Traditional Medical Education Research Articles

Disaster 101: A Novel Approach to Disaster Medicine Training for Health Professionals

Despite efforts to improve preparedness training for health professionals, disaster medicine remains a peripheral component of traditional medical education in the United States (US) and is a rarely studied topic in the medical literature. Using a pre-/post-test design, we measured the extent to which 4(th)-year medical students perceive, rapidly learn, and apply basic concepts of disaster medicine via a novel curriculum. Via a modified Delphi technique, an expert curriculum panel developed a 90-min didactic training scenario and two 40-min training exercises for medical students: a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins. Medical students were quizzed before and after the didactic training scenario about their perceptions and their disaster medicine knowledge. Students rated their overall knowledge as 3.76/10 pretest compared to 7.64/10 after the didactic program. Students' post-test scores improved by 54% and students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 min. The average overall rating for the experience was 4.85/5. The results of this educational demonstration project reveal that students will value and can rapidly learn some core elements of disaster medicine via a novel addition to a medical school's curriculum. We believe the principle of a highly effective and well-received medical student course that can be easily added to a university curriculum has been demonstrated. Further research is needed to validate core competencies and performance-based education goals for US health professional trainees.

What Does Recovery From Schizophrenia Mean? Perceptions of Medical Students and Trainee Psychiatrists

The attitudes of medical professionals towards recovery from schizophrenia are key in defining the therapeutic encounter and may change as they move through their medical career. A qualitative methodology was used based on three focus groups of medical students and trainee psychiatrists in Hong Kong. Both held pessimistic attitudes towards recovery in schizophrenia. Four major categories and one central theme emerged, with little difference between students and doctors. The four categories were: (1) recovery is defined by the cessation of medication and the resumption of normal psychosocial functioning; (2) formal recovery requires medical confirmation plus the patient's admission of illness; (3) recovery should be discussed, but largely in terms of the contribution of drug compliance; and (4) participants recognized that stigma was an impediment to recovery while holding attitudes that were as unaccepting towards people with schizophrenia as lay people's. Traditional medical education over-emphasizes symptomatic recovery and ignores the need for a more flexible construction of the concept. Professional knowledge must incorporate both quantitative and qualitative data and inculcate humanitarian concern through active contact with users, and acceptance of the legitimacy of their expert experience. Medical education should seek effective ways to change entrenched negative attitudes in students about schizophrenia and the possibility of recovery. Further large-scale research should be carried out to establish attitudes of medical professionals towards recovery from schizophrenia and how this changes during typical career trajectories. This information could then be used to devise effective means within medical education to combat stigma and change attitudes.

Responding to the Childhood Obesity Epidemic: From the Provider Visit to Health Care Policy—Steps the Health Care Sector Can Take

Pediatricians, along with most of the American public, now well know that childhood obesity is a leading threat to the long-term health of the population, rivaling smoking in its potential impact. What pediatricians and other health professionals who deal with children have not known is what they can do to affect this epidemic and how they can be most effective in doing it. From the perspective of the clinician in practice, the problem of obesity seems overwhelming. The number of children affected is vast, with healthy lifestyles a concern for all children and overweight or obesity affecting as many as one quarter of children ages 2–19 years. In part because of the limited emphasis on effective counseling methods in traditional medical education, addressing behaviors such as increasing use of car seats or reducing tobacco use is difficult for many clinicians. This has been the case even when the evidence is strong and there is broad societal support for these changes. Behaviors related to diet and physical activity seem even more difficult to influence, not only because they are embedded in family and ethnic culture, but because so many societal and community pressures lean on the side of foods of lower nutritional value (eg, sugar-sweetened beverages, highly processed fast foods) and limited exercise (unsafe neighborhoods, absence of sidewalks). Health professionals may feel that influencing these societal behaviors and policies are outside the scope of their professional role. Health professionals have also been unsure what to do, because no unequivocal direct scientific evidence links clinician counseling to the prevention of obesity. This has been clearly stated by the US Preventive Services Task Force (USPSTF), which reported in 2005 that there was insufficient evidence to recommend for or against counseling about childhood obesity by clinicians.1 However, although most observers acknowledge the state … Address correspondence to Charles J. Homer, MD, MPH, National Initiative for Children's Healthcare Quality, 20 University Rd, 7th Floor, Cambridge, MA 02138. E-mail: chomer{at}nichq.org

The Economics of Home Dialysis: Acting for the Individual While Planning Responsibly for the Population

