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Kosmos
Astronomia Astrofizyka
Inne

Kultura
Sztuka dawna i współczesna, muzea i kolekcje

Metoda
Metodologia nauk, Matematyka, Filozofia, Miary i wagi, Pomiary

Materia
Substancje, reakcje, energia
Fizyka, chemia i inżynieria materiałowa

Człowiek
Antropologia kulturowa Socjologia Psychologia Zdrowie i medycyna

Wizje
Przewidywania Kosmologia Religie Ideologia Polityka

Ziemia
Geologia, geofizyka, geochemia, środowisko przyrodnicze

Życie
Biologia, biologia molekularna i genetyka

Cyberprzestrzeń
Technologia cyberprzestrzeni, cyberkultura, media i komunikacja

Działalność
Wiadomości | Gospodarka, biznes, zarządzanie, ekonomia

Technologie
Budownictwo, energetyka, transport, wytwarzanie, technologie informacyjne

Medical Education Development

Many medical schools have transitioned to an integrated curriculum to provide a more salient contextual appreciation of the practice of medicine. Various types of assessments are used in these curricula to support this integration. One of these, multidisciplinary exams, creates challenges for recognizing student performance in different disciplines. A concern for faculty is those students who pass the exams but upon closer scrutiny do poorly in one or more disciplines. Unfortunately, this trend can continue throughout preclinical training. We constructed a database of discipline-specific objective data for each course and that also provided cumulative data longitudinally through the curriculum. The data are used to populate reports for the students, advisors, and administrators. The database was broadened to include data from clerkship performance and residency match to provide a complete profile of student performance. Together, the data and reports provide a useful tool for student review and data-driven curriculum decisions.

http://www.pagepress.org/journals/index.php/med/article/view/5231 2014/09/02 - 20:03

Background. Chief resident leadership development programs need to be more than a one/two day symposium to sustain leadership development. This article describes the structure and outcomes for an eight-month leadership development program for chief residents conducted over the past three years at the University of Iowa Hospitals & Clinics (UIHC), USA. Additionally, it provides keys to success and logistical issues for any institution that is considering a similar program. Innovation. Current chiefs must formally apply in late August. Sessions are held on the second Tuesday of each month for two hours. Facilitators guide each session in such a manner that they allow participants to do most of the discussion. Facilitators also provide opportunities for insight from other chiefs, and provoke deeper understanding of behaviors or thoughts. Eight topics are covered during the year with intersession assignments. Additionally, chiefs are required to attend 75% of the sessions, develop a leadership philosophy, and conduct some type of leadership presentation within their own department. Evaluation. Each year since 2010, the number of participating chiefs has risen (6, 9, 9). Evaluation data indicates a marked increase in before and after leadership knowledge and self-awareness. Additionally, chiefs have reported positive behavioral impacts regarding their leadership. Chiefs are the best advertising source for the program. Conclusions. The leadership program continues to evolve and evaluation results indicate that the content is instructive and the format is supportive for participants. Most chiefs recommend it highly for future chiefs.

http://www.pagepress.org/journals/index.php/med/article/view/5089 2014/07/26 - 03:49

Medical students experience stress during medical education that can negatively impact performance. Typical curricula in U.S. medical schools are rigorously intense and provide little or no time off between courses in the first two years of training. This intensity contributes to increased stress for students accustomed to performing academically near the top of the class prior to matriculating in medical school. We describe an innovative new academic calendar that was modified to create a Professional Enrichment Program. Students can step back from the rigors of coursework and engage in several types of activities in order to decompress from recent studying and examinations. These activities include electives, service opportunities, independent study, and clinical experiences that are self-selected by students. Students and faculty complete surveys about the activities they completed and the usefulness of their choices. Results show broad approval of the program with the greatest results supporting an appreciation of time to decompress and an increase in time for family and personal activities.

http://www.pagepress.org/journals/index.php/med/article/view/med.2013.e3 2013/08/13 - 06:49

