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1.  Survey of undergraduate teaching in genitourinary medicine in Britain. 
Genitourinary Medicine  1994;70(5):311-313.
OBJECTIVE--To determine whether the time allocated for undergraduate teaching of genitourinary medicine has changed since 1984 and to determine the impact of HIV/AIDS on the teaching of the specialty. METHODS--A self completion questionnaire was sent to the consultant in charge of each department of genitourinary medicine attached to a UK medical school. RESULTS--Replies were received from all twenty seven medical schools. Most schools (24/27) offer a course of lectures accompanied by clinical teaching; however, one medical school does not include teaching of genitourinary medicine in the undergraduate curriculum at all and two others are unable to offer all students clinical tuition. The mean time devoted to lectures is 6.7 hours (range 0-15 hours) made up of 4.8 hours of genitourinary medicine lectures and 1.9 hours of lectures on HIV/AIDS. The mean time allocated for clinic-based teaching of each student is 9.2 hours (range 0-27 hours). On average the time allocated for lecturing and clinical teaching of the speciality has decreased since 1984 although there is considerable variation between schools (time for clinical teaching and lecturing combined ranges from 0-41.0 hours). CONCLUSIONS--The findings of this survey suggest there is considerable variation in both the quantity and quality of undergraduate teaching of genitourinary medicine provided throughout the UK.
PMCID: PMC1195272  PMID: 8001940
2.  An audit of university education in trauma and orthopaedic surgery in Great Britain. 
An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools. To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set.
PMCID: PMC1294726  PMID: 1433062
3.  Evaluation of Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) as a tool for Assessing the Cognitive Skills of Undergraduate Medical Students 
Developing and testing the cognitive skills and abstract thinking of undergraduate medical students are the main objectives of problem based learning. Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) may both be designed to test these skills. The objectives of this study were to assess the effectiveness of both forms of questions in testing the different levels of the cognitive skills of undergraduate medical students and to detect any item writing flaws in the questions.
A total of 50 MEQs and 50 MCQs were evaluated. These questions were chosen randomly from various examinations given to different batches of undergraduate medical students taking course MED 411–412 at the Department of Medicine, Qassim University from the years 2005 to 2009. The effectiveness of the questions was determined by two assessors and was defined by the question’s ability to measure higher cognitive skills, as determined by modified Bloom’s taxonomy, and its quality as determined by the presence of item writing flaws. ‘SPSS15’ and ‘Medcalc’ programs were used to tabulate and analyze the data.
The percentage of questions testing the level III (problem solving) cognitive skills of the students was 40% for MEQs and 60% for the MCQs; the remaining questions merely assessed the recall and comprehension. No significant difference was found between MEQ and MCQ in relation to the type of questions (recall; comprehension or problem solving x2 = 5.3, p = 0.07).The agreement between the two assessors was quite high in case of MCQ (kappa=0.609; SE 0.093; 95%CI 0.426 – 0.792) but lower in case of MEQ (kappa=0.195; SE 0.073; 95%CI 0.052 – 0.338). 16% of the MEQs and 12% of the MCQs had item writing flaws.
A well constructed MCQ is superior to MEQ in testing the higher cognitive skills of undergraduate medical students in a problem based learning setup. Constructing an MEQ for assessing the cognitive skills of a student is not a simple task and is more frequently associated with item writing flaws.
PMCID: PMC3312767  PMID: 22489228
Modified essay question; Multiple-choice question; Bloom’s Taxonomy; cognition
4.  Interns' knowledge of clinical pharmacology and therapeutics after undergraduate and on-going internship training in Nigeria: a pilot study 
A sound knowledge of pathophysiology of a disease and clinical pharmacology and therapeutics (CPT) of a drug is required for safe and rational prescribing. The aim of this study was therefore to assess how adequately the undergraduate CPT teaching had prepared interns in Nigeria for safe and rational prescribing and retrospectively, to know how they wanted the undergraduate curriculum to be modified so as to improve appropriate prescribing. The effect of internship training on the prescribing ability of the interns was also sought.
A total of 100 interns were randomly selected from the Lagos State University Teaching Hospital (LASUTH), Ikeja; Lagos University Teaching Hospital (LUTH), Idiaraba; General Hospital Lagos (GHL); the EKO Hospital, Ikeja; and Havana Specialist Hospital, Surulere. A structured questionnaire was the instrument of study. The questionnaire sought information about the demographics of the interns, their undergraduate CPT teaching, experience of adverse drug reactions (ADRs) and drug interactions since starting work, confidence in drug usage and, in retrospect; any perceived deficiencies in their undergraduate CPT teaching.
The response rate was 81%. All the respondents graduated from universities in Nigeria. The ability of the interns to prescribe rationally (66, 81.4%) and safely (47, 58%) was provided by undergraduate CPT teaching. Forty two (51.8%) respondents had problems with prescription writing. The interns would likely prescribe antibiotics (71, 87.6%), nonsteroidal analgesics (66, 81.4%), diuretics (55, 67.9%), sedatives (52, 62.9%), and insulin and oral hypoglycaemics (43, 53%) with confidence and unsupervised. The higher the numbers of clinical rotations done, the more confident were the respondents to prescribe unsupervised (χ2 = 19.98, P < 0.001). Similarly, respondents who had rotated through the four major clinical rotations and at least a special posting (χ2 = 11.57, P < 0.001) or four major clinical rotations only (χ2 = 11.25, P < 0.001) were significantly more confident to prescribe drugs unsupervised.
