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1.  Breaking bad news – an interdisciplinary curricular teaching-concept 
Background: The concerns of patients suffering from life-threatening disease and end-of-life care aspects have gained increasing attention in public perception. The increasing focus on palliative medicine questions can be considered to be paradigmatic for this development. Palliative medicine became a compulsory subject of the undergraduate curriculum in Germany to be implemented until 2013. The preexisting conditions and qualifications at the medical faculties vary, though. We describe the conceptual process, didactic background, and first experiences with the new interdisciplinary course “Delivering bad news” as a compulsory part of the palliative medicine curriculum.
Methods: Since autumn 2009, this course has been taught at the University Medical Center Göttingen, consisting of two double lessons in the final year of medical education. Considering the curriculum-based learning goals in Göttingen, the focus of this course is to impart knowledge, attitudes and communication skills relating to “bad news”.
Results: Although the seminar requires adequate staff and is time-consuming, students have accepted it and gave high marks in evaluations. In particular, the teachers’ performance and commitment was evaluated positively.
Discussion and Conclusions: We describe the first experiences with a new course. Didactic structure, theoretical contents, role-plays and usage of media (film, novel) are well- suited to communicate topics such as “bad news”. Additional experiences and evaluations are necessary. According to the progressive nature of learning, it might be worthwhile to repeat communication- centered questions several times during medical studies.
PMCID: PMC3244731  PMID: 22205910
palliative medicine; medical teaching; communication skills; role play
2.  Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses 
Annals of the Rheumatic Diseases  2007;67(7):1017-1022.
To develop education guidelines for the conduct of future European League Against Rheumatism (EULAR) musculoskeletal ultrasound (MSUS) courses.
We undertook a consensus-based, iterative process using two consecutive questionnaires sent to 29 senior ultrasonographer rheumatologists who comprised the faculty of the 14th EULAR ultrasound course (June 2007). The first questionnaire encompassed the following issues: type of MSUS educational model; course timing; course curriculum; course duration; number of participants per teacher in practical sessions; time spent on hands-on sessions; and the requirements and/or restrictions for attendance at the courses. The second questionnaire consisted of questions related to areas where consensus had not been achieved in the first questionnaire, and to the topics and pathologies to be assigned to different educational levels.
The response rate was 82.7% from the first questionnaire and 87.5% from the second questionnaire. The respondents were from 11 European countries. The group consensus on guidelines and curriculum was for a three-level education model (basic, intermediate and advanced) with timing and location related to the annual EULAR Congresses. The topics and pathologies to be included in each course were agreed. The course duration will be 20 h. There will be a maximum of six participants per teacher and 50–60% of total time will be spent on practical sessions. There was also agreement on prerequisite experience before attending the intermediate and advanced courses.
We have developed European agreed guidelines for the content and conduct of EULAR ultrasound courses, which may also be recommended to national and local MSUS training programmes.
PMCID: PMC2564786  PMID: 17921183
3.  Does Instructor Type Matter? Undergraduate Student Perception of Graduate Teaching Assistants and Professors 
CBE Life Sciences Education  2012;11(2):187-199.
Graduate teaching assistants (GTAs) are used extensively as instructors in higher education, yet their status and authority as teachers may be unclear to undergraduates, to administrators, and even to the GTAs themselves. This study explored undergraduate perception of classroom instruction by GTAs and professors to identify factors unique to each type of instructor versus the type of classes they teach. Data collection was via an online survey composed of subscales from two validated instruments, as well as one open-ended question asking students to compare the same class taught by a professor versus a GTA. Quantitative and qualitative results indicated that some student instructional perceptions are specific to instructor type, and not class type. For example, regardless of type of class, professors are perceived as being confident, in control, organized, experienced, knowledgeable, distant, formal, strict, hard, boring, and respected. Conversely, GTAs are perceived as uncertain, hesitant, nervous, relaxed, laid-back, engaging, interactive, relatable, understanding, and able to personalize teaching. Overall, undergraduates seem to perceive professors as having more knowledge and authority over the curriculum, but enjoy the instructional style of GTAs. The results of this study will be used to make recommendations for GTA professional development programs.
