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1.  A Qualitative Assessment of The Small Group Teaching at Hawler College of Medicine 
Context: Although the medical schools in Iraq recently started to increasingly use the small group teaching approach, only little is known about the students’ perceptions toward this approach. Therefore, the aim of this study was to assess small group teaching as a method of teaching at Hawler College of Medicine, from the students’ perspectives.
Setting: This study was a qualitative study which was based on six focus group discussions which involved a sample of students from the three last years at the Hawler College of Medicine. A topic guide was used to lead the discussions and it covered questions on the positive aspects and the problems of small group teaching in the college, in addition to recommendations for its improvement. The qualitative data analysis involved a content analysis, followed by a thematic analysis.
Results: The participants were generally happy with the application of the small group teaching approach and they recognized many positive aspects which were related to this experience, which included, increasing the focus on the study subjects, enhancing the student-teacher interaction, building a better student-teacher relationship, encouraging the students’ attendance, providing a better opportunity to apply a student-centered learning, enhancing a more efficient use of time and assisting in a better understanding of the subjects. The main problems which were faced, included a poor infrastructure and teaching facilities, problems which were related to examinations and the mark distribution, an improper syllabus preparation and problems which were related to the teachers’ commitments and performances. The main suggestions which were put forth to improve this system, included, changing the assessment system with the focus more on the end of the course assessment, the students’ involvement in the curriculum design, improving the infrastructure and teaching facilities and a better organization and management of the system.
Conclusions: The concept of the small group teaching approach was well received by the students and many positive aspects of this approach have been highlighted. However, this experience witnessed many problems and faced different challenges that need better preparation, organization of the resources and the orientation of students and teachers, for insuring its success.
doi:10.7860/JCDR/2013/5455.2966
PMCID: PMC3681061  PMID: 23814734
Medical education; Small group teaching
2.  A trial of patient-oriented problem-solving system for immunology teaching in China: a comparison with dialectic lectures 
BMC Medical Education  2013;13:11.
Background
The most common teaching method used in China is lecturing, but recently, efforts have been widely undertaken to promote the transition from teacher-centered to student-centered education. The patient-oriented problem-solving (POPS) system is an innovative teaching-learning method that permits students to work in small groups to solve clinical problems, promotes self-learning, encourages clinical reasoning and develops long-lasting memory. To our best knowledge, however, POPS has never been applied in teaching immunology in China. The aim of this study was to develop POPS in teaching immunology and assess students’ and teachers’ perception to POPS.
Methods
321 second-year medical students were divided into two groups: I and II. Group I, comprising 110 students, was taught by POPS, and 16 immunology teachers witnessed the whole teaching process. Group II including the remaining 211 students was taught through traditional lectures. The results of the pre- and post-test of both groups were compared. Group I students and teachers then completed a self-structured feedback questionnaire for analysis before a discussion meeting attended only by the teachers was held.
Results
Significant improvement in the mean difference between the pre- and post-test scores of those in Groups I and II was seen, demonstrating the effectiveness of POPS teaching. Most students responded that POPS facilitates self-learning, helps them to understand topics and creates interest, and 88.12% of students favored POPS over simple lectures. Moreover, while they responded that POPS facilitated student learning better than lectures, teachers pointed out that limited teaching resources would make it difficult for wide POPS application in China.
Conclusions
While POPS can break up the monotony of dialectic lectures and serve as a better teaching method, it may not be feasible for the current educational environment in China. The main reason for this is the relative shortage of teaching resources such as space, library facilities and well-trained teachers.
doi:10.1186/1472-6920-13-11
PMCID: PMC3570451  PMID: 23356717
Patient-oriented problem-solving; Medical education; Immunology; China
3.  Evaluation of a task-based community oriented teaching model in family medicine for undergraduate medical students in Iraq 
Background
The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools.
Methods
An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC) in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students) was exposed to the experimental model and the control group (56 students) received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999–2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools.
Results
The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work.
Conclusion
A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established.
doi:10.1186/1472-6920-5-31
PMCID: PMC1215485  PMID: 16115312
4.  A randomised-controlled trial of two educational modes for undergraduate evidence-based medicine learning in Asia 
Background
As the overall evidence for the effectiveness of teaching of evidence based medicine (EBM) is not strong, and the impact of cultural and societal influences on teaching method is poorly understood, we undertook a randomised-controlled trial to test the effectiveness and learning satisfaction with two different EBM teaching methods (usual teaching vs. problem based learning (PBL)) for undergraduate medical students.