Undergraduate CPT teaching in Nigeria appears to be deficient. Principles of rational prescribing, drug dose calculation in children and pharmacovigilance should be the focus of undergraduate CPT teaching and should be taught both theoretically and practically. Medical students and interns should be periodically assessed on prescribing knowledge and skills during their training as a means of minimizing prescribing errors.
PMCID: PMC2724475  PMID: 19638199
5.  Does clinical teacher training always improve teaching effectiveness as opposed to no teacher training? A randomized controlled study 
Teacher training may improve teaching effectiveness, but it might also have paradoxical effects. Research on expertise development suggests that the integration of new strategies may result in a temporary deterioration of performance until higher levels of competence are reached. In this study, the impact of a clinical teacher training on teaching effectiveness was assessed in an intensive course in emergency medicine. As primary study outcome students’ practical skills at the end of their course were chosen.
The authors matched 18 clinical teachers according to clinical experience and teaching experience and then randomly assigned them to a two-day-teacher training, or no training. After 14 days, both groups taught within a 12-hour intensive course in emergency medicine for undergraduate students. The course followed a clearly defined curriculum. After the course students were assessed by structured clinical examination (SCE) and MCQ. The teaching quality was rated by students using a questionnaire.
Data for 96 students with trained teachers, and 97 students with untrained teachers were included. Students taught by untrained teachers performed better in the SCE domains ‘alarm call’ (p < 0.01) and ‘ventilation’ (p = 0.01), while the domains ‘chest compressions’ and ‘use of automated defibrillator’ did not differ. MCQ scores revealed no statistical difference. Overall, teaching quality was rated significantly better by students of untrained teachers (p = 0.05).
At the end of a structured intensive course in emergency medicine, students of trained clinical teachers performed worse in 2 of 4 practical SCE domains compared to students of untrained teachers. In addition, subjective evaluations of teaching quality were worse in the group of trained teachers. Difficulties in integrating new strategies in their teaching styles might be a possible explanation.
PMCID: PMC3893403  PMID: 24400838
Expertise; Faculty development; Standardized clinical examination; Teacher training; Teaching effectiveness
6.  The Trauma Evaluation and Management (TEAM) teaching module: its role for senior medical students in Canada 
Canadian Journal of Surgery  2003;46(2):99-102.
The objective of this study was to report on the role of the Trauma Evaluation and Management (TEAM) module devised by the American College of Surgeons in the trauma education of senior medical students.
Twenty-nine medical students who completed their surgical clerkship at the University of Toronto were randomly divided into 2 groups: a control and a TEAM group. All students completed a 20-item multiple-choice questionnaire (MCQ) pre-test. The TEAM group (15 students) took a post-test after completing the TEAM program and the control group (14 students) took the same “post-test” without completing the TEAM program. Students in the control group did complete the TEAM program after taking the post-test, allowing all 29 students to complete a post-module evaluation questionnaire. Paired t-tests were used for within group comparisons and unpaired t-tests for between group comparisons. The results of the evaluation questionnaire were analyzed according to the percentage of response in each of 5 categories of 1 = strongly disagree to 5 = strongly agree, as well as according to the median, range and 95% confidence intervals.
The students had similar mean (± standard deviation) scores on the MCQ pre-test (TEAM 46.3 [5.5], control 47.5 [9.9]), but the TEAM group showed a significant (p < 0.05) improvement in their scores after they completed the TEAM program (TEAM 80.7 [11.5], control 44.6 [6.3]). Eight of the 15 students in the TEAM group reached the Advanced Trauma Life Support (ATLS) pass mark of 80%, whereas none in the control group achieved this mark. With respect to the evaluation questionnaire, a score of 4 or greater was assigned by 100% of the students when asked if the objectives were met, 100% when asked if trauma knowledge was improved, 62% when asked whether clinical trauma skills were improved, 100% for overall satisfaction and 100% in recommending that the module be made mandatory in the undergraduate curriculum.
This study demonstrates the teaching effectiveness of the TEAM module. It also was very well accepted by the senior medical students who unanimously indicated that this module should be mandatory in the undergraduate medical curriculum.
PMCID: PMC3211688  PMID: 12691345
7.  Attitude, perception and feedback of second year medical students on teaching–learning methodology and evaluation methods in pharmacology: A questionnaire-based study 
To assess the student's attitude, perception and feedback on teaching–learning methodology and evaluation methods in pharmacology.
Materials and Methods:
One hundred and forty second year medical students studying at Smt. Kashibai Navale Medical College, Pune, were selected. They were administered a pre-validated questionnaire containing 22 questions. Suggestions were also asked regarding the qualities of good pharmacology teachers and modification in pharmacology teaching methods. Descriptive statistics were used and results were expressed as percentage.