PMCID: PMC3366904  PMID: 22665591
4.  Teaching About the Brain and Reaching the Community: Undergraduates in the Pipeline Neuroscience Program at the University of Pennsylvania 
This article provides an overview of the University of Pennsylvania School of Medicine’s Pipeline Neuroscience Program, a multi-tiered mentorship and education program for Philadelphia high school students in which University of Pennsylvania undergraduates are integrally involved. The Pipeline Neuroscience Program provides mentorship and education for students at all levels. High school students are taught by undergraduates, who learn from medical students who, in turn, are guided by neurology residents and fellows.
Throughout a semester-long course, undergraduates receive instruction in neuroanatomy, neuroscience, and clinical neurology as part of the Pipeline’s case-based curriculum. During weekly classes, undergraduates make the transition from students to community educators by integrating their new knowledge into lesson plans that they teach to small groups of medically and academically underrepresented Philadelphia high school students. The Pipeline program thus achieves the dual goals of educating undergraduates about neuroscience and providing them with an opportunity to perform community service.
PMCID: PMC3592656  PMID: 23493190
community educators; mentoring; community service; service learning; case-based curriculum; neuroscience; neuroanatomy; clinical neurology
5.  Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study 
BMC Medical Education  2013;13:84.
As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University.
240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method.
There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students’ self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students’ DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies.
Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.
PMCID: PMC3686658  PMID: 23758796
Undergraduate medical education; Ultrasound; Ultrasonography; Clinical competence
6.  Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist 
The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.
A consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS.
Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis.
This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.
PMCID: PMC2553775  PMID: 18822149
7.  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
8.  Validating the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate physiology curriculum 
It has been proved that basic science knowledge learned in the context of a clinical case is actually better comprehended and more easily applied by medical students than basic science knowledge learned in isolation. The present study intended to validate the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate medical curriculum at Melaka Manipal Medical College (Manipal Campus), Manipal, India.
COPT was a teaching strategy wherein, students were taught physiology using cases and critical thinking questions. Three batches of undergraduate medical students (n = 434) served as the experimental groups to whom COPT was incorporated in the third block (teaching unit) of Physiology curriculum and one batch (n = 149) served as the control group to whom COPT was not incorporated. The experimental group of students were trained to answer clinically oriented questions whereas the control group of students were not trained. Both the group of students undertook a block exam which consisted of clinically oriented questions and recall questions, at the end of each block.
Comparison of pre-COPT and post-COPT essay exam scores of experimental group of students revealed that the post-COPT scores were significantly higher compared to the pre-COPT scores. Comparison of post-COPT essay exam scores of the experimental group and control group of students revealed that the experimental group of students performed better compared to the control group. Feedback from the students indicated that they preferred COPT to didactic lectures.
The study supports the fact that assessment and teaching patterns should fall in line with each other as proved by the better performance of the experimental group of students compared to the control group. COPT was also found to be a useful adjunct to didactic lectures in teaching physiology.
PMCID: PMC2503982  PMID: 18652649
9.  Identification of novel monosodium urate crystal regulated mRNAs by transcript profiling of dissected murine air pouch membranes 
The murine air pouch is a bursa-like space that resembles the human synovial membrane. Injection of monosodium urate (MSU) crystals into the pouch elicits an acute inflammatory response similar to human gout. We conducted the present study to identify mRNAs that were highly regulated by MSU crystals in the pouch membrane.
Air pouch membranes were meticulously dissected away from the overlying skin. Gene expression differences between MSU crystal stimulated and control membranes were determined by oligonucleotide microarray analysis 9 hours after injection of MSU crystals or buffer only. Differential regulation of selected targets was validated by relative quantitative PCR in time course experiments with dissected air pouch membranes and murine peritoneal macrophages.
