Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. Th...Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos' clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.展开更多
Background: Assessment is the systematic collection, review, and use of information about educational programs undertaken to improve teaching and learning. It ensures quality in training programmes, motivates, and dir...Background: Assessment is the systematic collection, review, and use of information about educational programs undertaken to improve teaching and learning. It ensures quality in training programmes, motivates, and directs students’ learning. Assessment is also used for verification of achievement of objectives of training, feedback to students, licencing, certification, and screening of students for advanced training. It is guided by several principles, including the aims of the assessment (why assess), who to assess, timing (when to assess), what to assess, methods (how to assess), and the criteria for determining the usefulness of the assessment. Objective: To describe the assessment methods used during clinical years of the undergraduate programme at Moi University School of Medicine (MUSOM) and determine the student’s perspectives concerning the comprehensiveness, relevance, objectivity of various assessment methods and challenges faced. Methodology: The study was carried out at MUSOM and a cross-sectional study design was employed. Ten study participants were studied using convenience sampling. Data were collected using an interview guide and was analyzed using content analysis. An informed consent was obtained from the study participants. Results: The methods used during clinical years at MUSOM for assessing knowledge and its applications include multiple-choice questions (MCQ), short answer questions (SAQ), modified essay questions (MEQ), long essay questions (LEQ), and oral exam. Whereas the methods for assessing clinical competence include long case, short cases, objective structured clinical examinations (OSCE), and logbook. Students felt that MCQs were comprehensive, objective, and relevant to the curriculum content. They reported that feedback was not provided after assessments. Conclusion: The assessment methods used at MUSOM during clinical years include MCQ, SAQ, MEQ, LEQ, Short cases, long cases, and OSCE. Students reported varied perceptions of the different assessment methods but favored MCQ and OSCE over other formats for assessing knowledge and clinical skills respectively.展开更多
The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner,his public disclosure of the poor conditions at many medical schools provided a means to ga...The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner,his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur.He could say what other reformers could not,due to their links to the medical education community.But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students,the decline in the number and quality of investigator initiated research among clinical researchers,lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis,poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes.The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations.This de-Flexnerization trend and regression to pre-Flexnerian era standards,ideologies,structures,processes,and attitudes,are bound to beget pre-Flexnerian outcomes,for you get what you designed for.展开更多
This pilot study evaluated effectiveness and acceptance of a new hospital-based reproductive endocrinology curriculum among Iranian medical students. A voluntary, anonymous questionnaire was used to compare two teachi...This pilot study evaluated effectiveness and acceptance of a new hospital-based reproductive endocrinology curriculum among Iranian medical students. A voluntary, anonymous questionnaire was used to compare two teaching methods as applied to junior medical students at Tehran University of Medical Sciences. Students were randomly assigned to one of two clinical teaching settings;no student experienced both modules. Coursework for the pilot (experimental) group (n = 19) utilized a teaching approach comprising lectures, genetics laboratory, pelvic ultrasound, small group sessions, and opportunities to observe advanced reproductive technologies such as in vitro fertilization, ICSI, and embryo transfer. A control group (n = 34) received reproductive endocrinology instruction by the ‘traditional curriculum’, consisting mainly of lectures. Students were sampled at baseline and again atthe conclusion of their reproductive endocrinology session. Pre- and post-test data were analyzed for both groups;post-test differences between groups were also compared. No significant differences in mean age or gender mix were identified between the two study groups. Overall, the ques- tionnaire did not identify any significant intergroup differences for any parameter investigated. Although student acceptance rate appeared similar for both educational modules, the ratio of students having a “favorable regard” for reproductive medicine declined only among students randomized to the control group (41.2% vs. 32.3%). This report offers the first data on teaching reproductive endocrinology to medical students in Iran. Both traditional and innovative approaches to teaching reproductive endocrinology were well-accepted by students, although negative post-test responses were more common among students in the control group. While periodic quality assessments for existing clinical teaching methods are necessary, introduction of alternative teaching approaches is also important. Additional studies are planned to evaluate the impact this initiative may have on results on standardized tests measuring reproductive endocrinology knowledge, as well as election of further specialization in training.展开更多
Background: Negative stress symptoms are reported in the literature among clinical dental and medical students and can include signs of anxiety or depression. However, very little has been researched about existing ps...Background: Negative stress symptoms are reported in the literature among clinical dental and medical students and can include signs of anxiety or depression. However, very little has been researched about existing psychological preconditions of these students that could make them more vulnerable to negative stress symptoms. Objective: The aims were to explore first year clinical dental and medical students’ experiences of stress intensity, stress sensitivity and signs of anxiety or depression. Gender was also explored as a possible predictor of these psychosocial phenomena. Methods: First year clinical students at Aarhus University dental (n = 49) and medical schools (n = 59) were recruited to fill out a 45-item questionnaire that comprised demographics and three scales: Cohens Perceived Personal Stress (PPS-10), Stress Sensitivity Inventory (SSI) and Depression Anxiety & Stress Scale (DASS-21). Groups and genders were compared by frequency and using association statistics, bivariate odds ratios, nominal logistic regression and ANOVA. Results: Stress intensity perceptions were moderate to high for many. Dental students scored higher than medical students on all mean test scores. In general, women showed higher levels of stress than men. Dental students scored significantly higher than medical students on Depression, Anxiety and Chronic Stress with ANOVA tests. However, when gender, age and medical or dental student status were added into a logistic regression analysis in which high stress sensitivity was the main dependent variable, only high scores in perceived stress intensity and signs of depression and anxiety showed significant main effects. Conclusion: Present study confirmed the literature that reports high degrees of stress among dental and medical students. But more importantly, Stress Sensitivity Inventory appeared to be a reliable and excellent predictor of high perceived stress and signs of depression and anxiety. It can be useful to detect and prevent student psychosocial dysfunction in clinical learning environments. An important challenge for medical and dental educational institutions is to provide specific student emotional support as early as needed as well as to consider appropriate stress prevention curriculum reforms.展开更多
Objectives: Although effective performance in clinical settings requires the integration between theory and practice,there is a gap between theoretical knowledge as taught in the classroom and what the students experi...Objectives: Although effective performance in clinical settings requires the integration between theory and practice,there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings.This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings.Methods: A qualitative study was adopted with a conventional content analysis approach.Fifteen nursing and paramedic's students,faculty members and experienced nursing staff participated in the study.Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10.Results: Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e.non-standard practices in clinical settings;lack of trust in clinical competence;lack of perceived professional support;insufficiencies in teaching and learning process;and differences between doing things in simulated and real clinical situations.Conclusion: Transferring theory into practice in a structured manner requires professional support in the workplace,trust and the opportunity for direct experience,using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios.展开更多
BACKGROUND System based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficu...BACKGROUND System based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless,structured assessment is required for training programs. We hypothesized that objective structured clinical examination(OSCE) would be an effective tool for assessment of SBP.AIM To develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.METHODS For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twentysix first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.RESULTS Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22(SBP1), 4.34(SBP2), 3.35(SBP3), and 6.42(SBP4)out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training,and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was "very useful." One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.CONCLUSION OSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP.展开更多
基于问题导向式的临床教学模式(problem based learning,PBL)是指通过问题案例或场景使学生确定自己的学习目标,且经由学生自我独立式学习和小组讨论以完善知识。经过60余年的教学实践,在世界许多国家的临床医学教育中都取得了良好的效...基于问题导向式的临床教学模式(problem based learning,PBL)是指通过问题案例或场景使学生确定自己的学习目标,且经由学生自我独立式学习和小组讨论以完善知识。经过60余年的教学实践,在世界许多国家的临床医学教育中都取得了良好的效果,PBL引入我国也有近30年的历史,其在我国临床医学教育的应用中仍然处于探索和改革的阶段。文章就PBL在国内中西医结合临床各科室中的教学现状进行总结,发现其对提高学生积极性,改善学习效果,提高学生的教学满意度等方面效果较好,同时探讨其目前存在的问题,并针对现有的问题提出应对策略,如“靶向PBL教学”模式,以期为未来的医学临床教育提供思路。展开更多
文摘Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos' clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.
文摘Background: Assessment is the systematic collection, review, and use of information about educational programs undertaken to improve teaching and learning. It ensures quality in training programmes, motivates, and directs students’ learning. Assessment is also used for verification of achievement of objectives of training, feedback to students, licencing, certification, and screening of students for advanced training. It is guided by several principles, including the aims of the assessment (why assess), who to assess, timing (when to assess), what to assess, methods (how to assess), and the criteria for determining the usefulness of the assessment. Objective: To describe the assessment methods used during clinical years of the undergraduate programme at Moi University School of Medicine (MUSOM) and determine the student’s perspectives concerning the comprehensiveness, relevance, objectivity of various assessment methods and challenges faced. Methodology: The study was carried out at MUSOM and a cross-sectional study design was employed. Ten study participants were studied using convenience sampling. Data were collected using an interview guide and was analyzed using content analysis. An informed consent was obtained from the study participants. Results: The methods used during clinical years at MUSOM for assessing knowledge and its applications include multiple-choice questions (MCQ), short answer questions (SAQ), modified essay questions (MEQ), long essay questions (LEQ), and oral exam. Whereas the methods for assessing clinical competence include long case, short cases, objective structured clinical examinations (OSCE), and logbook. Students felt that MCQs were comprehensive, objective, and relevant to the curriculum content. They reported that feedback was not provided after assessments. Conclusion: The assessment methods used at MUSOM during clinical years include MCQ, SAQ, MEQ, LEQ, Short cases, long cases, and OSCE. Students reported varied perceptions of the different assessment methods but favored MCQ and OSCE over other formats for assessing knowledge and clinical skills respectively.
文摘The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner,his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur.He could say what other reformers could not,due to their links to the medical education community.But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students,the decline in the number and quality of investigator initiated research among clinical researchers,lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis,poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes.The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations.This de-Flexnerization trend and regression to pre-Flexnerian era standards,ideologies,structures,processes,and attitudes,are bound to beget pre-Flexnerian outcomes,for you get what you designed for.
