A study of the combined influence of prior knowledge and stimulus dimensionality on category learning was conducted. Subjects learned category structures with the same number of necessary dimensions but more or fewer additional redundant dimensions, and with either knowledge-related or knowledge-unrelated features. Minimal-learning models predict that all subjects, regardless of condition, should learn either the same number of dimensions, or else should respond more slowly to each dimension. Despite similar learning rates and response times, subjects learned more features in the high-dimensional than in the low-dimensional condition. Furthermore, prior knowledge interacted with dimensionality, increasing what was learned especially in the high-dimensional case. A second experiment confirmed that the participants did in fact learn more features during the training phase, rather than simply inferring them at test. These effects can be explained by direct associations among features (representing prior knowledge) combined with feedback between features and the category label, as shown by simulations of the knowledge-resonance, or KRES, model of category learning.
The purpose of this study was to describe the types of pain information described by older adults with chronic osteoarthritis pain. Pain descriptions were obtained from older adults’ who participated in a posttest only double blind study testing how the phrasing of healthcare practitioners’ pain questions affected the amount of communicated pain information. The 207 community dwelling older adults were randomized to respond to either the open-ended or closed-ended pain question. They viewed and orally responded to a computer displayed videotape of a practitioner asking them the respective pain question. All then viewed and responded to the general follow up question, ““What else can you tell me?” and lastly, “What else can you tell me about your pain, aches, soreness or discomfort?” Audio-taped responses were transcribed and content analyzed by trained, independent raters using 16 a priori criteria from the American Pain Society (2002) Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Older adults described important but limited types of information primarily about pain location, timing, and intensity. Pain treatment information was elicited after repeated questioning. Therefore, practitioners need to follow up older adults’ initial pain descriptions with pain questions that promote a more complete pain management discussion. Routine use of a multidimensional pain assessment instrument that measures information such as functional interference, current pain treatments, treatment effects, and side effects would be one way of insuring a more complete pain management discussion with older adults.
pain; communication; geriatrics; arthritis
Little is known about surrogate healthcare decision-making for individuals with intellectual disability (ID). This study examined healthcare decision-making by residential-agency directors to learn their process and the extent to which the individual is included.
Content analysis of qualitative data from a mailed survey of residential-agency directors in a large US mid-Atlantic state.
Narrative comments of 102 directors (65% of respondents) are reported. Three themes emerged: (a) Identifying someone else’s “best interest” is challenging; (b) Perceptions of the healthcare community, especially related to quality of life, can influence care provided; and (c) Surrogate decision-making is a team effort.
With knowledge of how decisions are made, the healthcare community can better interact with the complex array of service agencies and persons who determine care for this vulnerable population.
surrogate healthcare decision-making; intellectual disability; healthcare decision-making; qualitative methods; content analysis
Are doctors and nurses bound by just the same constraints as everyone else in regard to honesty? What, anyway, does honesty require? Telling no lies? Avoiding intentional deception by whatever means? From a utilitarian standpoint lying would seem to be on the same footing as other forms of intentional deception: yielding the same consequences. But utilitarianism fails to explain the wrongness of lying. Doctors and nurses, like everyone else, have a prima facie duty not to lie--but again like everyone else, they are not duty-bound to avoid intentional deception, lying apart; except where it would involve a breach of trust.
Assessment is a powerful driver of student learning: it gives a message to learners about what they should be learning, what the learning organisation believes to be important, and how they should go about learning. Assessment tools allow measurement of student achievement and thereby give teachers insight into their students' learning, and enable teachers to make systematic judgements about progress and achievement. It is vital then that assessment tools drive students to learn the right things as well as measure student learning appropriately. Any attempts to reform curricula and teaching methods must consider the role of assessment in the learning process.
Libyan doctors and medical students have been calling for changes to teaching and assessment methods at undergraduate and postgraduate levels. A team from the Academic Centre for Medical Education at University College, London have been running workshops in conjunction with the Libyan Board of Medical Specialties since 2006 to discuss strategic aims of assessment in medical education in Libya for the 21st century and to deliver an assessment skills course to Libyan educators. This article outlines the course and the outcomes of preliminary discussions between academics from the UK, participants in the assessment courses and representatives from the Libyan Board of Medical Specialties. As a result of these discussions it was agreed by all that Libyan Medical School assessment methods need updating and, despite significant challenges, changes in assessment must be made as soon as possible. There is a real need for support in both addressing these changes and for practical training for assessors in contemporary assessment methods.