Eleven of the 12 most highly upregulated mRNAs were related to innate immunity and inflammation. They included mRNAs encoding histidine decarboxylase (the enzyme that synthesizes histamine), IL-6, the cell surface receptors PUMA-g and TREM-1, and the polypeptides Irg1 and PROK-2. IL-6 mRNA rose 108-fold 1 hour after crystal injection, coinciding with a surge in mRNAs encoding IL-1β, tumour necrosis factor-α and the immediate early transcription factor Egr-1. The other mRNAs rose up to 200-fold within the subsequent 3 to 8 hours. MSU crystals induced these mRNAs in a dose-dependent manner in cultured macrophages, with similar kinetics but lower fold changes. Among the downregulated mRNAs, quantitative PCR confirmed significant decreases in mRNAs encoding TREM-2 (an inhibitor of macrophage activation) and granzyme D (a constituent of natural killer and cytotoxic T cells) within 50 hours after crystal injection.
This analysis identified several genes that were previously not implicated in MSU crystal inflammation. The marked rise of the upregulated mRNAs after the early surge in cytokine and Egr-1 mRNAs suggests that they may be part of a 'second wave' of factors that amplify or perpetuate inflammation. Transcript profiling of the isolated air pouch membrane promises to be a powerful tool for identifying genes that act at different stages of inflammation.
PMCID: PMC2483455  PMID: 18522745
10.  A randomized control trial: training program of university students as health promoters 
BMC Public Health  2013;13:162.
Several studies have reported the following as determining factors for the adoption of healthy lifestyles among undergraduate students: gender, socioeconomic level, prior lifestyles, environment, parental lifestyles and health status, career choice, and healthy support networks. However, these factors are influenced by students’ knowledge about healthy lifestyles.
We will carry out a randomized trial in a sample of 280 new undergraduate students at the National Autonomous University of Mexico’s Faculty of Higher Studies-Zaragoza (FES-Zaragoza, UNAM). There will be an experimental group (n = 140), comprising 20 students from each of the seven university departments (careers); these students will receive training as university student health promoters through an e-learning course. This course will allow the topics necessary for such promoters to be reviewed. There will be a control group (n = 140), comprising 20 students from each of the seven departments (careers); these students will not undergo the training. Later, the students who comply satisfactorily with the e-learning course will replicate the course to 10 of their classmates. A healthy-lifestyle questionnaire will be given to all the participants, and the parameters established in the self-care card will be recorded before and after the training. The study variables are as follows: (i) independent variable—compliance with the e-learning course; (ii) dependent variables—lifestyles changes prior to the educative intervention (including healthy eating, physical activity, and addiction prevention) and parameters related to health status established in self-care (including weight, body mass index, waist circumference, and hip circumference). Data will be analyzed using Student’s t test and logistic regression analysis odds ratios with 95% confidence intervals. The analysis of the open answers will be carried out with ATLAS. ti 5.5 software.
Health promotion among university students should incorporate options that are feasible for and attractive to students. Thus, as proposed in the present protocol, e-learning courses offer excellent possibilities because they allow students to program their learning in their available time without affecting their academic studies.
Trial registration
PMCID: PMC3608970  PMID: 23433061
University health promoter; University student health promoter; Self-care; Health promotion
11.  Innovative Health Care Disparities Curriculum for Incoming Medical Students 
Journal of General Internal Medicine  2008;23(7):1028-1032.
1) To pilot a health disparities curriculum for incoming first year medical students and evaluate changes in knowledge. 2) To help students become aware of personal biases regarding racial and ethnic minorities. 3) To inspire students to commit to serving indigent populations.
First year students participated in a 5-day elective course held before orientation week. The course used the curricular goals that had been developed by the Society of General Internal Medicine Health Disparities Task Force. Thirty-two faculty members from multiple institutions and different disciplinary backgrounds taught the course. Teaching modalities included didactic lectures, small group discussions, off-site expeditions to local free clinics, community hospitals and clinics, and student-led poster session workshops. The course was evaluated by pre-post surveys.
Sixty-four students (60% of matriculating class) participated. Survey response rates were 97–100%. Students’ factual knowledge (76 to 89%, p < .0009) about health disparities and abilities to address disparities issues improved after the course. This curriculum received the highest rating of any course at the medical school (overall mean 4.9, 1 = poor, 5 = excellent).