Majority of the students found cardiovascular system (49.25%) as the most interesting topic in pharmacology, whereas most of the students opined that cardiovascular system (60.10%), chemotherapy (54.06%) and central nervous system (44.15%) are going to be the most useful topics in internship. 48.53% students preferred clinical/patient-related pharmacology and 39.13% suggested use of audiovisual-aided lectures. Prescription writing and criticism of prescription were amongst the most useful and interesting in practical pharmacology. Students expressed interest in microteaching and problem-based learning, whereas seminars, demonstrations on manikin and museum studies were mentioned as good adjuvants to routine teaching. Multiple Choice Question (MCQ) practice tests and theory viva at the end of a particular system and periodical written tests were mentioned as effective evaluation methods. Students were found to have lot of interest in gathering information on recent advances in pharmacology and suggested to include new drug information along with prototype drugs in a comparative manner.
There is a need of conducting few microteaching sessions and more of clinical-oriented problem-based learning with MCQ-based revisions at the end of each class in the pharmacology teaching at undergraduate level.
PMCID: PMC3644742  PMID: 23661897
Evaluation methods; medical students; pharmacology; teaching–learning methodology
8.  Assessment of an undergraduate psychiatry course in an African setting 
International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper.
An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination.
There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%–84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards.
The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard.
PMCID: PMC2383891  PMID: 18430237
9.  Efficacy and perceived utility of podcasts as a supplementary teaching aid among first-year dental students 
The Australasian Medical Journal  2013;6(9):450-457.
The advent of newer technology and students’ growing familiarity with it has enabled information providers to introduce newer teaching methods such as audio podcasting in education. Inclusion of audio podcasts as a teaching aid for undergraduate medical or dental students could serve as a useful supplement to make reviewing more convenient and to enhance understanding and recall of the subject matter.
To assess the efficacy of podcasts as a supplementary teaching and learning aid for first-year dental students of Manipal.
To study students’ attitudes towards audio podcasts and perceived utility of podcasts.
This study was conducted at the Manipal College of Dental Sciences, India. The participants were first-year dental students. Live lecture classes were conducted for the students (n=80). The students were then divided randomly into two equal groups of 40 each. Group 1 students (n=40) had a study session followed by a multiple choice question (MCQ) test. This was followed by a podcasting session. Group 2 students had a study session along with an opportunity to listen to a podcast, followed by the test. Following this both groups completed a feedback form intended to assess their perceived utility and attitude towards podcasts. The performance score was analysed using SPSS and an independent sample t test was used to test the significance of differences in the mean score between the two groups.
Our analysis revealed a significant difference (p = 0.000) in the mean score between the two groups. Group 1 scored a mean of 7.95 out of 13 and group 2 scored a mean of 6.05 out of 13. Analysis of the feedback forms showed that 91.3 per cent of the students found the podcasts useful, as they could listen to lecture content repeatedly and at their own convenience. Sixty-three per cent of the students, however, felt that the absence of images and diagrams in podcasts was a disadvantage.
Students benefited when podcasts were used to supplement live lectures and textbook content. This was indicated by better student performance in the podcast group. Also, students showed a favourable attitude for podcasts being used as a supplementary teaching and learning aid.
PMCID: PMC3794415  PMID: 24133537
Audio podcasts; dental students; student attitude
10.  A Model for Persistent Improvement of Medical Education as Illustrated by the Surgical Reform Curriculum HeiCuMed 
Background: Heidelberg Medical School underwent a major curricular change with the implementation of the reform curriculum HeiCuMed (Heidelberg Curriculum Medicinale) in October 2001. It is based on rotational modules with daily cycles of interactive, case-based small-group seminars, PBL tutorials and training of sensomotor and communication skills. For surgical undergraduate training an organisational structure was developed that ensures continuity of medical teachers for student groups and enables their unimpaired engagement for defined periods of time while accounting for the daily clinical routine in a large surgery department of a university hospital. It includes obligatory didactic training, standardising teaching material on the basis of learning objectives and releasing teaching doctors from clinical duties for the duration of a module.
Objective: To compare the effectiveness of the undergraduate surgical reform curriculum with that of the preceding traditional one as reflected by students' evaluations.
Method: The present work analyses student evaluations of the undergraduate surgical training between 1999 and 2008 including three cohorts (~360 students each) in the traditional curriculum and 13 cohorts (~150 students each) in the reform curriculum.
Results: The evaluation of the courses, their organisation, the teaching quality, and the subjective learning was significantly better in HeiCuMed than in the preceding traditional curriculum over the whole study period.
Conclusion: A medical curriculum based on the implementation of interactive didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching. The organisational strategy adopted in the surgical training of HeiCuMed has been successful in enabling the maintenance of a complex modern curriculum on a continuously high level within the framework of a busy surgical environment.
PMCID: PMC3149464  PMID: 21818239
Medical education; undergraduate surgery curriculum; evaluation
Assessment has a powerful influence on curriculum delivery. Medical instructors must use tools which conform to educational principles, and audit them as part of curriculum review.
To generate information to support recommendations for improving curriculum delivery.
Pre-clinical and clinical departments in a College of Medicine, Saudi Arabia.
A self-administered questionnaire was used in a cross-sectional survey to see if assessment tools being used met basic standards of validity, reliability and currency, and if feedback to students was adequate. Excluded were cost, feasibility and tool combinations.
