The National Library of Medicine's (NLM) monographic resources in the medical behavioral sciences (MBS) were examined to assess NLM's ability to support the needs of researchers writing in this area. A sample of 239 representative monographs derived from citations in MBS-related articles published in 61 journals in 1981 were evaluated. These monographs were limited to works published between 1978 and 1981, inclusive. The subject distribution of the sample included fourteen of the twenty-one main classes in the LC classification, although BF (psychology), H (social sciences), and R (medicine) constituted 80.3% of the sample. The study revealed that NLM held 48.5% of the sample. The holdings of ten research medical libraries, including six of the seven regional medical libraries, were also evaluated in order to gauge NLM's ability to support that element of the medical library network. The holding rates of these libraries ranged widely (9.6% to 36%), although NLM was found to have far more extensive holdings overall, and when assessed against classes BF, H, and R. Overall, NLM could have supplied from 28.8% to 44.5% of the monographs not held by the medical libraries. In only a few cases were the ten medical libraries able to provide access to monographs not held by NLM. The findings of the study indicate that, regardless of NLM's indication of support to the MBS area, the holdings of more general research and academic libraries are essential to support the monograph needs of MBS researchers.
One of the best opportunities that undergraduates have to learn to write like a scientist is to write a thesis after participating in faculty-mentored undergraduate research. But developing writing skills doesn't happen automatically, and there are significant challenges associated with offering writing courses and with individualized mentoring. We present a hybrid model in which students have the structural support of a course plus the personalized benefits of working one-on-one with faculty. To optimize these one-on-one interactions, the course uses BioTAP, the Biology Thesis Assessment Protocol, to structure engagement in scientific peer review. By assessing theses written by students who took this course and comparable students who did not, we found that our approach not only improved student writing but also helped faculty members across the department—not only those teaching the course—to work more effectively and efficiently with student writers. Students who enrolled in this course were more likely to earn highest honors than students who only worked one-on-one with faculty. Further, students in the course scored significantly better on all higher-order writing and critical-thinking skills assessed.
The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care.
In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis.
Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals.
Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
Family Practice; Internship and Residency; Perspective
Teaching the principles of scientific research in a comprehensive way is important at medical and dental schools. In many countries medical and dental training is not complete until the candidate has presented a diploma thesis. The objective of this study was to evaluate the nature, quality, publication pattern and visibility of Finnish medical diploma theses.
A total of 256 diploma theses presented at the University of Oulu from 2001 to 2003 were analysed. Using a standardised questionnaire, we extracted several characteristics from each thesis. We used the name of the student to assess whether the thesis resulted in a scientific publication indexed in medical article databases. The number of citations received by each published thesis was also recorded.
A high proportion of the theses (69.5%) were essentially statistical in character, often combined with an extensive literature review or the development of a laboratory method. Most of them were supervised by clinical departments (55.9%). Only 61 theses (23.8%) had been published in indexed scientific journals. Theses in the fields of biomedicine and diagnostics were published in more widely cited journals. The median number of citations received per year was 2.7 and the range from 0 to 14.7.
The theses were seldom written according to the principles of scientific communication and the proportion of actually published was small. The visibility of these theses and their dissemination to the scientific community should be improved.
Patients across North America are using complementary and alternative medicine (CAM) with increasing frequency as part of their management of many different health conditions. The objective of this study was to develop a guide for academic health sciences centers that may wish to consider starting an integrative medicine program.
We queried North American leaders in the field of integrative medicine to identify initial sites. Key stakeholders at each of the initial sites visited were then asked to identify additional potential study sites (snowball sampling), until no new sites were identified. We conducted structured interviews to identify critical factors associated with success and failure in each of four domains: research, education, clinical care, and administration. During the interviews, field notes were recorded independently by at least two investigators. Team meetings were held after each visit to reach consensus on the information recorded and to ensure that it was as complete as possible. Content analysis techniques were used to identify key themes that emerged from the field notes.