This innovative course provided students an opportunity for learning and exploration of a comprehensive curriculum on health disparities at a critical formative time.
PMCID: PMC2517917  PMID: 18612738
health disparities; curriculum; education; medical students; underserved
12.  Ready for the OR? – Clinical anatomy and basic surgical skills for students in their preclinical education 
Medical students’ first experience in the operating theatre often takes place during their electives and is therefore separated from the university’s medical curriculum. In the winter term 2009/10, the Institute of Anatomy and Cell Biology at the University of Ulm implemented an elective called “Ready for the OR” for 2nd year medical students participating in the dissection course. We attempted to improve learning motivation and examination results by transferring anatomical knowledge into a surgical setting and teaching basic surgical skills in preparation of the students’ first participation in the OR. Out of 69 online applicants, 50 students were randomly assigned to the Intervention Group (FOP) or the Control Group. In 5 teaching session students learned skills like scrubbing, stitching or the identification of frequently used surgical instruments. Furthermore, students visited five surgical interventions which were demonstrated by surgical colleagues on donated bodies that have been embalmed using the Thiel technique. The teaching sessions took place in the institute’s newly built “Theatrum Anatomicum” for an ideal simulation of a surgical setting. The learning outcomes were verified by OSPE. In a pilot study, an intervention group and a control group were compared concerning their examination results in the dissection course and their learning motivation through standardized SELLMO-test for students. Participants gained OSPE results between 60.5 and 92% of the maximum score. “Ready for the OR” was successfully implemented and judged an excellent add-on to anatomy teaching by the participants. However, we could not prove a significant difference in learning motivation or examination results. Future studies should focus on the learning orientation, the course’s long-term learning effects and the participants’ behavior in a real surgery setting.
PMCID: PMC3159200  PMID: 21866247
anatomy; teaching; basic surgical skills; motivation; examination results
13.  Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study 
Journal of General Internal Medicine  2008;23(7):1057-1059.
Evidence-based medicine (EBM) is increasingly taught in medical schools, but few curricula have been evaluated using validated instruments.
To evaluate a longitudinal medical school EBM curriculum using a validated instrument.
Design, Participants, Measurements
We evaluated EBM attitudes and knowledge of 32 medical students as they progressed through an EBM curriculum. The first part was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second part integrated EBM assignments with third-year clinical rotations. The validated 15-item Berlin Questionnaire was administered before the course, after the short course, and at the end of the third year.
EBM knowledge scores increased from baseline by 2.8 points at the end of the second year portion of the course (p = .0001), and by 3.7 points at the end of the third year (p < .0001). Self-rated EBM knowledge increased from baseline by 0.8 and 1.1 points, respectively (p = .0006 and p < .0001, respectively). EBM was felt to be of high importance for medical education and clinical practice at all time points, peaking after the short course.
A longitudinal medical school EBM curriculum was associated with increased EBM knowledge. This knowledge increase was sustained throughout the curriculum.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-008-0625-x) contains supplementary material, which is available to authorized users.
PMCID: PMC2517920  PMID: 18612744
medical education; evidence-based medicine; medical school
14.  Teaching medical students a clinical approach to altered mental status: simulation enhances traditional curriculum 
Medical Education Online  2013;18:10.3402/meo.v18i0.19775.
Simulation-based medical education (SBME) is increasingly being utilized for teaching clinical skills in undergraduate medical education. Studies have evaluated the impact of adding SBME to third- and fourth-year curriculum; however, very little research has assessed its efficacy for teaching clinical skills in pre-clerkship coursework. To measure the impact of a simulation exercise during a pre-clinical curriculum, a simulation session was added to a pre-clerkship course at our medical school where the clinical approach to altered mental status (AMS) is traditionally taught using a lecture and an interactive case-based session in a small group format. The objective was to measure simulation's impact on students’ knowledge acquisition, comfort, and perceived competence with regards to the AMS patient.