Traditional medical education paradigms tend not to focus on health economics and economic evaluation. This has led to a culture in which bedside clinicians simply allocate health care resources made available to them, with often minimal input as to what these resources are at the population or health care system level. Life sustaining chronic dialysis therapies for end-stage renal disease are heterogeneous in terms of health care costs and the quality of life provided to patients receiving them. From the traditional clinician's perspective, they may be considered equivalent because there are no well-designed randomized control trials establishing the superiority of one particular dialysis modality in terms of all-cause mortality or cardiovascular events. The intent of this review is to provide clinicians practicing in the area of chronic kidney disease some insights into the concepts of economic evaluation and how it may be integrated into clinical decision making at a programmatic level while not compromising individual patient care at the bedside. An epidemiologic perspective will be used to help frame how the implementation of home dialysis modalities vary depending on local health policies in place. Lessons learned by regional nephrology care systems may be readily transferable to other jurisdictions in augmenting the uptake of home dialysis modalities where they are dwindling or struggling to grow. A high-level understanding of economic data in this area may help influence health policy in the direction of the most efficient provision of dialysis to patients while not adversely affecting their quality of life or health outcomes.

Competency Testing Using a Novel Eye Tracking Device

Assessment and evaluation metrics currently rely upon interpretation of observed performance or end points by an ‘expert’ observer. Such metrics are subject to bias since they rely upon the traditional medical education model of ‘see one, do one, teach one’. The Institute of Medicine's Report and the Flexner Report have demanded improvements in education metrics as a means to improve patient safety. Additionally, advancements in adult learning methods are challenging traditional medical education measures. Educators are faced with the daunting task of developing rubrics for competency testing that are currently limited by judgment and interpretation bias. Medical education is demanding learner‐centered metrics to reflect quantitative and qualitative measures to document competency. Using a novel eye tracking system, educators now have the ability to know how their learners think. The system can track the focus of the learner during task performance. The eye tracking system demonstrates a learner‐centered measuring tool capable of identifying deficiencies in task performance. The device achieves the goal of timely and direct feedback of performance metrics based on the learner's perspective. Employment of the eye tracking system in simulation education may identify mastery and retention deficits before compliance and quality improvement issues develop into patient safety concerns.

Some Thoughts on Education Innovation of Traditional Chinese Medicine

At present, the training pattern in the higher-education institutions of traditional Chinese medicine (TCM) is still characterized as a trilogy of basic medical theory courses, clinical medical courses and graduation clinic practice, which results in the slow-cultivation of the TCM talent, and brings into the severe problems of theory being divorced from practice and bad social adaptability in the graduates. Under this situation, it is imperative to reform the traditional training patterns and to advocate innovation in the education. It is suggested that creative teachers, students' creative study and a democratic, harmonious, relaxing and easy study atmosphere are helpful to the cultivation of TCM talents. Therefore, a student-orientating training pattern of classroom-teaching synchronized with the clinic practice, emphasizing clinic practice, and aiming to improve the scientific research ability is advocated in higher-education of TCM. This is expected to provide some thoughts for the development of TCM higher education in the new era. Key words: Innovation; Traditional Chinese Medical Education; Talents

Problems Of Diseases Manifested By X-ray Local Opacity Syndrome, And Differential Diagnostic Algorithm For Its Solution

Objective: Efficiency of traditional and algorithmic diagnostics comparison; Differential Diagnostic Algorithm creation for effective X-ray differential diagnostics of diseases accompanied with local opacity. Methods: Comparative evaluation of X-ray traditional and algorithmic diagnostics has been performed by principle of other equal conditions. The first stage of independent diagnostics has reflected the results of traditional medical education. The same radiograms have been used by the same examinees in the same time for repeated diagnostics with original innovative diagnostic algorithm on the second stage.Results: X-ray diagnostic algorithm significantly decreased of errors obtained at independent diagnostics. Conclusion: Traditional X-ray diagnostics based on nosological thinking is ineffective. Syndromic algorithmic X-ray diagnostics used innovative the most effective intellectual activity, therefore, optimized results radically.Definition: Differential Diagnostic Algorithm or diagnostic algorithm is the exact comprehensible to all determination about step-by-step of elementary intellectual operations and actions in the certain sequence for establishment of a diagnosis of each of all diseases manifested by the given leading

Richard Deckelbaum: building bridges to better health

Richard Deckelbaum, the current president of the Global Health Education Consortium (GHEC), began thinking about the need for a new kind of doctor as a young physician in Jerusalem and Zambia in the late 1960s and early 1970s. This new doctor would be comfortable practising in underserved communities anywhere in the world, and would help populations, not only patients, by addressing issues beyond the scope of traditional medical education, such as sanitation, clean water, and preventive nutrition.