We identified ten leading North American integrative medical centers, and visited nine during 2002–2003. The centers visited suggested that the initiation of an integrative medicine program requires a significant initial outlay of funding and a motivated "champion". The centers had important information to share regarding credentialing, medico-legal issues and billing for clinical programs; identifying researchers and research projects for a successful research program; and strategies for implementing flexible educational initiatives and establishing a functional administrative structure.
Important lessons can be learned from academic integrative programs already in existence. Such initiatives are timely and feasible in a variety of different ways and in a variety of settings.
Medical writing involves writing scientific documents of different types which include regulatory and research-related documents, disease or drug-related educational and promotional literature, publication articles like journal manuscripts and abstracts, content for healthcare websites, health-related magazines or news articles. The scientific information in these documents needs to be presented to suit the level of understanding of the target audience, namely, patients or general public, physicians or the regulators. Medical writers require an understanding of the medical concepts and terminology, knowledge of relevant guidelines as regards the structure and contents of specific documents, and good writing skills. They also need to be familiar with searching medical literature, understanding and presenting research data, the document review process, and editing and publishing requirements. Many resources are now available for medical writers to get the required training in the science and art of medical writing, and upgrade their knowledge and skills on an ongoing basis. The demand for medical writing is growing steadily in pharmaceutical and healthcare communication market. Medical writers can work independently or be employed as full time professionals. Life sciences graduates can consider medical writing as a valuable career option.
Medical writing; Regulatory; Publication; Technical guidelines; Skills; Resources
The ability to write clearly and effectively is of central importance to the scientific enterprise. Encouraged by the success of simulation environments in other biomedical sciences, we developed WriteSim TCExam, an open-source, Web-based, textual simulation environment for teaching effective writing techniques to novice researchers. We shortlisted and modified an existing open source application - TCExam to serve as a textual simulation environment. After testing usability internally in our team, we conducted formal field usability studies with novice researchers. These were followed by formal surveys with researchers fitting the role of administrators and users (novice researchers)
The development process was guided by feedback from usability tests within our research team. Online surveys and formal studies, involving members of the Research on Research group and selected novice researchers, show that the application is user-friendly. Additionally it has been used to train 25 novice researchers in scientific writing to date and has generated encouraging results.
WriteSim TCExam is the first Web-based, open-source textual simulation environment designed to complement traditional scientific writing instruction. While initial reviews by students and educators have been positive, a formal study is needed to measure its benefits in comparison to standard instructional methods.
Medical computing is frequently viewed as the application of established computer science techniques in medical domains. However, it is the thesis of this paper that many clinical computing tasks demand techniques that are as yet undeveloped. As a result, medical computing research should logically be closely tied to basic research in computer science. Failure to recognize that this developing discipline often requires fundamental investigation has tended to foster unrealistic expectations of the field.
This article presents a detailed guide for high school through graduate level instructors that leads students to write effective and well-organized scientific papers. Interesting research emerges from the ability to ask questions, define problems, design experiments, analyze and interpret data, and make critical connections. This process is incomplete, unless new results are communicated to others because science fundamentally requires peer review and criticism to validate or discard proposed new knowledge. Thus, a concise and clearly written research paper is a critical step in the scientific process and is important for young researchers as they are mastering how to express scientific concepts and understanding. Moreover, learning to write a research paper provides a tool to improve science literacy as indicated in the National Research Council's National Science Education Standards (1996), and A Framework for K–12 Science Education (2011), the underlying foundation for the Next Generation Science Standards currently being developed. Background information explains the importance of peer review and communicating results, along with details of each critical component, the Abstract, Introduction, Methods, Results, and Discussion. Specific steps essential to helping students write clear and coherent research papers that follow a logical format, use effective communication, and develop scientific inquiry are described.
This book should be of interest, as the author states, to “those who are chiefly concerned with healing and the relief of suffering.”
The state of medicine is unsatisfying and due for an overhaul—a difficult premise to reject. Remodelling Medicine proposes guiding principles for the process. This is “integrative care,” with an emphasis on care. Dr Swayne does not write a prescription for remodeling medicine; instead, he offers “arguments that cannot be ignored and that will provoke lively debate.”