AMS simulation exercises were added to the lecture and small group case sessions in June 2010 and 2011. Simulation sessions consisted of two clinical cases using a high-fidelity full-body simulator followed by a faculty debriefing after each case. Student participation in a simulation session was voluntary. Students who did and did not participate in a simulation session completed a post-test to assess knowledge and a survey to understand comfort and perceived competence in their approach to AMS.
A total of 154 students completed the post-test and survey and 65 (42%) attended a simulation session. Post-test scores were higher in students who attended a simulation session compared to those who did not (p<0.001). Students who participated in a simulation session were more comfortable in their overall approach to treating AMS patients (p=0.05). They were also more likely to state that they could articulate a differential diagnosis (p=0.03), know what initial diagnostic tests are needed (p=0.01), and understand what interventions are useful in the first few minutes (p=0.003). Students who participated in a simulation session were more likely to find the overall AMS curriculum useful (p<0.001).
Students who participated in a simulation exercise performed better on a knowledge-based test and reported increased comfort and perceived competence in their clinical approach to AMS. SBME shows significant promise for teaching clinical skills to medical students during pre-clinical curriculum.
PMCID: PMC3617787  PMID: 23561054
mental status change; simulation; pre-clinical medical students
15.  Student performance and their perception of a patient-oriented problem-solving approach with audiovisual aids in teaching pathology: a comparison with traditional lectures 
We use different methods to train our undergraduates. The patient-oriented problem-solving (POPS) system is an innovative teaching–learning method that imparts knowledge, enhances intrinsic motivation, promotes self learning, encourages clinical reasoning, and develops long-lasting memory. The aim of this study was to develop POPS in teaching pathology, assess its effectiveness, and assess students’ preference for POPS over didactic lectures.
One hundred fifty second-year MBBS students were divided into two groups: A and B. Group A was taught by POPS while group B was taught by traditional lectures. Pre- and posttest numerical scores of both groups were evaluated and compared. Students then completed a self-structured feedback questionnaire for analysis.
The mean (SD) difference in pre- and post-test scores of groups A and B was 15.98 (3.18) and 7.79 (2.52), respectively. The significance of the difference between scores of group A and group B teaching methods was 16.62 (P < 0.0001), as determined by the z-test. Improvement in post-test performance of group A was significantly greater than of group B, demonstrating the effectiveness of POPS. Students responded that POPS facilitates self-learning, helps in understanding topics, creates interest, and is a scientific approach to teaching. Feedback response on POPS was strong in 57.52% of students, moderate in 35.67%, and negative in only 6.81%, showing that 93.19% students favored POPS over simple lectures.
It is not feasible to enforce the PBL method of teaching throughout the entire curriculum; However, POPS can be incorporated along with audiovisual aids to break the monotony of dialectic lectures and as alternative to PBL.
PMCID: PMC3661239  PMID: 23745071
medical education; problem-solving exercise; problem-based learning
16.  Organizational Philosophy as a New Perspective on Understanding the Learning of Professionalism 
Objective. To define the concept of “organizational philosophy” through identification of elements within undergraduate pharmacy curricula in the United Kingdom that contribute to students’ learning of professionalism.
Methods. A qualitative study using curriculum mapping was conducted to identify “intended,” “taught,” and “received” curriculum in 3 schools of pharmacy. The study involved review of course materials, interviews with teaching staff members, focus groups with final year students, and observation of classes.
Results. “Organizational philosophy” (totality of all contributors) played a vital part in students’ professionalism learning. Key contributions were not restricted to the “taught” curriculum but extended to the wider academic environment. Setting of high standards appeared important; role models had particular significance. Importance of professionalism learning being grounded and longitudinal throughout the curriculum was highlighted. An “integrated” organizational philosophy appeared to be achieved where maximum overlap occurred between “intended,” “taught,” and “received” curricula.
Conclusions. Professionalism learning goes beyond the “taught” curriculum in pharmacy schools. The concept of “organizational philosophy” acknowledges the importance of integration between “intended,” “taught,” and “received” curriculum in the context of overall organization.
