curriculum groups. Results United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students (t-value = 1·32, P=0·21). Mean Step 2 scores over the seven-year period were 208 for Traditional Curriculum students and 206 for Parallel Curriculum students (t-value=1·08, P=0·30). Statistically significant main effects were noted by cohort year and curricular track for both the Step 1 and Step 2 examinations. Conclusion The totality of experience in both groups, although differing by curricular type, may be similar enough that the comparable scores are what should be expected. These results should be reassuring to curricular planners and faculty that problem-based learning can provide students with the knowledge needed for the subsequent phases of their medical education.

Medical Students’ Attitudes Toward Underserved Patients: A Longitudinal Comparison of Problem-Based and Traditional Medical Curricula

Medical education has been shown to negatively influence student attitudes toward certain types of patient populations. Past research does not inform current educational practice because today's medical school environment is different from when most of the published research was conducted. There are more female students, curricular innovations such as problem-based learning have changed the framework for educational delivery, and longitudinal studies, which could inform when interventions may be needed, are uncommon. The purposes of this longitudinal, prospective cohort study were to compare the attitudes of Problem-based learning and Traditional curriculum students toward providing care for medically indigent patients as they progressed through the four-year undergraduate medical education curriculum, and to determine if gender differences were apparent and persisted over time. Attitudes of one cohort of students enrolled in separate curricula were studied. The outcome measure was the Medical Student Attitudes Toward the Underserved questionnaire, which was administered three times. A linear mixed effects regression analysis was performed to examine changes in factor scores over time and whether these changes differed between Problem-based and Traditional students, and males and females. Longitudinal findings revealed that commitment to caring for the medically underserved was greater when students entered medical school than when they graduated. Students in both curricula, as well as male and female students, experienced increasingly negative attitudes over the four year period. Decline in attitudes toward medically underserved patients was similar to previous research results. This study showed that attitudes of students were not influenced by the preclinical curriculum they experienced.

The conceptualisation of "soft skills" among medical students before and after curriculum reform

Objective: This paper reports on the conceptualisation of as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. Methods: Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). Results: Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients’ well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. Conclusion: The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations.

Implementing Evidence‐Based Practice in Undergraduate Teaching Clinics: A Systematic Review and Recommendations

The objective of this project was to identify an effective methodology of approaching and implementing evidence-based principles in undergraduate teaching clinics to promote evidence-based dentistry in future clinical practice. A systematic review was undertaken to examine evidence-based clinical teaching and faculty continuing education. Research published from 1996 to 2002 was retrieved by searching several databases and the Internet, along with conducting hand searches and reviewing bibliographies maintained by faculty experts. Qualitative checklists for different types of studies were created to evaluate the literature. Relevant studies were selected if they met all four predetermined essential criteria and a minimum of two out of three desirable criteria. Systematic reviews were chosen if they met all five essential criteria. Data from selected articles were extracted, and study quality was assessed. We found that three systematic reviews and nine original research articles were deemed methodologically acceptable. Problem-based learning and evidence-based health care interventions increased student knowledge of medical topics and their ability to search, evaluate, and appraise medical literature. Dental students in a problem-based learning curriculum, emphasizing evidence-based practices, scored higher on the NDB I (National Dentistry Boards, Part I) than students in traditional curricula. While effective modules in implementing theoretical evidence-based principles exist, very few high-quality studies are available that examine these principles in dental undergraduate teaching clinics. No methodologically appropriate studies on the education of faculty in the implementation of evidence-based principles are available. Some studies promote promising theories and methodologies of teaching evidence-based care; based on these theories, a comprehensive model is proposed in this article. Considering the strength of evidence in the reviewed literature, we concluded that an evidence-based approach to clinical care is effective.