Methods
A mixed methods study that included a randomised-controlled crossover trial with two intervention arms (usual teaching and PBL) and a nested qualitative study with focus groups to explore student perceptions of learning and to assess the effectiveness and utility of the two teaching methods.
All 129 second-year medical students at the University of Hong Kong in 2007.
The main outcomes measures were attitudes towards EBM; personal application and current use of EBM; EBM knowledge; future use of EBM.
Results
PBL was less effective at imparting knowledge than usual teaching consisting of a lecture followed by a group tutorial. After usual teaching students showed improvement in scores for 'attitudes towards EBM', 'personal application and current use of EBM' and 'EBM knowledge, which were not evident after PBL. In contrast to the usual teaching, students found PBL difficult as they lacked the statistical knowledge necessary to support discussion, failed to understand core concepts, and lost direction.
Conclusion
The evidence presented here would suggest that the teaching of EBM within an Asian environment should adopt a format that facilitates both the acquisition of knowledge and encourages enquiry.
doi:10.1186/1472-6920-9-63
PMCID: PMC2761870  PMID: 19785777
5.  EVALUATION OF THREE INSTRUCTIONAL METHODS OF TEACHING FOR UNDERGRADUATE MEDICAL STUDENTS, AT KING SAUD UNIVERSITY, SAUDI ARABIA 
Background:
There is an international move from traditional curriculum towards the learner – centered, and patient-oriented curriculum. In spite of its advantages, problem-based learning requires a larger number of teaching staff and space. This study was done to compare the problem-based learning (PBL), lectures and modified PBL methods.
Methods:
Thirty-three fifth year medical students who were taking the Family Medicine rotation participated in the study at the College of Medicine, King Saud University. Three instructors participated in the teaching of three topics to the three groups of students. Students acted as control for themselves across the three instructional methods, namely; lectures, PBL and modified PBL. The main outcomes were students’ recall of knowledge, problem solving skills and topic comprehension.
Results:
In the initial assessment, there was a significant difference in favor of PBL and the modified PBL regarding comprehension of the topic as tested by the short answer questions (p = 0.0001), problem solving skills as tested by the modified essay question (p = 0.002). Non-significant results were observed at the second stage of assessment. The modified PBL method was the preferred one for 39% of the students, followed by the PBL (36%) and lastly the lectures (25%).
Conclusion:
This empirical study suggests some advantages for the PBL method and the modified PBL over the lecture method. Larger studies are needed to confirm our results of this important issue as the modified PBL is an affordable option for schools that can not meet the staff and space requirements of the PBL curriculum.
PMCID: PMC3377127  PMID: 23012180
Instructional methods; lectures; modified PBL; PBL; Saudi Arabia
6.  Complementary and Alternative Medicine Familiarization: What's happening in Medical Schools in Wales? 
Despite recommendations that complementary and alternative medicine (CAM) familiarization should be offered to UK medical students, in Wales little such teaching was offered. We decided to assess medical students’ knowledge of CAMs, perceived training needs in CAMs, their view of its role in the National Health Service (NHS) and current teaching given. Analysis of data from a questionnaire given to medical students and direct questioning of senior academic medical school staff in Cardiff and Swansea Medical Schools was carried out. The participants comprised 78 first year medical students in the undergraduate entry program in Cardiff and 58 first year medical students from the graduate entry program in Swansea. Senior academic medical school staff at Cardiff and Swansea Medical Schools were asked about current CAM teaching. Results revealed that 32% of undergraduate entry students (UGES) had previous knowledge of CAMs compared with 51% of graduate entry students (GES). Of the UGES, 62% believed they should be taught about CAM's compared with 94% of GES. Of UGES 31% felt that CAMs have a role in the NHS compared with 50% of GES. None of the students had received teaching about CAMs and little formal CAM teaching is currently included in the curricula at each site. The majority of medical students in Wales would like to receive CAM teaching and significant numbers support a role for CAMs in the NHS. Little formal teaching is currently provided.
doi:10.1093/ecam/nem185
PMCID: PMC2862934  PMID: 18955309
CAM teaching; medical students; integrated healthcare
7.  Addressing Assessment in Libyan Medical Education 
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.
doi:10.4176/081020
PMCID: PMC3066704  PMID: 21483506
Education; Medical; Educational measurement; Libya
8.  Developing medical educators – a mixed method evaluation of a teaching education program 
Medical Education Online  2014;19:10.3402/meo.v19.23868.