文摘This pilot study evaluated effectiveness and acceptance of a new hospital-based reproductive endocrinology curriculum among Iranian medical students. A voluntary, anonymous questionnaire was used to compare two teaching methods as applied to junior medical students at Tehran University of Medical Sciences. Students were randomly assigned to one of two clinical teaching settings;no student experienced both modules. Coursework for the pilot (experimental) group (n = 19) utilized a teaching approach comprising lectures, genetics laboratory, pelvic ultrasound, small group sessions, and opportunities to observe advanced reproductive technologies such as in vitro fertilization, ICSI, and embryo transfer. A control group (n = 34) received reproductive endocrinology instruction by the ‘traditional curriculum’, consisting mainly of lectures. Students were sampled at baseline and again atthe conclusion of their reproductive endocrinology session. Pre- and post-test data were analyzed for both groups;post-test differences between groups were also compared. No significant differences in mean age or gender mix were identified between the two study groups. Overall, the ques- tionnaire did not identify any significant intergroup differences for any parameter investigated. Although student acceptance rate appeared similar for both educational modules, the ratio of students having a “favorable regard” for reproductive medicine declined only among students randomized to the control group (41.2% vs. 32.3%). This report offers the first data on teaching reproductive endocrinology to medical students in Iran. Both traditional and innovative approaches to teaching reproductive endocrinology were well-accepted by students, although negative post-test responses were more common among students in the control group. While periodic quality assessments for existing clinical teaching methods are necessary, introduction of alternative teaching approaches is also important. Additional studies are planned to evaluate the impact this initiative may have on results on standardized tests measuring reproductive endocrinology knowledge, as well as election of further specialization in training.
文摘Background: Negative stress symptoms are reported in the literature among clinical dental and medical students and can include signs of anxiety or depression. However, very little has been researched about existing psychological preconditions of these students that could make them more vulnerable to negative stress symptoms. Objective: The aims were to explore first year clinical dental and medical students’ experiences of stress intensity, stress sensitivity and signs of anxiety or depression. Gender was also explored as a possible predictor of these psychosocial phenomena. Methods: First year clinical students at Aarhus University dental (n = 49) and medical schools (n = 59) were recruited to fill out a 45-item questionnaire that comprised demographics and three scales: Cohens Perceived Personal Stress (PPS-10), Stress Sensitivity Inventory (SSI) and Depression Anxiety & Stress Scale (DASS-21). Groups and genders were compared by frequency and using association statistics, bivariate odds ratios, nominal logistic regression and ANOVA. Results: Stress intensity perceptions were moderate to high for many. Dental students scored higher than medical students on all mean test scores. In general, women showed higher levels of stress than men. Dental students scored significantly higher than medical students on Depression, Anxiety and Chronic Stress with ANOVA tests. However, when gender, age and medical or dental student status were added into a logistic regression analysis in which high stress sensitivity was the main dependent variable, only high scores in perceived stress intensity and signs of depression and anxiety showed significant main effects. Conclusion: Present study confirmed the literature that reports high degrees of stress among dental and medical students. But more importantly, Stress Sensitivity Inventory appeared to be a reliable and excellent predictor of high perceived stress and signs of depression and anxiety. It can be useful to detect and prevent student psychosocial dysfunction in clinical learning environments. An important challenge for medical and dental educational institutions is to provide specific student emotional support as early as needed as well as to consider appropriate stress prevention curriculum reforms.
基金Maragheh University of Medical Sciences provided financial resources
文摘Objectives: Although effective performance in clinical settings requires the integration between theory and practice,there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings.This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings.Methods: A qualitative study was adopted with a conventional content analysis approach.Fifteen nursing and paramedic's students,faculty members and experienced nursing staff participated in the study.Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10.Results: Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e.non-standard practices in clinical settings;lack of trust in clinical competence;lack of perceived professional support;insufficiencies in teaching and learning process;and differences between doing things in simulated and real clinical situations.Conclusion: Transferring theory into practice in a structured manner requires professional support in the workplace,trust and the opportunity for direct experience,using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios.
文摘BACKGROUND System based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless,structured assessment is required for training programs. We hypothesized that objective structured clinical examination(OSCE) would be an effective tool for assessment of SBP.AIM To develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.METHODS For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twentysix first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.RESULTS Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22(SBP1), 4.34(SBP2), 3.35(SBP3), and 6.42(SBP4)out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training,and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was "very useful." One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.CONCLUSION OSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP.
文摘基于问题导向式的临床教学模式(problem based learning,PBL)是指通过问题案例或场景使学生确定自己的学习目标,且经由学生自我独立式学习和小组讨论以完善知识。经过60余年的教学实践,在世界许多国家的临床医学教育中都取得了良好的效果,PBL引入我国也有近30年的历史,其在我国临床医学教育的应用中仍然处于探索和改革的阶段。文章就PBL在国内中西医结合临床各科室中的教学现状进行总结,发现其对提高学生积极性,改善学习效果,提高学生的教学满意度等方面效果较好,同时探讨其目前存在的问题,并针对现有的问题提出应对策略,如“靶向PBL教学”模式,以期为未来的医学临床教育提供思路。