Thirty-one (out of 34) courses were evaluated. All 31 respondents used MCQs, especially one-best (28/31) and true/false (13/31). Groups of teachers selected test questions mostly. Pre-clinical departments sourced equally from “new” (10/14) and “used” (10/14) MCQs; clinical departments relied on ‘banked’ MCQs (16/17). Departments decided pass marks (28/31) and chose the College-set 60%; the timing was pre-examination in 13/17 clinical but post-examination in 5/14 pre-clinical departments. Of six essay users, five used model answers but only one did double marking. OSCE was used by 7/17 clinical departments; five provided checklist. Only 3/31 used optical reader. Post-marking review was done by 13/14 pre-clinical but 10/17 clinical departments. Difficulty and discriminating indices were determined by only 4/31 departments. Feedback was provided by 12/14 pre-clinical and 7/17 clinical departments. Only 10/31 course coordinators had copies of examination regulations.
MCQ with single-best answer, if properly constructed and adequately critiqued, is the preferred tool for assessing theory domain. However, there should be fresh questions, item analyses, comparisons with pervious results, optical reader systems and double marking. Departments should use OSCE or OSPE more often. Long essays, true/false, fill-in-the-blank-spaces and more-than-one-correct-answer can be safely abolished. Departments or teams should set test papers and collectively take decisions. Feedback rates should be improved. A Center of Medical Education, including an Examination Center is required. Fruitful future studies can be repeat audit, use of “negative questions” and the number of MCQs per test paper. Comparative audit involving other regional medical schools may be of general interest.
PMCID: PMC3410120  PMID: 23012084
Assessment Technique; Curriculum review; MCQ
12.  Station-based deconstructed training model for teaching procedural skills to medical students: a quasi-experimental study 
Every procedural skill consists of some microskills. One of the effective techniques for teaching a main procedural skill is to deconstruct the skill into a series of microskills and train students on each microskill separately. When we learn microskills, we will learn the main skill also. This model can be beneficial for tuition on procedural skills.
In this study, we propose a stationed-based deconstructed training model for tuition of each microskill, and then we assessed the medical students’ self-perceived abilities.
This quasi-experimental study was conducted in 268 medical students (536 matched pre- and post-questionnaires) at the surgical clerkship stage during five consecutive years in three teaching and learning groups. In this study, we taught each skill in 10 steps (proposed model) to the students. We then evaluated the students’ self-perceived abilities using a pre- and post-self-assessment technique. SPSS v13 software with one-way analysis of variance and paired t-tests were used for data collection and analysis.
Assessment of medical students’ perceived abilities before and after training showed a significant improvement (P < 0.001) in both cognitive and practical domains. There were also significant differences between the three teaching and learning groups (P < 0.001). There were no significant differences for the different years of training regarding the observed improvement.
This study suggests that deconstructing the practical skills into microskills and tuition of those microskills via the separated structured educational stations is effective according to the students’ self-ratings.
PMCID: PMC3643127  PMID: 23745058
clinical skills center; microskills; perceived ability; self-assessment; self-scoring stationed training
13.  Integrative vs. Traditional Learning from the Student Perspective 
Background: The interdisciplinary surgery block of the reformed undergraduate curriculum HeiCuMed includes daily cycles of interactive case-based seminars, problem-based tutorials, case presentation by students, skills and communication training, and bedside teaching. The teaching doctors receive didactic training. In contrast, the previous traditional course was based on lectures with only two weekly hours of bedside teaching. Didactic training was not available.
Objective: The present work aims at analysing the importance of active participation of students and the didactic components of the reformed and traditional curricula, which contribute to successful learning as evaluated by the students.
Method: Differentiated student evaluations of the undergraduate surgical courses between 1999 and 2008 were examined by correlation and regression analyses.
Results: The evaluation scores for organisation, dedication of the teaching staff, their ability to make lessons interesting and complex topics easily understandable, and the subjective gain of knowledge were significantly better in HeiCuMed than in the traditional curriculum. However, the dependence of knowledge gain on the didactic quality was the same in both curricula. The quality of discussions and the ability of the teaching doctors to promote active student participation were important to the subjective gain of knowledge in both seminars and practical courses of the reformed curriculum as well as for the overall evaluation of the practical courses but not the gain of knowledge in the traditional curriculum.
Conclusion: The findings confirm psychological-educational perceptions, that competent implementation of integrative didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching.
PMCID: PMC3149460  PMID: 21818238
Medical education; reform curriculum; sugery; didactics
14.  Choose Wisely: the Quality of Massage Education in the United States 
Assessing the quality of postsecondary education remains a difficult task, despite many efforts to do so. No consensus or standard definition of educational quality has yet been agreed upon or developed.
This study evaluated the quality of massage education in the United States using three closely-related questions to frame the evaluation: 1) Is accreditation improving the quality of education for massage therapy? If not, then what do we need to do to improve it? 2) Does accreditation by COMTA specifically improve quality of education compared to other vocational accrediting agencies that do not require curriculum competencies specific to massage? 3) Would adding competencies at an “advanced” level, or specific degree levels, be helpful in advancing massage therapy in the eyes of other health professions?
United States
Members of a national massage education organization, members affiliated with the educational arm of two national professional associations, and members of two national education organizations in complementary and integrative health care (CIHC).
Research Design
Mixed methods evaluation using three data sources: existing gainful employment data from the US Department of Education, analyzed by type of massage program and accreditation agency to determine average and relative value for cost; numbers of disciplinary actions against massage practitioners reported by state regulatory agencies, and a qualitatively developed survey administered to two different groups of educators.