Background
It is well accepted that medical faculty teaching staff require an understanding of educational theory and pedagogical methods for effective medical teaching. The purpose of this study was to evaluate the effectiveness of a 5-day teaching education program.
Methods
An open prospective interventional study using quantitative and qualitative instruments was performed, covering all four levels of the Kirkpatrick model: Evaluation of 1) ‘Reaction’ on a professional and emotional level using standardized questionnaires; 2) ‘Learning’ applying a multiple choice test; 3) ‘Behavior’ by self-, peer-, and expert assessment of teaching sessions with semistructured interviews; and 4) ‘Results’ from student evaluations.
Results
Our data indicate the success of the educational intervention at all observed levels. 1) Reaction: The participants showed a high acceptance of the instructional content. 2) Learning: There was a significant increase in knowledge (P<0.001) as deduced from a pre-post multiple-choice questionnaire, which was retained at 6 months (P<0.001). 3) Behavior: Peer-, self-, and expert-assessment indicated a transfer of learning into teaching performance. Semistructured interviews reflected a higher level of professionalism in medical teaching by the participants. 4) Results: Teaching performance ratings improved in students’ evaluations.
Conclusions
Our results demonstrate the success of a 5-day education program in embedding knowledge and skills to improve performance of medical educators. This multimethodological approach, using both qualitative and quantitative measures, may serve as a model to evaluate effectiveness of comparable interventions in other settings.
doi:10.3402/meo.v19.23868
PMCID: PMC3969510  PMID: 24679671
faculty development; medical education; medical teacher; educational theory; collaborative feedback
9.  Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers 
BMJ : British Medical Journal  1999;319(7218):1168-1171.
Objective
To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice.
Design
Qualitative semistructured interview study.
Setting
General practices throughout north London.
Subjects
30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice.
Results
The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching.
Conclusions
Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with.
Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education
PMCID: PMC28267  PMID: 10541508
10.  Lecture Classes in Human Anatomy: The Students’ Perceptions 
Introduction: The human anatomy, or in brief, the body structure has fascinated man for ages. Due to the information explosion and the increase in specializations, this knowledge is available in a very sketchy manner in high school biology courses. The first comprehensive course on the human anatomy is taught to the first year medical students in medical colleges. This is in keeping with the regulations of the Medical Council of India. The anatomy lecture classes occupy a considerable time of the course, to provide the students with an effective knowledge of the gross anatomy, histology, embryology and the clinical anatomy. On the other hand, the students’ feedback regarding the lecture methods and the teaching environment is crucial in judging the efficacy of the present curriculum.
Objective: To obtain the students’ feedback about the environment of the lecture classes, as regards the venue, the teaching and learning aids which are used, the lecture class schedule of the university (the number of classes per week, the durations of the lecture classes, etc.) and the existing departmental practices (display of the class routine in advance, synchronization between the lecture and the practical classes), so that their suggestions could help the faculty in planning the most effective teaching procedures.
Methods: A semi structured questionnaire was supplied to the students to get their feedback.
Result: Most of the students found the air conditioned seminar room’s environment to be more comfortable and they supported the existing durations of the lecture hours with the combined use of chalk and a board and overhead projectors (OHPs).
Conclusion: The perceptions of the learners helped in modifying the departmental practice in the desired way.
doi:10.7860/JCDR/2013/6254.3098
PMCID: PMC3708206  PMID: 23905111
Students feedback; Undergraduate medical education; Anatomy lecture class; Lecture hall environment
11.  Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement 
Background
As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system.
Methods
A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis.
Results
Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring.
Conclusions
This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.
doi:10.1186/1472-698X-12-21
PMCID: PMC3492068  PMID: 23016849
Primary care; Care providers; Focus group; Service delivery; Kurdistan region
12.  Perceptions of medical school graduates and students regarding their academic preparation to teach 
Postgraduate Medical Journal  2006;82(971):607-612.
Purpose
How medical students learn and develop the characteristics associated with good teaching in medicine is not well known. Information about this process can improve the academic preparation of medical students for teaching responsibilities. The purpose of this study was to determine how different experiences contributed to the knowledge, skills, and attitudes of medical school graduates and students regarding medical teaching.