The “biomedical model” is valuable, while inadequate by itself, to the tasks of healing and the relief of suffering. Swayne argues persuasively that we need to utilize science in “the right way,” a way that hears a patient's narrative and understands that narrative within the context of the person's entire life narrative.
Book review; integrative care; biomedicine; self-healing; homeopathy; occupational therapy
The aims of this thesis were to gather insights and investigate the factors influencing, outcomes and applications of medical students' motivation. This thesis consists of three literature reviews, four research papers and two application papers. Two research studies investigated the relationships of student motivation with study strategy, effort and academic performance through structural equation modelling and cluster analysis. The relationships of age, maturity, gender and educational background with motivation were investigated through multiple regression analysis. The results of this thesis were 1. Developments in medical education appear to have undervalued student motivation. 2. Motivation is an independent variable in medical education; intrinsic motivation is significantly associated with deep study strategy, high study effort and good academic performance. 3. Motivation is a dependent variable in medical education and is significantly affected by age, maturity, gender, educational background; intrinsic motivation is enhanced by providing students with autonomy, feedback and emotional support. 4. Strength of motivation for medical school can be reliably measured by Strength of Motivation for Medical School questionnaire. The conclusion of this thesis was that it is important to give consideration to motivation in medical education because intrinsic motivation leads to better learning and performance and it can be enhanced through giving students autonomy in learning, feedback about competence and emotional support.
Motivation; Medical students; Intrinsic motivation; Autonomy; Competence; Feedback
Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred medicine (PCM), an epistemological orientation for medical science which places the person as a physical, psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people, doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene. The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical, psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect for individual autonomy, personal culture, religion and beliefs.
Traditional, Complementary and alternative medicine; Biomedicine; Person-centred medicine; Personalised medicine; Prediction; Prevention; Salutogenesis; Health-care reform; Health-care education; Therapeutic relationship
An understanding of statistical methods and basic epidemiology are crucial for the practice of modern medicine.
To assess (1) the knowledge of basic methods of conducting research and data analysis among residents and practicing doctors and (2) the effect of country of medical school graduation, professional status, medical article reading and writing experience on the level of this knowledge.
Data were collected by means of a supervised self‐administered questionnaire, which was distributed among doctors at Soroka Medical Center, Beer‐Sheva, Israel. The questionnaire included 10 multiple‐choice questions on basic epidemiology and statistics, and respondent demographical data.
Of the 260 eligible doctors, 219 (84.2%) returned completed questionnaires. Of the 219 doctors, 50% graduated more than 8.5 years ago, 39.7% were specialists and the remaining were residents. The most frequent specialty was internal medicine (37.4%). Israel was the most frequent country of graduation (45.7%), followed by the former Soviet Union (Eastern medical education; 38.4%). The median total score of knowledge was 4 of 10 questions (interquartile range 2–6). A higher score was associated with a Western medical education, being a specialist, shorter elapsed time since graduation, higher number of publications and self‐reported reading of “methods” and “discussion” sections in scientific articles.
This study found a low level of knowledge of basic principles of research methods and data analysis among doctors, and this knowledge considerably differed by country of medical school graduation.
evidence‐based medicine; epidemiological methods; statistics; doctor; knowledge
Since 1839, Yale medical students have been writing theses as part of their professional training. It is an introduction to the practice of original research, a demanding and sometimes exhausting pursuit. The thesis project promotes a tenacity well suited for the practice of medicine. The thesis advisor has a challenging role as well — one that can only be filled by an individual whose dedication to research is matched with a patience for mentoring students.
In a dedicated commentary included in this issue of the journal, Margaret Drickamer, MD, Associate Professor of Medicine at Yale University, shares her account of one advisor’s relationship to a maturing clinician-scholar. Mila Rainof, MD, was a member of the Yale School of Medicine 2008 graduating class. She died tragically in April 2008, just months prior to beginning an emergency medicine residency in Oakland, California.