Education; Medical; Educational measurement; Libya
If someone is nice to you, you feel good and may be inclined to be nice to somebody else. This every day experience is borne out by experimental games: the recipients of an act of kindness are more likely to help in turn, even if the person who benefits from their generosity is somebody else. This behaviour, which has been called ‘upstream reciprocity’, appears to be a misdirected act of gratitude: you help somebody because somebody else has helped you. Does this make any sense from an evolutionary or a game theoretic perspective? In this paper, we show that upstream reciprocity alone does not lead to the evolution of cooperation, but it can evolve and increase the level of cooperation if it is linked to either direct or spatial reciprocity. We calculate the random walks of altruistic acts that are induced by upstream reciprocity. Our analysis shows that gratitude and other positive emotions, which increase the willingness to help others, can evolve in the competitive world of natural selection.
evolution of cooperation; upstream indirect reciprocity; direct reciprocity; spatial reciprocity; random walks on graphs
Behavior results from the integration of ongoing sensory signals and contextual information in various forms, such as past experience, expectations, current goals, etc. Thus, the response to a specific stimulus, say the ringing of a doorbell, varies depending on whether you are at home or in someone else's house. What is the neural basis of this flexibility? What mechanism is capable of selecting, in a context-dependent way an adequate response to a given stimulus? One possibility is based on a nonlinear neural representation in which context information regulates the gain of stimulus-evoked responses. Here I explore the properties of this mechanism.
By means of three hypothetical visuomotor tasks, I study a class of neural network models in which any one of several possible stimulus-response maps or rules can be selected according to context. The underlying mechanism based on gain modulation has three key features: (1) modulating the sensory responses is equivalent to switching on or off different subpopulations of neurons, (2) context does not need to be represented continuously, although this is advantageous for generalization, and (3) context-dependent selection is independent of the discriminability of the stimuli. In all cases, the contextual cues can quickly turn on or off a sensory-motor map, effectively changing the functional connectivity between inputs and outputs in the networks.
The modulation of sensory-triggered activity by proprioceptive signals such as eye or head position is regarded as a general mechanism for performing coordinate transformations in vision. The present results generalize this mechanism to situations where the modulatory quantity and the input-output relationships that it selects are arbitrary. The model predicts that sensory responses that are nonlinearly modulated by arbitrary context signals should be found in behavioral situations that involve choosing or switching between multiple sensory-motor maps. Because any relevant circumstancial information can be part of the context, this mechanism may partly explain the complex and rich behavioral repertoire of higher organisms.
It has been suggested that medical students wish to focus their learning in psychiatry on general skills that are applicable to all doctors. This study seeks to establish what aspects of psychiatry students perceive to be relevant to their future careers and what psychiatric knowledge and skills they consider to be important. It is relevant to consider whether these expectations about learning needs vary prior to and post-placement in psychiatry. To what extent these opinions should influence curriculum development needs to be assessed.
A questionnaire was distributed to medical students before they commenced their psychiatry placement and after they had completed it. The questionnaire considered the relevance of psychiatry to their future careers, the relevance of particular knowledge and skills, the utility of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry.
The students felt skills relevant to all doctors, such as assessment of suicide risk, were more important than more specialist psychiatric skills, such as the management of schizophrenia. They felt that knowledge of how psychiatric illnesses present in general practice was important and it was a useful setting in which to learn psychiatry. They thought that conditions that are commonly seen in the general hospital are important and that liaison psychiatry was useful.
Two ways that medical students believe their teaching can be made more relevant to their future careers are highlighted in this study. Firstly, there is a need to focus on scenarios which students will commonly encounter in their initial years of employment. Secondly, psychiatry should be better integrated into the overall curriculum, with the opportunity for teaching in different settings. However, when developing curricula the need to listen to what students believe they should learn needs to be balanced against the necessity of teaching the fundamentals and principles of a speciality.