354: Disaster 101: Can Fourth-Year Medical Students Rapidly Learn a Novel Disaster Medicine and Emergency Preparedness Curriculum?

Recent terrorist attacks and natural disasters have emphasized the need for all health care professionals to develop clinical competencies for emergency preparedness. Unfortunately, disaster medicine and emergency preparedness are uncommon components of traditional medical education in the United States. Recent studies highlight the deficiencies of training and the challenges associated with integrating this curriculum into residency training. Few studies have focused on the feasibility and efficacy of emergency preparedness training for medical students.

Traditional medical education and the new path - they are not mutually exclusive

Medical EducationVolume 35, Issue 3 p. 304-304 Traditional medical education and the new path – they are not mutually exclusive Alan Dugdale, Alan Dugdale University of Queensland AustraliaSearch for more papers by this author Alan Dugdale, Alan Dugdale University of Queensland AustraliaSearch for more papers by this author First published: 07 July 2008 https://doi.org/10.1111/j.1365-2923.2001.0901a.x Alan Dugdale Department of Paediatrics and Child Health, Medical School, University of Queensland, Herston Q4006, Australia. E-mail: A.Dugdale@mailbox.uq.edu.au Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume35, Issue3March 2001Pages 304-304 RelatedInformation

Consultant medical trainers, modernising medical careers (MMC) and the European time directive (EWTD): tensions and challenges in a changing medical education context

BackgroundWe analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers') in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC) and the European Working Time Directive (EWTD).MethodsQualitative study. Learning and continuing professional development (CPD), were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005.ResultsConsultant Trainers felt that new working patterns resulting from the EWTD and MMC have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the quality of medical training and patient care. Consultant Trainers' perceptions of medical education were embedded in a traditional medical education culture, which expected long hours' availability, personal sacrifices and learning without formal educational support and supervision. Over-reliance on apprenticeship in combination with lack of organisational support for Consultant Trainers' new responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in teaching, supervision and assessment represent potentially significant barriers to progress.ConclusionThis study identifies issues with significant implications for the implementation of MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS: Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and aspire to excellence. Further research is needed to investigate the views and educational practices of Consultant Medical Trainers and medical trainees.

Outcomes from a Comprehensive Stroke Telemedicine Program

Our team has studied the use of telemedicine to overcome obstacles to providing acute stroke care and expanding stroke education. We report a summary of our outcomes to provide evidence supporting greater development of stroke telehealth systems. Stroke telemedicine is audio-video communication (teleconferencing) between a stroke specialist and a remote party requiring stroke services. Using several models, we tested the validity, reliability, and effectiveness of telemedicine versus telephone consultations and face-to-face (traditional) medical care and education. Because of the challenges inherent to technology studies, we found a prospective, case control design most practical for testing hypotheses related to a comparison of telemedicine and traditional service delivery. Telemedicine-assisted neurologic evaluation and stroke diagnosis were as valid and reliable as traditionally delivered services. Clinical effectiveness was demonstrated by shortening times to treatment (17 [telemedicine] vs. 33 [control] minutes; p = 0.003) and increasing tissue plasminogen activator use at a remote hospital (from 5% to 24%). Evaluation of telemedicine as a means to expand stroke education to distant communities revealed that telemedicine and direct education achieve equivalent academic results. Stroke services delivered by telemedicine are safe, efficacious, and comparable to those rendered face-to-face. Telemedicine is a means of providing disability-reducing therapies earlier to a large number of patients. The current, geographically defined scheme for telemedicine service reimbursement fails to recognize that the main barrier to stroke care is lack of available stroke specialists. Contractual and third-party reimbursement structures should be modified to surmount this impediment to extending stroke specialty care and community education.

18 Graduate Medical Education and Knowledge Translation: One Problem‐Specific Approach in Residency

Traditional graduate medical education approaches to improving clinical performance based upon the latest research have included Journal Club and didactic lectures. Unfortunately, these educational interventions have rarely been demonstrated to change practice behavior or improve patient‐important outcomes. Using a structured approach to identifying a gap between best‐evidence knowledge and clinical practice, an illustrative one‐year residency‐wide translational research project was developed in a four year emergency medicine training program. Step one (assigned to the second year residents): identify and quantitatively justify a Knowledge Translation (KT) deficit within our institution. They identified steroids in adult bacterial meningitis as an unequivocal therapeutic option. Based upon a structured one‐year chart review, they next demonstrated that only 7% of meningitis patients received pre‐antimicrobial steroids. The next step (assigned to the first year residents): identify and quantify the physician “leaks” within the pipeline of information from publication to bedside utilization via an online survey. The third year residents hypothesized plugs for these information leaks, including examples of other specialties or institutions which have successfully navigated this specific clinical scenario. Finally, at an end‐of‐year Journal Club, the fourth year residents formulated a protocol for the appropriate use of steroids in suspected adult meningitis and brought together individuals from within the institution contributing to the best‐practice leak. Knowledge Translation involves multiple stages beyond simple evidence awareness and usually involves continuation beyond the emergency department. The Washington University KT project offers a structured, multidisciplinary example of moving beyond contemplation to implementation of an unequivocal therapy.