Average tuition cost across all reporting schools/programs was $13,605, with an average graduation rate of 71.9%. Of the schools and programs that reported student loan data, 84% of students received federal financial aid. Median loan amount was $8,052, with an average repayment rate of 43.4%. Programs in corporate-owned schools had the highest average cost, highest median loan amount, and lowest repayment rate, while community college programs had the lowest average cost, lowest graduation rate, and lowest median loan amount. Repayment rate data were not available for community colleges. Of the five states and the District of Columbia that require school accreditation, there were 208 disciplinary actions from 2009–2011. The remaining 28 regulated states that do not require school accreditation reported 1,702 disciplinary actions during the same period. Seventy-five percent of massage educators and 58% of CIHC educators stated that the current quality of massage education is inconsistent, with only 10% of massage educators and 8% of CIHC educators agreeing that current educational quality is adequate. Fifty-six percent of massage educators and 40% of CIHC educators agreed that educational quality needs to improve if massage therapists want to be considered comparable to other allied health professionals. Both groups suggested specific areas and means of improvement, including raising admission requirements and offering an academic degree.
Accreditation appears to improve the quality of massage education; however, more consistent methods for calculating tuition costs, educational outcomes, and classifying severity of disciplinary actions are needed. Both quantitative and qualitative evidence indicates that the current quality of massage education in the US is inconsistent and less than adequate. Specific areas of improvement needed for massage therapists to be perceived as comparable to other allied healthcare providers are described.
PMCID: PMC4145003  PMID: 25184011
massage education; educational research; accreditation; educational quality
15.  Undergraduate cancer education in Spain: The debate, the opportunities and the initiatives of the University Forum of the Spanish Society of Radiation Oncology (SEOR) 
Most medical schools in Spain (80%) offer undergraduate training in oncology. This education is highly variable in terms of content (theory and practical training), number of credits, and the medical specialty and departmental affiliation of the professors. Much of this variability is due to university traditions in the configuration of credits and programmes, and also to the structure of the hospital-based practical training. Undergraduate medical students deserve a more coherent and modern approach to education with a strong emphasis on clinical practice. Oncology is an interdisciplinary science that requires the input of professors from multiple specialties to provide the primary body of knowledge and skills needed to obtain both a theoretical and clinical understanding of cancer. Clinical skills should be a key focus due to their importance in the current model of integrated medical management and care.
Clinical radiation oncology is a traditional and comprehensive hospital-based platform for undergraduate education in oncology. In Spain, a significant number (n = 80) of radiation oncology specialists have a contractual relationship to teach university courses. Most Spanish universities (80%) have a radiation oncologist on staff, some of whom are department chairs and many others are full professors who have been hired and promoted under competitive conditions of evaluation as established by the National Agency for Quality Evaluation.
The Spanish Society of Radiation Oncology (SEOR) has identified new opportunities to improve undergraduate education in oncology. In this article, we discuss proposals related to theoretical (20 items) and practical clinical training (9 items). We also describe the SEOR University Forum, which is an initiative to develop a strategic plan to implement and organize cancer education at the undergraduate level in an interdisciplinary teaching spirit and with a strong contribution from radiation oncologists.
PMCID: PMC3863211  PMID: 24416587
Education; SEOR; University; Medical school
16.  Undergraduate radiology education in private and public teaching hospitals in Karachi, Pakistan: teaching duties, methodologies, and rewards 
In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan.
A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants.
The overall response rate was 78.51% (95/121). All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76%) agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%). Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%). The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and problem-based learning sessions were less favored by radiologists than by residents. Teaching via radiology films (86%) was the most frequent mode of instruction. Salary (59%) was the most commonly cited teaching reward. The majority of respondents (88%) were not satisfied with their current level of teaching rewards.
All radiologists and residents working in an academic radiology department are involved in teaching undergraduate students at multiple levels. The most valued teaching methodology involves use of images, with one-on-one interaction between the trainer and trainee. The monetary reward for teaching is inbuilt into the salary. The methodology adopted for teaching purposes was significantly different between respondents from private hospitals and those from public teaching hospitals. Because of low satisfaction among the respondents, efforts should be made to provide satisfying teaching rewards.
PMCID: PMC3661265  PMID: 23745098
radiology; hospital; department; medical faculty; teaching hospital
17.  Improving musculoskeletal clinical skills teaching. A regionwide audit and intervention study 
Annals of the Rheumatic Diseases  1998;57(11):656-659.
OBJECTIVE—To identify factors that influence medical students' perceptions of the quality of a clinical skills course; to apply these factors to the course at one hospital; to measure the effect of this change.
DESIGN—Cross sectional questionnaire survey; application of identified factors; repeat questionnaire survey.
SETTING—Three teaching hospitals and five district general hospitals in north east England.
SUBJECTS—Third year medical students attending locomotor clinical skills courses in two consecutive years.
MAIN OUTCOME MEASURES—Score awarded by students in five categories; numbers of patients seen by each student; comparisons with other clinical skills weeks.