Methods
A questionnaire was developed, addressing reliability and validity considerations, and given to first year residents and third year medical students (taught by those residents). Completed questionnaires were collected from 76 residents and 110 students (81% of the sample group). Item responses were analysed using descriptive and inferential statistics.
Results
Most residents (n = 54; 71%) positively viewed opportunities they had to practice teaching when they were seniors. Residents rated three activities for learning to teach highest: (1) observing teachers as they teach; (2) reviewing the material to be taught; and (3) directly teaching students; representing both individual and participatory ways of learning. Residents' self ratings of teaching behaviours improved over time and this self assessment by the residents was validated by the students' responses. Comparison between residents' self ratings and students' views of typical resident teaching behaviours showed agreement on levels of competence, confidence, and motivation. The students rated characteristics of enthusiasm, organisation, and fulfilment lower (p<0.002) than residents rated themselves.
Conclusions
The residents and students in this study viewed academic preparation for teaching responsibilities positively and showed agreement on characteristics of good teaching that may be helpful indicators in the process of developing medical teachers.
doi:10.1136/pgmj.2006.045393
PMCID: PMC2585736  PMID: 16954460
medical education, undergraduate; medical education, internship and residency; teaching methods; experiential learning; educational techniques
13.  Medical students’ evaluation of their exposure to the teaching of ethics 
Background:
The subject of Biomedical Ethics has become recognized as an essential integral component in the undergraduate curriculum of medical students.
Objectives:
(1) To review the current Biomedical Ethics Course offered at the College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS). (2) To explore the perception of medical students on the different components of the course.
Materials and Methods:
The medical students were requested to participate in the study at the end of the course by filling in a pre-designed questionnaire. A qualitative approach was used also to examine their perceptions about certain components of the course.
Results:
Forty-one medical students participated in this study. All students expressed their strong agreement on the importance of their learning biomedical ethics. Their views about the role of Biomedical Ethics were also considered. These include professional development, assessment of ethical competencies, and the timing of the teaching of ethics.
Conclusion:
The students provided valuable comments that were supported by the literature reviews. Medical Students’ views of the teaching of the various components of biomedical ethics are important and should be sought in the planning of a curriculum.
doi:10.4103/1319-1683.68788
PMCID: PMC3195073  PMID: 22022670
Bioethics; bioethics curriculum; bioethics learning; bioethics teaching; professional development
14.  Effects of “Teaching Method Workshop” on general surgery residents’ teaching skills 
Introduction:
Residents have an important role as teachers and need to know about teaching, teaching methods and skills. In developed countries, “resident-as-teacher” programs have been implemented progressively; but there is little information about this theme in developing countries such as Iran. This study aimed to determine effects of “teaching method” workshop on surgical residents’ teaching skills in Isfahan University of Medical Sciences.
Materials and Methods:
In this quasi-experimental study, 18 residents in 1st, 2nd, and 3rd years of surgical residency in Isfahan University of Medical Sciences have attended in a 10-hour workshop. Two questionnaires (validity and reliability) was verified: Clinical teaching self-assessment and clinical teaching evaluation was completed before and after the intervention (“teaching method” workshop) by attending residents and rater interns, respectively. Paired-samples T-test was used to analyze collecting data.
Results:
After intervention, Self-assessment mean scores were increased in two categories: feedback from 3.34 to 3.94 (P = 0.011) and promoting self- directed learning from 3.53 to 4.02 (P = 0.009); whereas, there was no significant differences in evaluation mean scores.
Conclusion:
Statistical results from self-assessment and evaluation scores show little improvement in residents’ teaching skills after the intervention, but residents assessed the workshop as useful. Lack of motivation in interns and little reward for residents who attend in educational activities could be responsible for these results. So, to promote role of residents’ as teachers, we offer revision in residency curriculum and residents’ formal duties as well as designing educational programs in teaching theme based on our needs and resources.
doi:10.4103/2277-9531.104808
PMCID: PMC3577416  PMID: 23555141
Clinical teaching; resident; teaching skill
15.  Introduction of structured physical examination skills to second year undergraduate medical students 
F1000Research  2013;2:16.
Introduction: Effective learning of physical examination skills (PES) requires suitable teaching and learning techniques and assessment methods. The Tribhuvan University (Nepal) curriculum recommends involving the departments of Medicine and Surgery in PES training (PEST) for second year students as a part of early clinical exposure. The project was developed to make teaching/learning of PES structured, involving eight clinical sciences departments and using appropriate methods for teaching and assessment in KIST Medical College, Nepal.