Models of medical education in Australia, Europe and North America

Background: The universal goal of medical education is to train excellent physicians, able to maintain the health of individuals and communities. The route to achieving this goal has shifted over time. This paper describes the absolutes and ambiguities of philosophical vision, responsiveness to stakeholders, curriculum content and delivery, and assessment of trainees and training programs across much of the developed world.Description: Traditional medical education is content focused and organized by organ systems. Newer curricula, informed by current learning theories, emphasize a competencies based approach, with clinical scenarios at the centre of teaching and assessment of students. Associated with this is a shift from the in-depth knowledge of the specialist to a ‘what must a generalist know’ approach. These models are explored as are options for curriculum delivery, input from governments, students, the public and faculty, and methods and importance of accreditation.Conclusion: The goals and the process of training physicians to achieve these exhibit numerous commonalities across time and place throughout the developed world while still allowing for cultural or national adaptations. All models and content aim for minimum basic knowledge, while emphasizing communication skills, cultural awareness and professionalism amongst future physicians.

Bridging the gap: Enhancing interprofessional education using simulation

Simulated learning and interprofessional education (IPE) are increasingly becoming more prevalent in health care curriculum. As the focus shifts to patient-centred care, health professionals will need to learn with, from and about one another in real-life settings in order to facilitate teamwork and collaboration. The provision of simulated learning in an interprofessional environment helps replicate these settings thereby providing the traditional medical education model with opportunities for growth and innovation. Learning in context is an essential psychological and cognitive aspect of education. This paper offers a conceptual analysis of the salient issues related to IPE and medical simulation. In addition, the paper argues for the integration of simulation into IPE in order to develop innovative approaches for the delivery of education and improved clinical practice that may benefit students and all members of the health care team.

Service user involvement in psychiatric training: a practical perspective

The systematic involvement of service users (patients or clients; McGuire-Snieckus et al, 2003) and carers in an active educational role in psychiatric training is a relatively recent development. The National Service Framework for Mental Health states that ‘Service users and carers should be involved in planning, providing and evaluating training for all health care professionals' (Department of Health, 1999). The Royal College of Psychiatrists declared that from June 2005 all psychiatric trainees must have training from service users or carers. This is a sizeable shift away from traditional medical teaching, where patients have been involved only in a passive way, as the possessor of symptoms and signs, with teaching delivered by experienced clinicians and academics. The reasons behind these changes have been discussed frequently in recent medical literature (Livingston & Cooper, 2004). The primary arguments for this initiative are that service users have a unique understanding of their illness and are best placed to judge trainees on their empathy and communication skills. Increasingly, service users' views are being taken into account in training and examination of medical students and doctors (Vijayakrishnan et al, 2006).

Assessment of Competency in Anesthesiology

Assessment of competency in traditional graduate medical education has been based on observation of clinical care and classroom teaching. In anesthesiology, this has been relatively easy because of the high volume of care provided by residents under the direct observation of faculty in the operating room. With the movement to create accountability for graduate medical education, there is pressure to move toward assessment of competency. The Outcome Project of the Accreditation Council for Graduate Medical Education has mandated that residency programs teach six core competencies, create reliable tools to assess learning of the competencies, and use the data for program improvement. General approaches to assessment and how these approaches fit into the context of anesthesiology are highly relevant for academic physicians.

The Israel Center for Medical Simulation: A Paradigm for Cultural Change in Medical Education

Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.

Training Medical Students in the Community - Memoirs and Reflections of the University of Transkei Medical School

Not long after its inception, the undergraduate medical program at the University of Transkei (UNITRA) departed from the traditional hospicentric medical education approach to one tailored around a Community-Based Medical Education (CBME) curriculum adopting the Problem-based Learning (PBL) pedagogy. This article reflects on the experiences of the faculty in establishing and implementing CBME, exploring what it has meant to train medical students in the community. It further appraises CBME by reviewing its impact on students, the faculty, and the community at large.

Students Learning from Patients: Let’s Get Real in Medical Education

Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient's care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad 'professionalism' framework. Paradoxically, while aiming to strengthen patient-student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical 'education' displaces traditional forms of medical 'training' that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.