A reward or punishment can seem better or worse depending on what else might have happened. Little is known, however, about how neural representations of an anticipated incentive might be influenced by the available alternatives. We used event-related FMRI to investigate the activation in the nucleus accumbens (NAcc), while we varied the available alternative incentives in a monetary incentive delay task. Some task blocks included only uncertain gains and losses; others included the same uncertain gains and losses intermixed with certain gains and losses. The availability of certain gains and losses increased NAcc activation for uncertain losses and decreased the difference between uncertain gains and losses. We suggest that this pattern of activation can result from reference point changes across blocks, and that the worst available loss may serve as an important anchor for NAcc activation. These findings imply that NAcc activation represents anticipated incentive value relative to the current context of available alternative gains and losses.
context; reference points; reward; nucleus accumbens; fMRI
Creative, dynamic strategies are the ones that identify new and better ways of uniquely offering the target customers what they want or need. A
business can achieve competitive advantage if it chooses a marketing strategy that sets the business apart from anyone else. Healthcare services
companies have to understand that the customer should be placed in the centre of all specific marketing operations. The brand message should reflect the
focus on the patient. Healthcare products and services offered must represent exactly the solutions that customers expect. The touchpoints with the
patients must be well mastered in order to convince them to accept the proposed solutions. Healthcare service providers must be capable to look
beyond customer's behaviour or product and healthcare service aquisition. This will demand proactive and far–reaching changes, including
focusing specifically on customer preference, quality, and technological interfaces; rewiring strategy to find new value from existing and unfamiliar
sources; disintegrating and radically reassembling operational processes; and restructuring the organization to accommodate new typess of work and skill.
In this article, tragedy and utopia are juxtaposed, and it is proposed that the problem of “medicalisation” is better understood in a framework of tragedy than in a utopian one. In utopia, it is presupposed that there is an error behind every setback and every side effect, whereas tragedy brings to light how side effects can be the result of irreconcilable conflicts. Medicalisation is to some extent the result of such a tragic conflict. We are given power by medical progress, but are also confronted with our fallibility, thus provoking insecurity. This situation is illustrated by the sudden infant death syndrome (SIDS). Recent epidemiological investigations have shown that infants sleeping in a prone position have a 15–20 times higher risk of dying from SIDS than infants sleeping in a supine position. A simple means of preventing infant death is suggested by this discovery, but insecurity is also created. What else has been overlooked? Perhaps a draught, or wet diapers, or clothes of wool are just as dangerous as sleeping prone? Further investigations and precautions will be needed, but medicalisation prevails.
Small-world networks, according to Watts and Strogatz, are a class of networks that are “highly clustered, like regular lattices, yet have small characteristic path lengths, like random graphs.” These characteristics result in networks with unique properties of regional specialization with efficient information transfer. Social networks are intuitive examples of this organization, in which cliques or clusters of friends being interconnected but each person is really only five or six people away from anyone else. Although this qualitative definition has prevailed in network science theory, in application, the standard quantitative application is to compare path length (a surrogate measure of distributed processing) and clustering (a surrogate measure of regional specialization) to an equivalent random network. It is demonstrated here that comparing network clustering to that of a random network can result in aberrant findings and that networks once thought to exhibit small-world properties may not. We propose a new small-world metric, ω (omega), which compares network clustering to an equivalent lattice network and path length to a random network, as Watts and Strogatz originally described. Example networks are presented that would be interpreted as small-world when clustering is compared to a random network but are not small-world according to ω. These findings have important implications in network science because small-world networks have unique topological properties, and it is critical to accurately distinguish them from networks without simultaneous high clustering and short path length.
brain networks; graph theory
We developed and evaluated the outcomes of an e-learning course for evidence based medicine (EBM) training in postgraduate medical education in different languages and settings across five European countries.
We measured changes in knowledge and attitudes with well-developed assessment tools before and after administration of the course. The course consisted of five e-learning modules covering acquisition (formulating a question and search of the literature), appraisal, application and implementation of findings from systematic reviews of therapeutic interventions, each with interactive audio-visual learning materials of 15 to 20 minutes duration. The modules were prepared in English, Spanish, German and Hungarian. The course was delivered to 101 students from different specialties in Germany (psychiatrists), Hungary (mixture of specialties), Spain (general medical practitioners), Switzerland (obstetricians-gynaecologists) and the UK (obstetricians-gynaecologists). We analysed changes in scores across modules and countries.
On average across all countries, knowledge scores significantly improved from pre- to post-course for all five modules (p < 0.001). The improvements in scores were on average 1.87 points (14% of total score) for module 1, 1.81 points (26% of total score) for module 2, 1.9 points (11% of total score) for module 3, 1.9 points (12% of total score) for module 4 and 1.14 points (14% of total score) for module 5. In the country specific analysis, knowledge gain was not significant for module 4 in Spain, Switzerland and the UK, for module 3 in Spain and Switzerland and for module 2 in Spain. Compared to pre-course assessment, after completing the course participants felt more confident that they can assess research evidence and that the healthcare system in their country should have its own programme of research about clinical effectiveness.