Does the curriculum matter in peer mentoring? From mentee to mentor in problem‐based learning: a unique case study

Peer mentoring has been used for many years by the Nelson R. Mandela School of Medicine to integrate new students into the academic and social culture of the institution. In 2001, an unusual situation arose. A problem‐based learning (PBL) curriculum was introduced and the first cohort in this programme was mentored by senior traditional curriculum students. The present study, by canvassing the 2002 PBL mentors, set out to determine whether the mismatch in curricula impacted on students' mentoring experiences. There was overwhelming agreement that curriculum did matter—it is only when mentors are able to share the same experiences as mentees, can they fully understand student problems. Notwithstanding this and other difficulties (e.g. timetable clashes), some 2001 mentees did form bonds with their traditional curriculum mentors. Some even identified them as role models. The 2002 PBL mentors also indicated that they had undergone considerable personal development as a result of their experiences.

A Comparison of Students Who Chose a Traditional or a Problem-Based Learning Curriculum After Failing Year 2 in the Traditional Curriculum: A Unique Case Study at the Nelson R. Mandela School of Medicine

Purpose: To canvas perceptions and experiences of students who had failed Year 2 of a traditional medical program and who chose to remain in the conventional program (n = 6) or had swapped to Curriculum 2001 (C2001), a problem-based learning (PBL) curriculum (n = 14).Methods: A year after their decision regarding curriculum choice, students were canvassed (largely open-ended survey) about this decision and about their perceptions of their curricular experiences.Results: C2001 students were positive about their PBL experiences. Overwhelmingly, their decision to swap streams had been a good one. They identified PBL features as supporting their learning. Repeating traditional curriculum students were, however, more circumspect in their opinions.Conclusions: C2001 students had clearly embraced PBL. They were now medical students, largely because of PBL activities underpinned by a sound educational philosophy. This unique case study has provided additional evidence that PBL students are generally more content with their studies than their conventional curriculum counterparts.

Influence of curriculum type on student performance in the United States Medical Licensing Examination Step 1 and Step 2 exams: problem-based learning vs. lecture-based curriculum.

The results of the United States Medical Licensing Examination Step 1 and 2 examinations are reported for students enrolled in a problem-based and traditional lecture-based curricula over a seven-year period at a single institution. There were no statistically significant differences in mean scores on either examination over the seven year period as a whole. There were statistically significant main effects noted by cohort year and curricular track for both the Step 1 and 2 examinations. These results support the general, long-term effectiveness of problem-based learning with respect to basic and clinical science knowledge acquisition. This paper reports the United States Medical Licensing Examination Step 1 and Step 2 results for students enrolled in a problem-based and traditional lecture-based learning curricula over the seven-year period (1992-98) in order to evaluate the adequacy of each curriculum in supporting students learning of the basic and clinical sciences. Six hundred and eighty-nine students who took the United States Medical Licensing Examination Step 1 and 540 students who took Step 2 for the first time over the seven-year period were included in the analyses. T-test analyses were utilized to compare students' Step 1 and Step 2 performance by curriculum groups. United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students (t-value = 1.32, P=0.21). Mean Step 2 scores over the seven-year period were 208 for Traditional Curriculum students and 206 for Parallel Curriculum students (t-value=1.08, P=0.30). Statistically significant main effects were noted by cohort year and curricular track for both the Step 1 and Step 2 examinations. The totality of experience in both groups, although differing by curricular type, may be similar enough that the comparable scores are what should be expected. These results should be reassuring to curricular planners and faculty that problem-based learning can provide students with the knowledge needed for the subsequent phases of their medical education.

Mathematics Performance Assessment: Technical Quality and Diverse Student Impact

Reform in mathematics education calls for a closer tie between instruction and assessment. This study developed performance assessments from hands-on instructional activities and examined their reliability and validity for obtaining individual achievement data in large-scale surveys. The major source of unreliability was the tasks, not the raters. Many tasks are needed to get a dependable measure of a student's mathematics achievement. With respect to validity, results suggested that the performance assessments measure different aspects of mathematics achievement than do traditional multiple-choice tests. Moreover, the performance assessments, but not the multiple-choice test, distinguished the performance of students in hands-on and traditional curricula with the former scoring higher, on average, than the latter. Ethnic group comparisons indicated that Anglos scored higher, on average, than Latinos on all achievement measures. The magnitude of the difference varied by the curricular experience of the student. For students in traditional curricula, qualitative analysis indicates that Anglo and Latino students approached the problems similarly, made the same types of errors, and employed the same strategies in solving the mathematics problems.