PMCID: PMC3872933  PMID: 24371338
professionalism; professionalism learning; organizational philosophy; curriculum mapping; hidden curriculum
17.  Library instruction in the medical school curriculum: a survey of medical college libraries. 
Future physicians must learn to cope with continuing changes in access to medical information. New instructional techniques, such as problem-based learning, emphasize the importance of research skills to medical students. To investigate the feasibility of establishing library instruction as a required part of the East Tennessee State University College of Medicine curriculum for undergraduates, the university's medical library surveyed 123 medical school libraries to determine the level of instruction offered by other academic medical libraries. The survey asked whether formal instruction was offered or required, and which courses were taught at each level of undergraduate training. Analysis of the fifty-five responses revealed that 75% offered formal library instruction, and that 49% of these respondents (36% of the total sample) required all students to take such courses. The courses offered most often were library tours, online catalog instruction, and MEDLINE-on-CD-ROM classes. Overall, thirty-three different course titles were offered by responding libraries. The majority of classes involved second- and third-year students. The survey responses reveal the prevalence of required library instruction in medical school curricula, and a broad-scale commitment to the development of lifelong learning skills among future health professionals.
PMCID: PMC299401  PMID: 8826622
18.  Prescribing knowledge in the light of undergraduate clinical pharmacology and therapeutics teaching in India: views of first-year postgraduate students 
The study aimed to review the prescribing knowledge of first-year postgraduate doctors in a medical college in India, using the principles of good prescribing, to suggest strategies to improve rational prescribing, and to recommend what curriculum planners can do to accomplish this objective.
Fifty first-year postgraduate doctors were asked to fill in a structured questionnaire that sought information regarding their undergraduate training in clinical pharmacology and therapeutics, prescribing habits, and commonly consulted drug information sources. Also, the questionnaire assessed any perceived deficiencies in their undergraduate clinical pharmacology teaching and sought feedback regarding improvement in the teaching.
Eighty-eight percent of residents said that they were taught prescription writing in undergraduate pharmacology teaching; 48% of residents rated their prescribing knowledge at graduation as average, 28% good, 4% excellent, 14% poor, and 4% very poor; 58% felt that their undergraduate training did not prepare them to prescribe safely, and 62% felt that their training did not prepare them to prescribe rationally. Fifty-eight percent of residents felt that they had some specific problems with writing a prescription during their internship training, while 92% thought that undergraduate teaching should be improved. Their suggestions for improving teaching methods were recorded.
This study concludes that efforts are needed to develop a curriculum that encompasses important aspects of clinical pharmacology and therapeutics along with incorporation of the useful suggestions given by the residents.
PMCID: PMC3650870  PMID: 23762001
clinical pharmacology and therapeutics; medical education; prescription writing; undergraduate medical curriculum; pharmacovigilance; pharmacoeconomics
19.  Assessment of knowledge retention and the value of proctored ultrasound exams after the introduction of an emergency ultrasound curriculum 
Optimal training required for proficiency in bedside ultrasound is unknown. In addition, the value of proctored training is often assumed but has never been quantified.
To compare different training regimens for both attending physicians and first year residents (interns), a prospective study was undertaken to assess knowledge retention six months after an introductory ultrasound course. Eighteen emergency physicians and twelve emergency medicine interns were assessed before and 6 months after an introductory ultrasound course using a standardized, image-based ultrasound test. In addition, the twelve emergency medicine interns were randomized to a group which received additional proctored ultrasound hands-on instruction from qualified faculty or to a control group with no hands-on instruction to determine if proctored exam training impacts ultrasound knowledge. Paired and unpaired estimates of the median shift in test scores between groups were made with the Hodges-Lehmann extension of the Wilcoxon-Mann-Whitney test.
Six months after the introductory course, test scores (out of a 24 point test) were a median of 2.0 (95% CI 1.0 to 3.0) points higher for residents in the control group, 5.0 (95% CI 3.0 to 6.0) points higher for residents in the proctored group, and 2.5 (95% CI 1.0 to 4.0) points higher for the faculty group. Residents randomized to undergo proctored ultrasound examinations exhibited a higher score improvement than their cohorts who were not with a median difference of 3.0 (95% CI 1.0 to 5.0) points.