RESULTS—Response rates were 71 of 150 and 89 of 161. Factors associated with a high awarded score were: organisation of the course by a rheumatologist (p<0.01); teaching from a rheumatologist (p<0.01); higher number of patients seen (r=0.76). Mean number of patients seen varied widely, from 7 per student at one hospital to 20.4 at another. Teaching hospitals scored poorly. In the second year, after making changes at one teaching hospital the mean total score improved (p<0.01), and students saw more patients (p<0.01). The ranking of this hospital rose from 6 to 1. The additional cost of the modified course was £640 per student.
CONCLUSIONS—The standard of teaching of locomotor clinical skills varies widely and can be improved by application of factors identified in this survey, although additional costs are incurred.

 Keywords: undergraduate teaching; musculoskeletal system; rheumatology; clinical skills
PMCID: PMC1752506  PMID: 9924206
18.  Quality improvement practices used by teaching versus non-teaching trauma centres: analysis of a multinational survey of adult trauma centres in the United States, Canada, Australia, and New Zealand 
BMC Surgery  2014;14(1):112.
Although studies have suggested that a relationship exists between hospital teaching status and quality improvement activities, it is unknown whether this relationship exists for trauma centres.
We surveyed 249 adult trauma centres in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their quality improvement programs. Trauma centres were stratified into two groups (teaching [academic-based or –affiliated] versus non-teaching) and their quality improvement programs were compared.
All participating trauma centres reported using a trauma registry and measuring quality of care. Teaching centres were more likely than non-teaching centres to use indicators whose content evaluated treatment (18% vs. 14%, p < 0.001) as well as the Institute of Medicine aim of timeliness of care (23% vs. 20%, p < 0.001). Non-teaching centres were more likely to use indicators whose content evaluated triage and patient flow (15% vs. 18%, p < 0.001) as well as the Institute of Medicine aim of efficiency of care (25% vs. 30%, p < 0.001). While over 80% of teaching centres used time to laparotomy, pulmonary complications, in hospital mortality, and appropriate admission physician/service as quality indicators, only two of these (in hospital mortality and appropriate admission physician/service) were used by over half of non-teaching trauma centres. The majority of centres reported using morbidity and mortality conferences (96% vs. 97%, p = 0.61) and quality of care audits (94% vs. 88%, p = 0.08) while approximately half used report cards (51% vs. 43%, p = 0.22).
Teaching and non-teaching centres reported being engaged in quality improvement and exhibited largely similar quality improvement activities. However, differences exist in the type and frequency of quality indicators utilized among teaching versus non-teaching trauma centres.
PMCID: PMC4320430  PMID: 25533153
Trauma quality improvement; Teaching status; Survey
19.  Evaluating the impact of the reconfiguration of gynaecology services at a University Hospital NHS trust in the United Kingdom 
The project aim was to investigate the impact of reconfiguring gynaecology services on the key performance indicators of a University Hospital NHS Trust in the UK. The reconfiguration involved the centralisation of elective gynaecology on one hospital site and emergency gynaecology on the other.
Data measuring outcomes of the Trust’s performance indicators (clinical outcomes, patient experience, staff satisfaction, teaching/training, research/development and value for money) were collected. Two time periods, 12 months before and after the reconfiguration in March 2011, were compared for all outcome measures except patient experience. Retrospective data from the hospitals audit department on clinical activity/outcomes and emergency gynaecology patient’s feedback questionnaires were analysed. Staff satisfaction, teaching/training and research/development were measured through an online survey of gynaecology consultants.
Post reconfiguration, the total number of admissions reduced by 6% (6,867 vs 6,446). There was a 14% increase in elective theatre sessions available (902.29 vs 1030.57) and an 84% increase in elective theatre sessions cancelled (44.43 vs 81.71). However, the average number of elective operations performed during each theatre session remained similar (2.63 vs 2.5). There was a significant increase in medical devices related clinical incidents (2 vs 11). With patient experience, there was a significant reduction in patient’s overall length of stay on the emergency gynaecology ward and waiting times for investigations. For staff satisfaction, Consultants were significantly more dissatisfied with workload (3.45 vs 2.85) and standards of care (3.75 vs 2.93). With research and development, consultants remained dissatisfied with time/funding/opportunities for research. No significant impact on undergraduate/postgraduate teaching was found. No financial data on gynaecology was provided for the assessment of value for money.
Reconfiguration of gynaecology services at this Trust may have resulted in a reduction in gynaecological activity and increased cancellation of elective operations but did not significantly reduce the number of elective operations performed. Although consultants expressed increased dissatisfaction with standards of clinical care, clinical incident reports did not significantly increase apart from medical devices incidents. Patient experience of emergency gynaecology services was improved. This manuscript provides a framework for similar exercises evaluating the impact of service redesign in the NHS.
PMCID: PMC4263049  PMID: 25249035
Evaluation methodology; Patient satisfaction; Incident reporting; Obstetrics and gynaecology; Patient safety
20.  Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial 
BMC Medical Education  2012;12:85.
The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.
Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.
The ASK-group (n = 70, age 23.4 (20–36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20–53) yrs.) and the CON-group (n = 88, 22.8 (20–33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).
The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
PMCID: PMC3473305  PMID: 22958784
Arthroscopy; Education, Anatomic competence, Randomized controlled trial, Knee joint, Shoulder joint, Students; Medical, Musculoskeletal ultrasound
21.  Undergraduate radiology teaching from the student’s perspective 
Insights into Imaging  2012;4(1):103-109.