By including Drickamer’s commentary with Rainof’s thesis abstract, the Yale Journal of Biology and Medicine honors Rainof’s memory and also celebrates the professional work and scholarly life that took form during her relationship with her thesis advisor.
The Yale School of Medicine has established the Mila Rainof, MD, Memorial Fund in her honor.
Despite substantial evidence that writing can be an effective tool to promote student learning and engagement, writing-to-learn (WTL) practices are still not widely implemented in science, technology, engineering, and mathematics (STEM) disciplines, particularly at research universities. Two major deterrents to progress are the lack of a community of science faculty committed to undertaking and applying the necessary pedagogical research, and the absence of a conceptual framework to systematically guide study designs and integrate findings. To address these issues, we undertook an initiative, supported by the National Science Foundation and sponsored by the Reinvention Center, to build a community of WTL/STEM educators who would undertake a heuristic review of the literature and formulate a conceptual framework. In addition to generating a searchable database of empirically validated and promising WTL practices, our work lays the foundation for multi-university empirical studies of the effectiveness of WTL practices in advancing student learning and engagement.
During the past few decades, research has reported gender bias in various areas of clinical and academic medicine. To prevent such bias, a gender perspective in medicine has been requested, but difficulties and resistance have been reported from implementation attempts. Our study aimed at analysing this resistance in relation to what is considered good medical research.
We used a theoretical model, based on scientific competition, to understand the structures of scientific medicine and how they might influence the resistance to a gender perspective in medicine. The model was originally introduced to discuss how pluralism improves rationality in the social sciences.
The model provided a way to conceptualise different fields of research in medicine: basic research, applied research, medical philosophy, and 'empowering' research. It clarified how various research approaches within medicine relate to each other, and how they differ and compete. It also indicated why there might be conflicts between them: basic and applied research performed within the biomedical framework have higher status than gender research and other research approaches that are performed within divergent research paradigms.
This hierarchy within medical research contributes to the resistance to a gender perspective, causing gender bias and making medical scientific rationality suboptimal. We recommend that the theoretical model can be applied in a wider medical context when different and hierarchically arranged research traditions are in conflict. In this way, the model might contribute to shape a medical community where scientific pluralism is acknowledged to enlarge, not to disturb, the scientific rationality of medicine.
While clinical medicine is often well-supported by health system information technology infrastructure, clinical research may need to create strategies to use clinical medicine informational technology tools. The authors describe a medication safety initiative that was carried out in a National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA)-sponsored clinical research environment. A Web-based, medical informatics application was designed and implemented which allowed research groups to build protocol-specific, electronic medication templates that were subsequently used to create participant-specific medication order sets for conductance of clinical research activities in the CTSA-sponsored clinical research environment. The medical informatics initiative eliminated typewritten or handwritten medication orders, created research protocol-specific templates meeting institutional order-writing requirements, and formalized a rigorous review and approval process. Enhancing safety in medication ordering and prescribing practices in a clinical research environment provided the background for multi-disciplinary cooperation in medical informatics.
In 2008, the Association of Academic Health Sciences Libraries established an Education Research Task Force (ERTF) to plan research addressing research priorities outlined in key Association of American Medical Colleges reports. ERTF members conducted a literature review to describe the state of collaborative research at the intersection of medical education and health sciences librarianship. Analysis of initial results revealed instruction in evidence-based medicine (EBM) was a shared interest and is thus the focus of this review.
Searches on EBM teaching programs were conducted, and results were posted to a shared online citation management service. Individual articles were assessed and assigned metadata describing subject matter, scope, and format.
Article analysis identified key themes. Most papers were descriptive narratives of curricular development. Evaluation studies were also prominent and often based on student satisfaction or self-reported competency. A smaller number of controlled studies provide evidence of impacts of librarian involvement in EBM instruction.
Scholarship of EBM instruction is of common interest between medical educators and health sciences librarians. Coauthorship between the groups and distribution of literature points to a productive collaboration. An emerging literature of controlled studies measuring the impact of cross-disciplinary efforts signals continued progress in the arena of EBM instruction.