Background. Faculty development is essential to provide skills not taught in typical medical training such as designing curricula or scientific writing, to help medical faculty acquire new skills valued today such as financial management, and to maintain institutional vitality. Faculty development receives relatively little attention in many medical schools and is narrowly focused upon teaching skills. Innovation. We propose a program that includes individual needs assessment and strategic planning. This strategy is consistent with Knowles’ principles of andragogy, a model of adult learning that differs in some ways from traditional pedagogy. We have included a self-assessment tool that may be useful to medical schools and an illustrative case study. Evaluation. We have introduced the self-assessment tool to a small number of faculty members who have found it clear and useful. We plan to introduce it to a large number of faculty members and to measure completion rates, perceived usefulness, and subsequent participation in faculty development activities and fulfillment of goals. Conclusions. Faculty development needs to be a higher priority in medical schools and to better reflect the current needs of faculty members. An individualized faculty development process has the potential to have a substantial impact upon acquisition of important skills, and faculty and institutional morale and vitality.

http://www.pagepress.org/journals/index.php/med/article/view/med.2013.e2 2013/02/19 - 04:41

There are deficiencies in trauma leader performance. Simulation training and video-based feedback can lead to durable changes in behavior. A trauma resuscitation team leader training curriculum was developed. The curriculum consisted of eight simulated trauma scenarios with a mix of acuities and injury patterns using patient simulators. Other team members included a surgeon, an anesthesiologist, a chief resident, a trauma nurse, a medical student, and presenting emergency medicine staff. Each scenario was followed by video-based feedback. Attitudes regarding this curriculum were evaluated before and after the intervention with Likert-based surveys. Eight residents completed the curriculum. On a seven-point Likert scale, the median overall curriculum rating, the video discussion quality, the plan to apply leadership skills, and the plan to apply learned knowledge and behaviors was 7/7. A Wilcoxon Sign-Rank test showed improved confidence for leading Level 1 trauma resuscitations, improved beliefs in adequate training, and improved attitudes regarding team leader training (P<0.05). There was reduced nervousness of being the team leader (P=0.048). Qualitative analyses showed that the learners valued the feedback process and scenario realism. This pilot curriculum was well-received by trauma residents and offers insight into meta-cognition of trauma team leaders.

http://www.pagepress.org/journals/index.php/med/article/view/med.2013.e1 2013/02/11 - 21:24

In many countries courses on Literature and Medicine (LitMed) are part of the medical curriculum, to develop and teach knowledge and skills in the area of Medical Humanities. We describe a LitMed course designed to encourage medical students at a university medical center to incorporate the biopsychosocial model into their clinical skills. A LitMed course for medical students is described and contextualized within the field of medical humanities with a focus on biopsychosocial responses to illness. The components of the course are presented, along with details of specific relevant novels employed, other study materials, and assignment examples. Preliminary evidence for positive course outcomes included students publishing peer reviewed papers, and enthusiastic faculty response. The course also led to renewed initiatives to incorporate LitMed in the medical curriculum. Suggestions for future teaching activities in this area are provided. Teaching a LitMed course is feasible, strengthens the adoption of a biopsychosocial approach in medical students, and is evaluated positively by students and staff from medical schools.

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e7 2012/09/27 - 11:30

As medical curricula evolve, many universities have adopted a clinical case-centered medical curriculum with a strong focus on small group learning and reduction of traditional lectures such that anatomy has become a self-taught subject supported by e-learning modules. One caveat of this approach is decreased student-faculty interaction and reduced student engagement. Thus use of e-learning must be balanced with the need for continued student-faculty interaction to promote healthy student engagement. To both support self-directed learning of anatomy and to simulate student-faculty interaction, we created the Virtual Anatomy Lab (VAL) that features a human pedagogical agent, called the eDemonstrator, who guides student navigation through the available learning resources. The VAL was evaluated using a mixed methods approach (usage statistics and focus groups) by two medical student populations at the University of Ottawa: first year medical students in a revised curriculum where anatomy lectures were abolished and laboratory sessions were self-taught, and second year medical students in the former curriculum in which anatomy lectures were given in advance of each laboratory session. We conclude that online modules such as the VAL, well designed with a human pedagogical agent, can be used within the curriculum without negatively impacting student engagement. Ethical Approval for this study was obtained from the Ottawa Hospital Research Ethics Board (protocol number #2009055-01H).