Methods: Irby’s three stages of clinical teaching model (Preparation, Teaching, Reflection), was applied for teaching. Skill acquisition was based on Millers’ learning pyramid at “show how level” and Dreyfus’ competency model at “competent level”. Teaching/learning was conducted in small groups. A tutorial, demonstration and practice (TDS) model was developed for teaching/learning techniques based on a simple five-step method for teaching clinical skills. Assessment of effectiveness of training was done at “reaction level” as per Kirkpatrick’s model based on students’ feedback, “shows how level” as per Miller’s pyramid of learning by OSCE and “competent level” as per Dreyfus’ model using retro-pre questionnaire.
Results: The analysis of retro-pre questionnaire based on the Dreyfus model found the average skill score (max score 184), before the introduction of the project module as 15.9 (median = 13.5) and after as 116.5 (median = 116). A paired t-test showed the difference to be statistically significant (100.5±23 and 95% CI 95.45 – 105.59). The average overall feedback score for the students on PES training based on seven items on a five point Likert scale was found to be 4.30. The mean total objective structured clinical examination (OSCE) score was 3.77 (SD+/- 0.33) out of 5; 80% of students scored more than 70%.
Conclusion: Students learned most of the skills with the implementation of the structured PES module and did well in the OSCE. Students and faculty were satisfied with the training and assessment.
doi:10.12688/f1000research.2-16.v1
PMCID: PMC3901509  PMID: 24555027
16.  Statistics teaching in medical school: Opinions of practising doctors 
BMC Medical Education  2010;10:75.
Background
The General Medical Council expects UK medical graduates to gain some statistical knowledge during their undergraduate education; but provides no specific guidance as to amount, content or teaching method. Published work on statistics teaching for medical undergraduates has been dominated by medical statisticians, with little input from the doctors who will actually be using this knowledge and these skills after graduation. Furthermore, doctor's statistical training needs may have changed due to advances in information technology and the increasing importance of evidence-based medicine. Thus there exists a need to investigate the views of practising medical doctors as to the statistical training required for undergraduate medical students, based on their own use of these skills in daily practice.
Methods
A questionnaire was designed to investigate doctors' views about undergraduate training in statistics and the need for these skills in daily practice, with a view to informing future teaching. The questionnaire was emailed to all clinicians with a link to the University of East Anglia Medical School. Open ended questions were included to elicit doctors' opinions about both their own undergraduate training in statistics and recommendations for the training of current medical students. Content analysis was performed by two of the authors to systematically categorise and describe all the responses provided by participants.
Results
130 doctors responded, including both hospital consultants and general practitioners. The findings indicated that most had not recognised the value of their undergraduate teaching in statistics and probability at the time, but had subsequently found the skills relevant to their career. Suggestions for improving undergraduate teaching in these areas included referring to actual research and ensuring relevance to, and integration with, clinical practice.
Conclusions
Grounding the teaching of statistics in the context of real research studies and including examples of typical clinical work may better prepare medical students for their subsequent career.
doi:10.1186/1472-6920-10-75
PMCID: PMC2987935  PMID: 21050444
17.  Lessons from Lithuania: rethinking public health training. 
BMJ : British Medical Journal  1993;306(6882):911-914.
Lithuania faces stark problems that are familiar to most countries in the former Soviet Union: high morbidity and mortality rates, pollution, an unstable economy, and rapid changes in the financing and organisation of health care. In this environment Moore and Dixon visited Kaunas Medical Academy to help identify how training in public health medicine could contribute towards improving the health of the population. Although over 200 hours are devoted to public health training for medical undergraduates, teaching is unfocused, fragmented, and includes little epidemiology--the core subject for public health physicians. Teaching is mainly through long lectures with few group discussions. Student participation and motivation are low. As well as recommending redesign of the curriculum, Moore and Dixon suggested training in teaching methods for teachers. They also suggested that postgraduate training in public health should begin and should be targeted at hospital managers, teaching staff, and existing public health physicians.
Images
PMCID: PMC1677372  PMID: 8490421
18.  Application of biostatistics in research by teaching faculty and final-year postgraduate students in colleges of modern medicine: A cross-sectional study 
Context:
Biostatistics is well recognized as an essential tool in medical research, clinical decision making, and health management. Deficient basic biostatistical knowledge adversely affects research quality. Surveys on this issue are uncommon in the literature.
Aims:
To study the use of biostatistics in research by teaching faculty and postgraduate students from colleges of modern medicine.