E-learning in EBM can be harmonised for effective teaching and learning in different languages, educational settings and clinical specialties, paving the way for development of an international e-EBM course.
Liposuction (suction-assisted lipectomy) is today an accepted, closed surgical technique utilized by physicians practicing in a number of different specialties. It is a procedure that can be learned and used as an adjunct to a number of open procedures, including rhytidectomy and abdominoplasty.
The two principal keys to successful liposuction procedures are: (1) good patient selection, and (2) realistic expectations. Good selection should be based on physiological skin age of the patient rather than chronological age. Many liposuction procedures can be performed under local anesthesia in an office surgical suite. A conservative approach is always appropriate, as overcorrection is difficult to treat.
Areas that can be suctioned effectively include the face, chin, neck, anterior and posterior axilary areas, arms, breasts, abdomen, waist, hips, buttocks, thighs, knees, and ankles. Using the blunt cannula technique pioneered by Fischer and modified and popularized by Illouz and Fournier yields a high percentage of good results. A low percentage of possible complications and undesired sequelae have been documented.
In the UK and many other countries, many specialties have had longstanding problems with recruitment and have increasingly relied on international medical graduates to fill junior and senior posts. We aimed to determine what specialties were the most popular and desirable among candidates for training posts, and whether this differed by country of undergraduate training.
We conducted a database analysis of applications to Modernising Medical Careers for all training posts in England in 2008. Total number of applications (as an index of popularity) and applications per vacancy (as an index of desirability) were analysed for ten different specialties. We tested whether mean consultant incomes correlated with specialty choice.
In, 2008, there were 80,949 applications for specialty training in England, of which 31,434 were UK graduates (39%). Among UK medical graduates, psychiatry was the sixth most popular specialty (999 applicants) out of 10 specialty groups, while it was fourth for international graduates (5,953 applicants). Among UK graduates, surgery (9.4 applicants per vacancy) and radiology (8.0) had the highest number of applicants per vacancy and paediatrics (1.2) and psychiatry (1.1) the lowest. Among international medical graduates, psychiatry had the fourth highest number of applicants per place (6.3). Specialty popularity for UK graduates was correlated with predicted income (p = 0.006).
Based on the number of applicants per place, there was some consistency in the most popular specialties for both UK and international medical graduates, but there were differences in the popularity of psychiatry. With anticipated decreases in the number of new international medical graduates training in the UK, university departments and professional associations may need to review strategies to attract more UK medical graduates into certain specialties, particularly psychiatry and paediatrics.
While the number of orbital surgeons is limited, it is hoped these can be recognized and patients referred to them by ophthalmologists not interested or trained in that specialty. Let the orbital surgeon determine whether he can handle the problem in 1 to 2 days, or whether a neurosurgeon should do the procedure or make it a joint effort. It may well involve other specialty team effort approaches. It is essential to have an understanding of x-rays, CT, angiography, and MRI techniques and films. Sit with these specialists to learn more and help to avoid negative, misdiagnosis reports in the interest of the patient. Use judgement in helping the patient decide on ophthalmic or the more extensive neurosurgical approach after careful study and what is in their best interest. The team approach is used in well established medical centers with the ophthalmologist and neurosurgeon (or other specialist) working together in the best interest of the patient. This is more interesting and keeps the ophthalmologist in the mainstream of medicine.
To our knowledge, no studies have examined energy intakes by food purchase location and food source using a representative sample of US children, adolescents and adults. Evaluations of purchase location and food sources of energy may inform public health policy.
Analyses were based on the first day of 24-hour recall for 22,852 persons in the 2003-4, 2005-6, and 2007-8 National Health and Nutrition Examination Surveys (NHANES). The most common food purchase locations were stores (grocery store, supermarket, convenience store, or specialty store), quick-service restaurants/pizza (QSR), full-service restaurants (FSR), school cafeterias, or food from someone else/gifts. Specific food sources of energy were identified using the National Cancer Institute aggregation scheme. Separate analyses were conducted for children ages 6-11y, adolescents ages 12-19y, and adults aged 20-50y and ≥51y.