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e5 2012/07/31 - 19:38

The skill of communication is one of the foundation stones of medical practice and profoundly influences patient-care and health outcomes. The importance of teaching, assessing, and learning communication skills in undergraduate medical education is supported by the literature, as is continually addressing these skills in continuing medical education practice. The following article explores the innovative nature of a communication skills examination and feedback from medical students early in their clinical training in relation to a communication skills examination process. This process comprises a learning cycle of preparation, experience, self-appraisal, and examiner feedback. A total of 125 students provided feedback on this examination process by responding to four items related to this communication skills examination. The evaluation statistics showed that students responded favourably to the usefulness of the examination showing that all four domains are integral to the examination process. This communication skills examination process with its learning activities is effective on several levels as it provides a summative grade that can be used as a measure for competency and it creates a significant impact on learning.

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e6 2012/07/24 - 15:44

Faculty development is an imperative if institutions are to develop professional and competent teachers, educators, researchers and leaders. Planning of faculty development currently focuses on meeting the perceived needs of staff and their interests. We would like to propose the Compass Model as a conceptual framework to plan faculty development, which was inspired by the interplay between intrinsic and extrinsic forces for learning, as outlined in the Self-Determination Theory (SDT). In planning faculty development, the Compass Model acknowledges four agendas (directions) from various stakeholders: Strategies (N), Competencies (E), Resources (S) and Wish lists (W). The model then describes four avenues for faculty development offerings (quadrants): Foundation (NE), Innovation (SE), Response (SW) and Motivation (NW) (i.e. outputs, activities). The model was compared theoretically with another approach to faculty development planning. It was then piloted as a quality measure for a current program to check for omissions or missed opportunities. We plan to use it in a multi-center study to compare approaches in faculty development planning in different contexts. We hope our model assists faculty developers to consider all stakeholders’ agendas when planning faculty development, beyond the current standard customer-based approach.

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e4 2012/07/24 - 15:44

Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to medical students. There is a need to objectively measure the quality of this feedback. This paper describes the theoretical and empirical development of the Quality of Standardized Patient Feedback form (QSF), an instrument designed to measure the quality of standardized/simulated patient verbal feedback. The QSF consists of 7 categories derived from existing literature on feedback. Interrater and internal consistency reliabilities of QSF scores were calculated through two pilot studies. In the first, 2 standardized patient educators (SPEs) analyzed 14 videos of SP verbal feedback (weighted kappa = 0.73). In the second study, 14 SPs rated 3 videos (Intraclass correlation coefficient = 0.92. Internal reliability was 0.79 (Cronbach’s alpha). Twenty-one expert SPEs were asked to rate the QSF categories as to their importance in providing feedback to learners. SPEs agreed on the importance of five of the seven categories, but were split on the importance of two categories. We found theoretical and practical support for the QSF categories. The QSF is a useful instrument for evaluating the quality of SP verbal feedback.

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e3 2012/07/24 - 15:44

Despite an increase in the number of formal research courses and the support services that institutions provide, the success that students achieve is modest suggesting the involvement of other factors. The authors seek to determine the extent to which barriers and resources affect the ability for students to be successful in research endeavors. The authors distributed a cross-sectional survey via the Internet to members of the American Medical Association-Medical Student Section (AMAMSS) and the American Medical Student Association. The authors also distributed a paper version of the survey during the AMAMSS national conference in San Diego, CA, October 2010. The primary outcome was selfidentified successful research. The authors also assessed the supportive factors and barriers the respondents faced. 422 students completed the survey and identified having mentorship (OR 1.38, 95% CI 1.11-1.60), student funding (OR 1.52, 95% CI 1.26-1.69), and having an office or director of student research (OR 1.52, 95% CI 1.26-1.70) as factors associated with successfully publishing as a medical student. Barriers to success in student research included being unaware what research occurs locally (OR 1.36, 95% CI 1.05- 1.76), lacking faculty mentors (OR 1.45, 95% CI 1.07-1.95), and lack of a research office/coordinator (OR 1.53, 95% CI 1.18-2.00). The effects of the barriers were not offset by the research curricula provided. To improve the success of medical students involved in involved in research, academic medical institutions must address barriers directly in addition to offering curricula in research methods.