Settings and Design:
Cross-sectional study in colleges of modern medicine.
Materials and Methods:
A pretested proforma was used to collect information about the use of biostatistics by teaching faculty and final-year postgraduate students from colleges of modern medicine. The study period was 6 months.
Statistical Analysis:
Chi-square test, Spearman rank correlation coefficient, and multivariate analysis were used for analysis of data.
Results:
With this questionnaire, the maximum possible score for appropriate use of biostatistics in research was 20. The range of scores obtained by the study subjects was 1–20 and the median was 11. Appropriate use of biostatistics was independent of sex, designation, and education (P>.05). Spearman coefficient showed low—but significant—correlation between the score and the number of papers presented and published (P=.002 and P=.000, respectively).
Conclusions:
The study showed that nearly half of the respondents were not using statistics appropriately in their research. There was also lack of awareness about the need for applying statistical methods from the stage of planning itself.
doi:10.4103/2229-516X.96792
PMCID: PMC3657982  PMID: 23776801
Awareness; biostatistical knowledge; PG students; teaching faculty
19.  Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project 
Background
Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments.
Methods
We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process.
Results
The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection.
Conclusion
This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in teaching EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuing medical education.
doi:10.1186/1472-6920-9-59
PMCID: PMC2753626  PMID: 19744327
20.  Faculty Development Seminars Based on the One-Minute Preceptor Improve Feedback in the Ambulatory Setting 
OBJECTIVE
While several models of medical student instruction in the ambulatory setting exist, few have been formally studied. We wished to assess the impact of a faculty development workshop based on the One-Minute Preceptor model on the amount and quality of feedback in the outpatient setting.
DESIGN
Ambulatory teaching behaviors were studied during consecutive outpatient precepting sessions before and after 3 faculty development workshops. Student–teacher interactions were assessed using audiotapes of teaching encounters coded through qualitative techniques, and surveys of teacher, learner, and patient satisfaction.
SETTING
Ambulatory internal medicine clinic in a tertiary care medical center.
PATIENTS/PARTICIPANTS
Nine board-certified internist faculty preceptors and 44 third-year medical students.
INTERVENTIONS
Three 90-minute faculty development seminars based on the One-Minute Preceptor teaching model.
MEASUREMENTS AND MAIN RESULTS
Ninety-four encounters with 18,577 utterances were recorded, half before and half after the seminars. After the workshops, the proportion of utterances that contained feedback increased from 17% to 22% (P = .09) and was more likely to be specific (9% vs 15%; P = .02). After the workshops, teachers reported that the learning encounters were more successful (P = .03) and that they were better at letting the students reach their own Conclusions (P = .001), at evaluating the learners (P = .03), and at creating plans for post-encounter learning (P = .02). The workshops had no effect on the duration of the student–teacher encounter or on student or patient satisfaction with the encounters.
CONCLUSIONS
Brief, interactive, faculty development workshops based on the One-Minute Preceptor model of clinical teaching resulted in modest improvements in the quality of feedback delivered in the ambulatory setting.
doi:10.1046/j.1525-1497.2002.11233.x
PMCID: PMC1495113  PMID: 12390554
feedback; ambulatory; teaching; faculty development
21.  Development of the clinical learning evaluation questionnaire for undergraduate clinical education: factor structure, validity, and reliability study 
BMC Medical Education  2014;14:44.
Background
Teaching and learning of clinical skills for undergraduate medical students usually takes place during the clinical clerkship. Therefore, it is of vital importance to ensure the effectiveness of the rotations within this clerkship. The aims of this study were to develop an instrument that measures the effectiveness of the clinical learning environment, to determine its factor structure, and to find first evidence for the reliability and validity of the total scale and the different factors.
Methods
The Clinical Learning Evaluation Questionnaire (CLEQ) is an instrument, consisting of 40 items, which have been developed after consideration of the results of a qualitative study that investigated the important factors influencing clinical learning, both from the perspective of students, as well as teachers. Results of relevant literature that investigated this issue were also incorporated in the CLEQ. This instrument was administered to a sample of students (N = 182) from three medical colleges in Riyadh city, the capital of Saudi Arabia. The factor structure of the CLEQ (Principal component analysis, Oblimin rotation) and reliability of the factor scales (Cronbach’s α) were determined. Hypotheses concerning the correlations between the different factors were tested to investigate their convergent and divergent validity.