We conclude that significant improvement in knowledge persists six months after a standard introductory ultrasound course, and incorporating proctored ultrasound training into an emergency ultrasound curriculum may yield even higher knowledge retention.
PMCID: PMC2223143  PMID: 17971234
20.  Evaluation of a web-based ECG-interpretation programme for undergraduate medical students 
Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institutet have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity.
A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group.
20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 – very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03).
Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.
PMCID: PMC2394519  PMID: 18430256
21.  Adaptation of EPEC-EM™ Curriculum in a Residency with Asynchronous Learning 
The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.
Curriculum adaptation followed Kern’s standardized six-step curriculum design process. Post-graduate year (PGY) 1–4 residents were taught all EPEC™-EM cognitive domains, divided as seven synchronous and seven asynchronous modules. All synchronous modules featured large group didactic lectures and review of EPEC™-EM course materials. Asynchronous modules use only EPEC™-EM electronic course media for resident self-study. Targeted evaluation for EPEC™-EM knowledge objectives was conducted by a prospective case-control crossover study, with synchronous learning serving as the quasi-control, using validated exam tools. We compared de-identified test scores for effectiveness of learning method, using aggregate group performance means for each learning strategy.
Of 45 eligible residents 55% participated in a pre-test for local needs analysis, and 78% completed a post-test to measure teaching method effect. Post-test scores improved across all EPEC™-EM domains, with a mean improvement for synchronous modules of +28% (SD=9) and a mean improvement for asynchronous modules of +30% (SD=18). The aggregate mean difference between learning methods was 1.9% (95% CI −15.3, +19.0). Mean test scores of the residents who completed the post-test were: synchronous modules 77% (SD=12); asynchronous modules 83% (SD=13); all modules 80% (SD=12).
EPEC™-EM adapted materials can improve resident knowledge of palliative medicine domains, as assessed through validated testing of course objectives. Synchronous and asynchronous learning methods appear to result in similar knowledge transfer, feasibly allowing some course content to be effectively delivered outside of large group lectures.
PMCID: PMC3027445  PMID: 21293772
22.  Using a Pocket Card to Improve End-of-life Care on Internal Medicine Clinical Teaching Units: A Cluster-randomized Controlled Trial 
Journal of General Internal Medicine  2008;23(8):1222-1227.
End-of-life care is suboptimally taught in undergraduate and postgraduate education in Canada. Previous interventions to improve residents’ knowledge and comfort have involved lengthy comprehensive educational modules or dedicated palliative care rotations.
To determine the effectiveness of a cheap, portable, and easily implemented pocket reference for improving residents’ knowledge and comfort level in dealing with pain and symptom management on the medical ward.
Cluster-randomized controlled trial conducted from August 2005 to June 2006.
Medical clinical teaching units (CTUs) in 3 academic hospitals in Toronto, Canada.
All residents rotating through the medical CTUs who consented to participate in the study.
Residents at 1 hospital received a pocket reference including information about pain and symptom control, as well as 1–2 didactic end-of-life teaching sessions per month normally given as part of the rotation. Residents at the other 2 hospitals received only the didactic sessions.
Main Outcome Measures
A 10-question survey assessing knowledge and comfort level providing end-of-life care to medical inpatients, as well as focus group interviews.
One hundred thirty-six residents participated on 3 CTUs for a participation rate of approximately 75%. Comfort levels improved in both control (p < .01) and intervention groups (p < .01), but the increase in comfort level was significantly higher in the intervention group (z = 2.57, p < .01). Knowledge was not significantly improved in the control group (p = .06), but was significantly improved in the intervention group (p = .01). Greater than 90% of residents in the intervention group used the card at least once per week, and feedback from the focus groups was very positive.
Our pocket card is a feasible, economical, and educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on CTUs.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-008-0582-4) contains supplementary material, which is available to authorized users.