http://www.pagepress.org/journals/index.php/med/article/view/med.2012.e2 2012/07/24 - 15:44

As medical curricula evolve, many universities have adopted a clinical case-centered medical curriculum with a strong focus on small group learning and reduction of traditional lectures such that anatomy has become a self-taught subject supported by e-learning modules. One caveat of this approach is decreased student-faculty interaction and reduced student engagement. Thus use of e-learning must be balanced with the need for continued student-faculty interaction to promote healthy student engagement. To both support self-directed learning of anatomy and to simulate student-faculty interaction, we created the Virtual Anatomy Lab that features a human pedagogical agent, called the eDemonstrator, who guides student navigation through the available learning resources. The VAL was evaluated by two medical student populations at the University of Ottawa: first year medical students in a revised curriculum where anatomy lectures were abolished and laboratory sessions were self-taught, and second year medical students in the former curriculum in which anatomy lectures were given in advance of each laboratory session using a mixed-methods approach (surveys and focus groups). We conclude that online modules such as the VAL, well designed with a human pedagogical agent, can be used within the curriculum without negatively impacting student engagement.

http://www.pagepress.org/journals/index.php/med/article/view/4253 2012/06/21 - 19:19

Faculty development is an imperative if institutions are to develop professional and competent teachers, educators, researchers and leaders. Planning of faculty development currently focuses on meeting the perceived needs of staff and their interests. We would like to propose the Compass Model as a conceptual framework to plan faculty development, which was inspired by the interplay between intrinsic and extrinsic forces for learning, as outlined in the Self-Determination Theory (SDT). In planning faculty development, the Compass Model acknowledges four agendas (directions) from various stakeholders: Strategies (N), Competencies (E), Resources (S) and Wish lists (W). The model then describes four avenues for faculty development offerings (quadrants): Foundation (NE), Innovation (SE), Response (SW) and Motivation (NW) (i.e. outputs, activities). The model was compared theoretically with another approach to faculty development planning. It was then piloted as a quality measure for a current program to check for omissions or missed opportunities. We plan to use it in a multi-center study to compare approaches in faculty development planning in different contexts. We hope our model assists faculty developers to consider all stakeholders’ agendas when planning faculty development, beyond the current standard customer-based approach.

http://www.pagepress.org/journals/index.php/med/article/view/ed.2012.e4 2012/06/02 - 11:18

Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to medical students. There is a need to objectively measure the quality of this feedback. This paper describes the theoretical and empirical development of the Quality of Standardized Patient Feedback form (QSF), an instrument designed to measure the quality of standardized/simulated patient verbal feedback. The QSF consists of 7 categories derived from existing literature on feedback. Interrater and internal consistency reliabilities of QSF scores were calculated through two pilot studies. In the first, 2 standardized patient educators (SPEs) analyzed 14 videos of SP verbal feedback (weighted kappa = 0.73). In the second study, 14 SPs rated 3 videos (Intraclass correlation coefficient = 0.92. Internal reliability was 0.79 (Cronbach’s alpha). Twenty-one expert SPEs were asked to rate the QSF categories as to their importance in providing feedback to learners. SPEs agreed on the importance of five of the seven categories, but were split on the importance of two categories. We found theoretical and practical support for the QSF categories. The QSF is a useful instrument for evaluating the quality of SP verbal feedback.

http://www.pagepress.org/journals/index.php/med/article/view/ed.2012.e3 2012/03/30 - 19:19

Educators seek to influence attitudes as well as enhance knowledge and skills. We wanted to know how a one week course on global health had altered the attitudes of the learners. We were aware that analysing group responses to Likert items using an interval approach has methodological flaws. All 126 third-year students at Trinity College Medical School were invited to complete an attitude survey before and after the course, with 18 Likert items. Changes in attitudes to each item were analysed by interval and ordinal methods. A total of 82 (65%) students completed both surveys and gave consent. There was a nine-fold difference in attitude change by individual students. Attitudes changed markedly in relation to some items and little to others. Analysing responses using an ordinal method revealed significant change regardless of whether responses to each item before the course were clustered at one end of the scale or were more neutral. The most sensitive and reliable analysis was an ordinal approach, presenting degrees of attitude change by individuals to each item. When presented by the change step method in a histogram important attitude change by individuals within the group is revealed, that the interval method conceals.