Results
One hundred and nine questionnaires were returned. The factor analysis yielded six factors: F1 Cases (8 items), F2 Authenticity of clinical experience (8 items), F3 Supervision (8 items), F4 Organization of the doctor-patient encounter (4 items), F5 Motivation to learn (5 items), and F6 Self awareness (4 items). The overall internal consistency (α) of the CLEQ was 0.88, and the reliabilities (Cronbach’s α) of the six factors varied from .60 to .86. Hypotheses concerning the correlations between the different factors were partly confirmed, which supported the convergent validity of the factors, but not their divergent validity. Significant differences were found between the scores of the students of the three different schools on the factors Supervision and Organization of patient-doctor encounter.
Conclusions
The results of this study demonstrated that CLEQ is a multidimensional and reliable instrument. It can be utilized as an evaluation tool for clinical teaching activities, both by educators as well as students. Further research is needed into the validity of the CLEQ.
doi:10.1186/1472-6920-14-44
PMCID: PMC3944808  PMID: 24592913
22.  Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules 
Background
Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions.
Methods
This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS).
Results
There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05).
Conclusion
1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.
doi:10.1186/1472-6920-7-34
PMCID: PMC2089058  PMID: 17919342
23.  Les résidents et l'enseignement: revue de la littérature. 
We reviewed the available data on residents' teaching role in the clinical setting to develop programs to improve their teaching skills. Articles published from 1966 to 1989 were identified through a computerized search of MEDLINE, and the bibliographies of identified papers were reviewed. Articles directly related to the topic were included and analysed. Taking into account their quality, we extracted data relevant to specific issues. Approximately 15% to 25% of an average work week was spent by residents in different teaching activities. Students acknowledged the importance of their contribution to clinical teaching. Residents benefitted from teaching by increasing their medical knowledge and promoting the development of important attitudes. Insufficient preparation for this task and the numerous practical problems faced by residents may explain their modest performance as teachers. Nevertheless, programs directed to residents might improve the quality of their teaching. We suggest some guidelines for the development of programs to improve their teaching skills and for future research.
PMCID: PMC1452407  PMID: 2207935
24.  Learning styles and approaches to learning among medical undergraduates and postgraduates 
BMC Medical Education  2013;13:42.
Background
The challenge of imparting a large amount of knowledge within a limited time period in a way it is retained, remembered and effectively interpreted by a student is considerable. This has resulted in crucial changes in the field of medical education, with a shift from didactic teacher centered and subject based teaching to the use of interactive, problem based, student centered learning. This study tested the hypothesis that learning styles (visual, auditory, read/write and kinesthetic) and approaches to learning (deep, strategic and superficial) differ among first and final year undergraduate medical students, and postgraduates medical trainees.
Methods
We used self administered VARK and ASSIST questionnaires to assess the differences in learning styles and approaches to learning among medical undergraduates of the University of Colombo and postgraduate trainees of the Postgraduate Institute of Medicine, Colombo.
Results
A total of 147 participated: 73 (49.7%) first year students, 40 (27.2%) final year students and 34(23.1%) postgraduate students. The majority (69.9%) of first year students had multimodal learning styles. Among final year students, the majority (67.5%) had multimodal learning styles, and among postgraduates, the majority were unimodal (52.9%) learners.
Among all three groups, the predominant approach to learning was strategic. Postgraduates had significant higher mean scores for deep and strategic approaches than first years or final years (p < 0.05). Mean scores for the superficial approach did not differ significantly between groups.
Conclusions
The learning approaches suggest a positive shift towards deep and strategic learning in postgraduate students. However a similar difference was not observed in undergraduate students from first year to final year, suggesting that their curriculum may not have influenced learning methodology over a five year period.
doi:10.1186/1472-6920-13-42
PMCID: PMC3620557  PMID: 23521845
Learning methods; Medicine; Post graduate; Undergraduate curriculum evaluation
25.  Patient safety education for undergraduate medical students: a systematic review 
BMC Medical Education  2011;11:33.
Background
To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China.
Methods
We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person.
Results
This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty knowledge and background in patient safety, other resources and outcome evaluation in these reports. The outcomes from including patient safety in the curriculum as measured by medical students' knowledge, skills, and attitudes varied between the studies.
Conclusions
There are only a few relevant published studies on the inclusion of patient safety education into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges.
doi:10.1186/1472-6920-11-33
PMCID: PMC3128569  PMID: 21669007

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