Stores (grocery, convenience, and specialty) were the food purchase locations for between 63.3% and 70.3% of dietary energy in the US diet. Restaurants provided between 16.9% and 26.3% of total energy. Depending on the respondents’ age, QSR provided between 12.5% and 17.5% of energy, whereas FSR provided between 4.7% and 10.4% of energy. School meals provided 9.8% of energy for children and 5.5% for adolescents. Vending machines provided <1% of energy. Pizza from QSR, the top food away from home (FAFH) item, provided 2.2% of energy in the diets of children and 3.4% in the diets of adolescents. Soda, energy, and sports drinks from QSR provided approximately 1.2% of dietary energy.
Refining dietary surveillance approaches by incorporating food purchase location may help inform public health policy. Characterizing the important sources of energy, in terms of both purchase location and source may be useful in anticipating the population-level impacts of proposed policy or educational interventions. These data show that stores provide a majority of energy for the population, followed by quick-service and full-service restaurants. All food purchase locations, including stores, restaurants and schools play an important role in stemming the obesity epidemic.
Energy intake; Obesity; Food away from home; Food source; Food purchase location
Objectives: To describe the development of emergency medicine (EM) in Israel and review the specific problems faced by the discipline and describe the solutions that were found.
Methods: A comprehensive literature search was conducted for data on development of EM in the UK and in North America, and the personal knowledge of two of the authors (PH and YW) was used in preparing the article.
Results: There are differences in development of EM between Israel and the UK/US models. In Israel the specialty developed within the context of established high quality clinical practice and consequently it met resistance from the system, which did not wish to invest in what it felt might be marginal improvements in patient care. The economics of Israeli medicine also dictated that EM be made into a super-specialty rather than a primary specialty. Certified specialists from family medicine, paediatrics, internal medicine, general surgery, anaesthesia, and orthopaedic surgery can access training positions in EM. Currently there are seven active EM programmes of 2.5 years duration and 16 residents. The curriculum is flexible and a national certification examination is being developed.
Conclusions: Development of EM can and should take different paths according to the specific local needs and realities. There is no single ideal model suitable for all circumstances. The practice of clinical EM in Israel is comparable with that of any developed country and daily progress is being made in the academic areas of teaching and research. There are worldwide similarities in the process of developing EM as a distinct discipline.
There is increased recognition that more mental health concerns are seen in primary care than any other healthcare setting. The Patient-Centered Medical Home (PCMH) is a significant redesign of primary care, and many of the principles of the PCMH appeal to the usage of a whole person mind-and-body treatment approach that is responsive to all the patient’s needs. This study examined the level of collaboration between National Committee for Quality Assurance (NCQA)-recognized PCMH primary care practices and outpatient specialty behavioral health services (when compared to other medically oriented specialties). In 2010, a 20-item survey was sent to 238 NCQA PCMHs to learn what they were doing to address behavioral health needs in primary care. A sub-dataset from the survey was analyzed in order to look specifically at referrals, communication, and scheduling-support processes. These data were compared with how the practice responded to similar questions about endocrinology and cardiology. Results from the participating 123 practices revealed that very few practices address behavioral health conditions as they would other medical conditions. This is evidenced by the lack of routinized processes to assist with referrals, communication, and scheduling to outpatient behavioral health services. There appears to be significant opportunity to improve how behavioral health is addressed in the patient-centered medical home.
Patient-Centered Medical Home; Primary care; Behavioral health
This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else close by. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else close by.
PMID: 20706565 CAMSID: cams1428
Research indicates that in the United States, children experience healthier BMI and fitness levels during school vs. summer, but research is limited. The primary goal of this pilot study was to assess where children spend their time during the months that school is not in session and to learn about the different types of activities they engage in within different care settings. A secondary goal of this pilot study was to learn what children eat during the summer months.
A nine-week summer study of 57 parents of second and third grade students was conducted in an economically, racial/ethnically and linguistically diverse US urban city. Weekly telephone interviews queried time and activities spent on/in 1) the main caregiver's care 2) someone else's care 3) vacation 4) and camp. Activities were categorised as sedentary, light, moderate, or vigorous (0-3 scale). For each child, a mean activity level was calculated and weighted for proportion of time spent in each care situation, yielding a weighted activity index. On the last phone call, parents answered questions about their child's diet over the summer. Two post-study focus groups were conducted to help interpret findings from the weekly activity interviews.