http://www.pagepress.org/journals/index.php/med/article/view/ed.2012.e1 2012/03/28 - 23:36

Despite an increase in the number of formal research courses and the support services that institutions provide, the success that students achieve is modest suggesting the involvement of other factors. The authors seek to determine the extent to which barriers and resources affect the ability for students to be successful in research endeavors. The authors distributed a cross-sectional survey via the Internet to members of the American Medical Association-Medical Student Section (AMAMSS) and the American Medical Student Association. The authors also distributed a paper version of the survey during the AMAMSS national conference in San Diego, CA, October 2010. The primary outcome was selfidentified successful research. The authors also assessed the supportive factors and barriers the respondents faced. 422 students completed the survey and identified having mentorship (OR 1.38, 95% CI 1.11-1.60), student funding (OR 1.52, 95% CI 1.26-1.69), and having an office or director of student research (OR 1.52, 95% CI 1.26-1.70) as factors associated with successfully publishing as a medical student. Barriers to success in student research included being unaware what research occurs locally (OR 1.36, 95% CI 1.05- 1.76), lacking faculty mentors (OR 1.45, 95% CI 1.07-1.95), and lack of a research office/coordinator (OR 1.53, 95% CI 1.18-2.00). The effects of the barriers were not offset by the research curricula provided. To improve the success of medical students involved in involved in research, academic medical institutions must address barriers directly in addition to offering curricula in research methods.

http://www.pagepress.org/journals/index.php/med/article/view/ed.2012.e2 2012/03/02 - 22:32

Educators seek to influence attitudes as well as enhance knowledge and skills.  We wanted to know how a one week course on global health had altered the attitudes of the learners.  We were aware that analysing group responses to Likert items using an interval approach has methodological flaws.  All 126 third-year students at Trinity College Medical School were invited to complete an attitude survey before and after the course, with 18 Likert items.  Changes in attitudes to each item were analysed by interval and ordinal methods.  A total of 82 (65%) students completed both surveys and gave consent.  There was a nine-fold difference in attitude change by individual students.  Attitudes changed markedly in relation to some items and little to others.  Analysing responses using an ordinal method revealed significant change regardless of whether responses to each item before the course were clustered at one end of the scale or were more neutral.  The most sensitive and reliable analysis was an ordinal approach, presenting degrees of attitude change by individuals to each item.  When presented by the ‘change step’ method in a histogram important attitude change by individuals within the group is revealed, that the interval method conceals.

http://www.pagepress.org/journals/index.php/med/article/view/3587 2012/01/03 - 01:00

Successful completion of public health projects is critical to achieving population health objectives. However project execution can be challenging due to scarce time and resources, rapidly changing environments and complex stakeholder requirements. To address these challenges physicians and other professionals working in public health need to learn the practical skills of project management. However curricula tailored to project management skill development for public health professionals is not widely available. A one-week curriculum on project management for public health professionals has been developed enabling participants to independently lead small-scale public health projects. This course adapts a private-sector curriculum for use in public health practice and incorporates a unique skill-building teaching method. Evaluation of the initial curriculum delivery at the Weill-Bugando University, Tanzania indicated the majority of students intended to use project management upon return to their positions in public health. Students indicated a lack of a critical mass of public health professionals with required knowledge and skills represents the greatest barrier to integration of project management into public health practice. A unique one-week curriculum in project management has been developed and is being made publicly available. The course will enable physicians and other professionals working in public health to rapidly learn and apply the methodology to the front lines of public health.

http://www.pagepress.org/journals/index.php/med/article/view/med.2011.e6 2011/06/13 - 23:21