To obtain medical students’ evaluation of the quality of undergraduate radiology teaching received, preferred teaching methods and resources. This is a follow-up project to an earlier study of junior doctors who felt that radiology teaching left them ill prepared for medical practice.
A questionnaire to third and fifth year medical students undertaking clinical rotations at Newcastle University, UK.
The questionnaire was completed by 57/60 (95 %) of third and 37/40 (93 %) of final year medical students. Students received minimal radiology teaching in pre-clinical years, feeling this was insufficient. The majority of students rated interactive case-based teaching as effective. Self-directed learning resources such as textbooks, journals and even online learning modules were perceived as less effective. Other types of web resources rated higher. Motivation for most students when studying radiology was to achieve learning objectives needed to pass their next exams and/or to improve as a doctor.
Medical students criticise the lack of radiology teaching in pre-clinical undergraduate years. Radiology teaching should be represented in all undergraduate years, preferably delivered via interactive teaching sessions. Currently available e-learning modules do not meet the students’ learning needs and there is a call for reliable, up-to-date open access electronic resources.
Main Messages
• Radiology teaching should be represented in all pre-clinical and clinical undergraduate years.
• Medical students rate interactive case-based teaching sessions as very effective.
• There is a call for reliable, up-to-date open access electronic resources for medical students.
PMCID: PMC3579990  PMID: 23225253
Radiology; Teaching; Student opinion; Teaching methods; Undergraduate medical education
22.  One year's experience of major trauma outcome study methodology. 
BMJ : British Medical Journal  1990;301(6744):156-159.
OBJECTIVE--To assess the feasibility and the validity of an audit using major trauma outcome study methods in an accident and emergency department. DESIGN--Prospective audit of all cases of trauma in patients admitted to a hospital from an accident and emergency department. SETTING--Accident and emergency department in a teaching hospital. PATIENTS--1577 Patients admitted with trauma, of whom 695 met the inclusion criteria for the study--that is, were admitted for more than three days, or admitted to intensive care, or died. 17 Patients were excluded because of failure to trace their notes. OUTCOME MEASURES--Review of case notes with TRISS (trauma score, injury severity score) methodology to compare expected and observed survival. RESULTS--Most (421/678) admissions were due to single orthopaedic injury. Serious injury was uncommon with only 43 patients having injury severity scores greater than 15. The calculated probability of survival matched the observed outcome for most of the seriously injured patients, with only two unexpected deaths. However, 36 of the 61 deaths in the 678 patients occurred in elderly patients with a fractured neck of the femur, and all of these patients had a high probability of survival predicted by TRISS methodology. CONCLUSIONS--Application of TRISS methodology seems to be valid for seriously injured patients except for elderly patients with single orthopaedic injuries, in whom there were major differences between observed and expected outcomes. Using outcome norms from the United States may not be applicable for this group. IMPLICATIONS--Audit of management of major injuries should be carried out by every hospital, and the methodology of the major trauma outcome study is an excellent system for carrying out such audit. The study of all patients admitted with trauma requires appreciable extra resources, but most hospitals should be able to monitor the care of seriously injured patients as their numbers are much fewer.
PMCID: PMC1663538  PMID: 2390603
23.  Auditing Orthopaedic Audit 
Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close the loop undermines the effectiveness of the audit process and wastes resources.
We analysed the effectiveness of audit in trauma and orthopaedics at a local hospital by comparing audit projects completed over a 6-year period to criteria set out in the NHS National Audit and Governance report.
Of the 25 audits performed since 1999, half were presented to the relevant parties and only 20% completed the audit cycle. Only two of these were audits against national standards and 28% were not based on any standards at all. Only a third of the audits led by junior doctors resulted in implementation of their action plan compared to 75% implementation for consultant-led and 67% for nurse-led audits.
A remarkably large proportion of audits included in this analysis failed to meet accepted criteria for effective audit. Audits completed by junior doctors were found to be the least likely to complete the cycle. This may relate to the lack of continuity in modern medical training and little incentive to complete the cycle. Supervision by permanent medical staff, principally consultants, and involvement of the audit department may play the biggest role in improving implementation of change.
PMCID: PMC2727811  PMID: 18828963
Medical audit; Orthopaedics
24.  Student perceptions of GP teachers' role in community-based undergraduate surgical education: a qualitative study 
JRSM Short Reports  2012;3(8):51.
To evaluate medical students' perceptions of a new community-based surgical module being delivered as part of a third-year clinical methods teaching (CMT) course at Imperial College, London.
A qualitative study using focus group interviews with medical students who had recently completed the surgical module. Focus group discussions were recorded, transcribed and analysed to identify key categories that reflected the positive and negative aspects of the student's perspectives.
Imperial College, London
Two groups of fourth-year medical students were invited to participate in the focus groups. The first group consisted of seven students from the surgery and Anaesthesia BSc course. The second group consisted of a random sample of five students from other BSc courses at Imperial College.
Main Outcome Measures
These were not defined pre-study as the purpose of the study was to obtain student perceptions of the surgical module. Facilitators were given guide questions to aid consistency and prompted discussion where required using an inductive approach to the topics discussed by the students.