The mean activity index was 1.05 ± 0.32 and differed between gender (p = 0.07), education (p = 0.08) and primary language spoken in the household (p = 0.01). Children who spent a greater percentage of time in parent care had on average a lower activity index (β = -0.004, p = 0.01) while children who spent a greater percentage of time in camp had a higher activity index (β = 0.004, p = 0.03). When stratified into type of camp, percentage of time spent in active camp was also positively associated with mean activity index (β = 0.005, p =< 0.001). With regards to diet, after adjusting for maternal education, children who attended less than five weeks of camp were four times more likely to eat their meals in front of the TV often/almost all of the time (OR = 4.0, 95%CI 1.0-16.2, p < 0.06).
Summer activities and some dietary behaviours are influenced by situation of care and socio-demographic characteristics. In particular, children who spend a greater proportion of time in structured environments appear to be more active. We believe that this pilot study is an important first step in our understanding of what children do during the summer months.
Plagiarism is the wrongful presentation of somebody else‘s work or idea as one’s own without adequately attributing it to the source. Most authors know that plagiarism is an unethical publication practice. Yet, it is a serious problem in the medical writing arena. Plagiarism is perhaps the commonest ethical issue plaguing medical writing. In this article, we highlight the different types of plagiarism and address the issues of plagiarism of text, plagiarism of ideas, mosaic plagiarism, self-plagiarism, and duplicate publication. An act of plagiarism can have several repercussions for the author, the journal in question and the publication house as a whole. Sometimes, strict disciplinary action is also taken against the plagiarist. The article cites examples of retraction of articles, suspension of authors, apology letters from journal editors, and other such actions against plagiarism.
Action against plagiarism; duplicate publication; medical writing; plagiarism; unethical publication practice
Postgraduate medical education and training in many specialties, including Clinical Radiology, is undergoing major changes. In part this is to ensure that shorter training periods maximise the learning opportunities but it is also to bring medical education in line with broader educational theory. Learning outcomes need to be defined so that there is no doubt what knowledge, skills, attitudes and behaviours are expected of those in training. Curricula should be developed into competency or outcome based models and should state the aims, objectives, content, outcomes and processes of a training programme. They should include a description of the methods of learning, teaching, feedback and supervision. Assessment systems must be matched to the curriculum and must be fair, reliable and valid. Workplace based assessments including the use of multisource feedback need to be developed and validated for use during radiology training. These should be used in a formative and developmental way, although the overall results from a series of such assessments can be used in a more summative way to determine progress to the next phase of training. Formal standard setting processes need to be established for ‘high stakes’ summative assessments such as examinations. In addition the unique skills required of a radiologist in terms of image interpretation, pattern recognition, deduction and diagnosis need to be evaluated in robust, reliable and valid ways. Through a combination of these methods we can be assured that decisions about trainees’ progression through training is fair and standardised and that we are protecting patients by establishing national standards for training, curricula and assessment methods.
Postgraduate; radiology; training; education
This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (including examples of patient education, home monitoring, and continuing education). The concluding section highlights how telemedicine affects health sciences librarianship, beginning with the development of online computerized literature searching. This section also discusses the medical resources available to health sciences librarians as a result of the Internet.
A wide range of e-learning modalities are widely integrated in medical education. However, some of the key questions related to the role of e-learning remain unanswered, such as (1) what is an effective approach to integrating technology into pre-clinical vs. clinical training?; (2) what evidence exists regarding the type and format of e-learning technology suitable for medical specialties and clinical settings?; (3) which design features are known to be effective in designing on-line patient simulation cases, tutorials, or clinical exams?; and (4) what guidelines exist for determining an appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and performance-based skill practices? Based on the existing literature and a variety of e-learning examples of synchronous learning tools and simulation technology, this paper addresses the following three questions: (1) what is the current trend of e-learning in medical education?; (2) what do we know about the effective use of e-learning?; and (3) what is the role of e-learning in facilitating newly emerging competency-based training? As e-learning continues to be widely integrated in training future physicians, it is critical that our efforts in conducting evaluative studies should target specific e-learning features that can best mediate intended learning goals and objectives. Without an evolving knowledge base on how best to design e-learning applications, the gap between what we know about technology use and how we deploy e-learning in training settings will continue to widen.
Education, Medical; Computer-Assisted Instruction; Learning