Explicit teaching of humanism is a goal of education reform, but specific strategies to do so are limited. The authors developed a longitudinal third-year medical student curriculum combining reflective and academic writing with literary reading and reflection to i) improve writing skills, ii) enhance scholarly activities, and iii) foster humanism in patient care. From 2005-2007, 24 third year Harvard Medical School (HMS) participated in a writing program at this hospital. All students completed pre/post surveys and qualitative assessments of the writing program. Students felt better-equipped to access resources (P=0.03), conduct a literature review (P<0.01), and understand the meaning of the patient’s narrative (P<0.01) after the program. Their total survey score (assessing writing skills and attitudes) was also significantly higher after the program (P=0.02). Students described positive effects of writing on self-acceptance, curiosity, and patient-centered care. Of the 24 students, 4 published 5 manuscripts in peer-reviewed journals in the first 2 years of the program. A writing curriculum focusing on humanism is feasible, and can enhance comfort with writing, early publication successes, self-awareness, and perceived humanistic qualities in the interactions of third-year students with their patients.

http://www.pagepress.org/journals/index.php/med/article/view/med.2011.e4 2011/04/12 - 14:28

The Accreditation Council for Graduate Medical Education (ACGME) requires U.S. physician training programs to teach and evaluate their trainees in six core competencies. Developing innovative methods to meet the ACGME requirements is an ongoing area of research in medical education. Here we describe the development of the Competency-based Objective Resident Education using Virtual Patients (CORE-VP) system, a web-based virtual patient simulator to teach and measure the ACGME core competencies. The user interface was built on Wavemaker technology including AJAX and javascript. A Flash component allows graphical navigation of the physical exam and linking of digital images and video to desired anatomic areas. The system contains tools for case authorship, management and execution and permits linking of files or web-based hypermedia content. Each case is designed to mimic a real-life patient encounter and includes history, physical exam, laboratory/ radiology, diagnosis and management. Automa­ted, multi-factorial, evaluation metrics were developed for each ACGME core competency. Upon completion of a case trainees receive immediate feedback in the form of an automated Performance Summary. We have developed a web-based virtual patient simulator called CORE-VP to teach and measure the ACGME core competencies. Work is currently underway to test and validate the system.

http://www.pagepress.org/journals/index.php/med/article/view/med.2011.e5 2011/03/18 - 05:10

Curricular integration is a primary focus of many efforts to improve clinical education, but the practical realities of connecting content across discipline-based learning experience is a formidable challenge. This paper describes the construction of a third-year clinical clerkship curriculum featuring integrated didactics, purposeful sequencing, linkage to clinical context and introduction of competency-based learning activities. We describe the organization of our curriculum, the methods by which we integrated our didactic curriculum, and the results of curricular evaluations. Over two years, we improved integration and reduced fragmented learning experiences in a longitudinal integrated clerkship. Individual lectures were highly rated with a mean overall score of 4.29 (SD=0.78) (1=poor, 5= excellent)(N=23). Integrated didactic sessions and competency-based learning activities, including a quality improvement curriculum and reflection sessions, were also highly rated. Purposeful integration of clinical content, sequencing of didactics across the academic year, linking didactic content to a clinical context and creating new competency-based learning activities were highly rated and feasible ways to combine didactics across disciplines in the core clerkship year. Similar integrated curricula may be used with students in longitudinal integrated clerkships or in a traditional third-year clerkship model.

http://www.pagepress.org/journals/index.php/med/article/view/med.2011.e1 2011/02/18 - 01:14

Although proposals for more public health education go back to 1855, the Institute of Medicine’s (IOM) landmark report, The Future of Public Health (1988) set the modern stage for reform of medical student education regarding public health. The momentum to improve and increase public health education has grown over the last several decades. The authors present the design of a unique public health clerkship for third and fourth year medical students, the Public Health Field Practicum. Students spend four weeks in an integrated program of public/environmental health activities, coupled with weekly didactic and feedback sessions with the course directors. Ten students have completed the practicum since its inception in March 2007. Significant increases in knowledge, desire to include public health in their medical career, and satisfaction are documented. Students gained substantial insight into public health and how it functions in the real world. This training requires a partnership between schools of public health and medicine and local/state health departments. Medical schools should develop these relationships to provide experiential public health opportunities for their students.

http://www.pagepress.org/journals/index.php/med/article/view/med.2011.e3 2011/02/18 - 01:14