Student opinions of surgical teaching delivered in the community compared favourably with the surgical teaching delivered in hospitals. Students identified the key benefits as: having protected time to learn, regular access to suitable patients, and teaching that was more learner-centred. Challenges identified by students included the GPs' lack of specialist knowledge and teaching that was dictated by individual interests rather than the syllabus.
Community-based teaching has been widely used to deliver teaching traditionally taught in hospital settings. However, surgical skills are still taught largely by surgical specialists within hospitals. Our study suggests that students are receptive to GPs teaching surgical topics in the community and perceive GPs as competent teachers. This study suggests that there may be benefits in delivering traditional surgical modules in community settings. Providing training for teachers may be a key factor in ensuring quality of surgical teaching for all students.
PMCID: PMC3434433  PMID: 23301139
25.  Patient Outcomes with Teaching Versus Nonteaching Healthcare: A Systematic Review 
PLoS Medicine  2006;3(9):e341.
Extensive debate exists in the healthcare community over whether outcomes of medical care at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertaining to this question.
Methods and Findings
We reviewed all studies that compared teaching versus nonteaching healthcare structures for mortality or any other patient outcome, regardless of health condition. Studies were retrieved from PubMed, contact with experts, and literature cross-referencing. Data were extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnoses considered, adjusting covariates, and estimates of effect for mortality and for each other outcome. Overall, 132 eligible studies were identified, including 93 on mortality and 61 on other eligible outcomes (22 addressed both). Synthesis of the available adjusted estimates on mortality yielded a summary relative risk of 0.96 (95% confidence interval [CI], 0.93–1.00) for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99–1.10) for minor teaching versus nonteaching ones. There was considerable heterogeneity between studies (I2 = 72% for the main analysis). Results were similar in studies using clinical and those using administrative databases. No differences were seen in the 14 studies fully adjusting for volume/experience, severity, and comorbidity (relative risk 1.01). Smaller studies did not differ in their results from larger studies. Differences were seen for some diagnoses (e.g., significantly better survival for breast cancer and cerebrovascular accidents in teaching hospitals and significantly better survival from cholecystectomy in nonteaching hospitals), but these were small in magnitude. Other outcomes were diverse, but typically teaching healthcare structures did not do better than nonteaching ones.
The available data are limited by their nonrandomized design, but overall they do not suggest that a healthcare facility's teaching status on its own markedly improves or worsens patient outcomes. Differences for specific diseases cannot be excluded, but are likely to be small.
Published data do not suggest that the teaching status of a hospital or other healthcare facility alone influences the outcome of patients treated in that facility.
Editors' Summary
When people need medical treatment they may be given it in a “teaching hospital.” This is a place where student doctors and other trainee healthcare workers are receiving part of their education. They help give some of the treatment that patients receive. Teaching hospitals are usually large establishments and in most countries they are regarded as being among the very best hospitals available, with leading physicians and surgeons among the staff. It is usually assumed that patients who are being treated in a teaching hospital are lucky, because they are getting such high-quality healthcare. However, it has sometimes been suggested that, because some of the people involved in their care are still in training, the patients may face higher risks than those who are in nonteaching hospitals.
Why Was This Study Done?
The researchers wanted to find out which patients do best after treatment—those who were treated in teaching hospitals or those who were in nonteaching hospitals. This is a difficult issue to study. The most reliable way of comparing two types of treatment would be to decide at random which treatment each patient should receive. (For more on this see the link below for “randomized controlled trials.”) In practice, it would be difficult to set up a study where the decision on which hospital a patient should go to was made at random. One problem is that, because of the high reputation of teaching hospitals, the patients whose condition is the most serious are often sent there, with other patients going to nonteaching hospitals. It would not be a fair test to compare the “outcome” for the most seriously ill patients with the outcome for those whose condition was less serious.
What Did the Researchers Do and Find?
The researchers conducted a thorough search for studies that had already been done, which met criteria which the researchers had specified in advance. This type of research is called a “systematic review.” They found 132 studies that had compared the outcomes of patients in teaching or nonteaching hospitals. None of these studies was a trial. (They were “observational studies” where researchers had gathered information on what was already taking place, rather than setting up an experiment.) However, in 14 studies, extensive allowances had been made for differences in such factors as the severity of the patients' condition, and whether or not they had more than one type of illness when they were treated. There was a great deal of variability in the results between the studies but, overall, there was no major difference in the effectiveness of treatment provided by the two types of hospital.
What Do These Findings Mean?
There is no evidence to support that it is better to be given treatment in a teaching or a nonteaching hospital. The authors do note that a limitation in their analysis is that it was based on studies that were not randomized controlled trials. They also raise the question that differences might be found if considering specific diseases one by one, rather than putting information on all conditions together. However, they believe that any such difference would be small. Their findings will be useful in the continuing debate on the most effective ways to train doctors, while at the same time providing the best possible care for patients.
Additional Information.
Please access these Web sites via the online version of this summary at
Wikipedia entry on teaching hospitals (note: Wikipedia is a free online encyclopedia that anyone can edit)
Information on randomized clinical trials from the US National Institutes of Health
A definition of systematic reviews from the Cochrane Collaboration, an organization which produces systematic reviews
All of the above include links to other Web sites where more detailed information can be found.
PMCID: PMC1564172  PMID: 16968119

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