PMCID: PMC2517963  PMID: 18446415
end-of-life; educational intervention; palliative care
23.  A two-year experience teaching computer literacy to first-year medical students using skill-based cohorts 
Because it is widely accepted that providing information online will play a major role in both the teaching and practice of medicine in the near future, a short formal course of instruction in computer skills was proposed for the incoming class of students entering medical school at the State University of New York at Stony Brook. The syllabus was developed on the basis of a set of expected outcomes, which was accepted by the dean of medicine and the curriculum committee for classes beginning in the fall of 1997. Prior to their arrival, students were asked to complete a self-assessment survey designed to elucidate their initial skill base; the returned surveys showed students to have computer skills ranging from complete novice to that of a systems engineer. The classes were taught during the first three weeks of the semester to groups of students separated on the basis of their knowledge of and comfort with computers. Areas covered included computer basics, e-mail management, MEDLINE, and Internet search tools. Each student received seven hours of hands-on training followed by a test. The syllabus and emphasis of the classes were tailored to the initial skill base but the final test was given at the same level to all students. Student participation, test scores, and course evaluations indicated that this noncredit program was successful in achieving an acceptable level of comfort in using a computer for almost all of the student body.
PMCID: PMC35215  PMID: 10783971
24.  Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial 
European Spine Journal  2012;21(5):992-998.
To assess the use of peer-assisted learning (PAL) of complex manipulative motor skills with respect to gender in medical students.
In 2007–2010, 292 students in their 3rd and 4th years of medical school were randomly assigned to two groups [Staff group (SG), PAL group (PG)] led by either staff tutors or student-teachers (ST). The students were taught bimanual practical and diagnostic skills (course education module of eight separate lessons) as well as a general introduction to the theory of spinal manipulative therapy. In addition to qualitative data collection (Likert scale), evaluation was performed using a multiple-choice questionnaire in addition to an objective structured clinical examination (OSCE).
Complex motor skills as well as palpatory diagnostic competencies could in fact be better taught through professionals than through ST (manipulative OSCE grades/diagnostic OSCE score; SG vs. PG; male: P = 0.017/P < 0.001, female: P < 0.001/P < 0.001). The registration of theoretical knowledge showed equal results in students taught by staff or ST. In both teaching groups (SG: n = 147, PG: n = 145), no significant differences were observed between male and female students in matters of manipulative skills or theoretical knowledge. Diagnostic competencies were better in females than in males in the staff group (P = 0.041) Overall, students were more satisfied with the environment provided by professional teachers than by ST, though male students regarded the PAL system more suspiciously than their female counterparts.
The peer-assisted learning system does not seem to be generally qualified to transfer such complex spatiotemporal demands as spinal manipulative procedures.
PMCID: PMC3337919  PMID: 22223196
Peer teaching; Gender differences; Randomised controlled trial; Complex motor skills; Spinal manipulative therapy
25.  (S)Partners for Heart Health: a school-based program for enhancing physical activity and nutrition to promote cardiovascular health in 5th grade students 
BMC Public Health  2008;8:420.
The American Heart Association Position Statement on Cardiovascular Health Promotion in Public Schools encourages school-based interventions for the primary prevention of cardiovascular disease (CVD) through risk factor prevention or reduction in children with an emphasis on creating an environment that promotes healthy food choices and physical activity (PA). In an effort to address issues related to CVD risk factors including obesity in Michigan children, a multi-disciplinary team of Michigan State University (MSU) faculty, clinicians, and health profession students was formed to "(S)partner" with elementary school physical education (PE) teachers and MSU Extension staff to develop and implement a cost-effective, sustainable program aimed at CVD risk factor prevention and management for 5th grade students. This (S)partnership is intended to augment and improve the existing 5th grade PE, health and nutrition curriculum by achieving the following aims: 1) improve the students' knowledge, attitudes and confidence about nutrition, PA and heart health; 2) increase the number of students achieving national recommendations for PA and nutrition; and 3) increase the number of students with a desirable CVD risk factor status based on national pediatric guidelines. Secondary aims include promoting school staff and parental support for heart health to help children achieve their goals and to provide experiential learning and service for MSU health profession students for academic credit.
This pilot effectiveness study was approved by the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year.
This paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multi-level intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams.
PMCID: PMC2628664  PMID: 19102777

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