Sir William Osler bequeathed his library to McGill University in 1919;
a decade later, the 8000 volumes arrived in Montreal. Then, as now,
the collection consisted of primary works ("rare books"), secondary
commentaries, and current works on the history of the health sciences.
In the last 80 years the collection has grown considerably and the library
now adds about 1,000 books to its collection yearly (mainly current
publications) and receives 200 current serial titles. The Osler Library is
one of the largest "history of medicine" libraries in the world and the
largest of its kind in Canada. The library tries to collect current material
on the history of the health sciences from all over the world and attempts
to collect all medical history published in Canada. The Osler offers its
resources to researchers and students through its website, publications
and Research Travel Grant programme.
The librarian of today, and it will be true still
more of the librarians of tomorrow, are not fiery
dragons interposed between the people and the
books. They are useful public servants, who
manage libraries in the interest of the public...
Many think still that a great reader, or a writer of
books, will make an excellent librarian. This is
- William Osler, (1)
The thesis is an integral part of postgraduate medical education in India. Publication of the results of the thesis in an indexed journal is desirable; it validates the research and makes results available to researchers worldwide.
To determine publication rates in indexed journals, of works derived from theses, and factors affecting publication.
Settings and Design:
Postgraduate theses submitted over a five-year period (2001-05) in a university medical college were analyzed in a retrospective, observational study.
Materials and Methods:
Data retrieved included name and gender of postgraduate student, names, department and hierarchy of supervisor and co-supervisor(s), year submitted, study design, sample size, and statistically significant difference between groups. To determine subsequent publication in an indexed journal, Medline search was performed up to December 2007.
Chi square test was used to compare publication rates based on categorical variables; Student's t-test was used to compare differences based on continuous variables.
One hundred and sixty theses were retrieved, forty-eight (30%) were published. Papers were published 8-74 (33.7 ± 17.33) months after thesis submission; the postgraduate student was first author in papers from 26 (54%) of the published theses. Gender of the student, department of origin, year of thesis submission, hierarchy of the supervisor, number and department of co-supervisors, and thesis characteristics did not influence publication rates.
Rate of publication in indexed journals, of papers derived from postgraduate theses is 30%. In this study we were unable to identify factors that promote publication.
Indexed journal; publication rate; postgraduate medical thesis
Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician’s expertise, the patient’s individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link.
Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews.
Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.
critical thinking and decision making in medicine; patient safety; quality of care; clinical reasoning and argumentation; logic of medicine; using evidence
To determine the importance of academic and research success during medical school upon subsequent academic activity, a computerized literature search was performed using the names of the 79 surviving members of the Yale Medical School Class of 1970. Individuals elected to Alpha Omega Alpha (AOA) during the third year of school had significantly more publications (mean 101.7 +/- 69.6) between 1970 and 1990 than those elected during the fourth year (mean 28.3 +/- 48.0, p = 0.01). Both had significantly more publications than non-AOA members (mean 11.1 +/- 19.4, p = 0.02). Publication of the student's medical school thesis was also associated with a greater number of publications than thesis non-publication (mean 22.1 +/- 37.5 vs 14.4 +/- 30.0, p = 0.005). These studies demonstrate that, at least at the institution studied, election to AOA and publication of the results of a research project were associated with increased publication rates in the medical field over the 20-year period following medical school graduation.
During the past 150 years an excellent health sciences information system has been developed in the United States. Led by the National Library of Medicine (NLM), the system grew along traditional lines until after World War II, when medical researchers, educators, and practitioners produced an enormous amount of new information. To cope with this growth, the power of computers joined traditional librarianship and MEDLARS was born. In 1965 Congress passed the Medical Library Assistance Act, which enabled NLM to lead the nation's and the world's health sciences professionals into the Information Age. Much as been accomplished by NLM, yet much remains to be done to make health information available cheaply, easily, and quickly to all who need it.
With the completed sequence of the human genome has come the prospect of substantially improving the quality of life for millions through personalized medicine approaches. Still, any advances in this direction require research involving human subjects. For decades science and ethics have enjoyed an allegiance reflected in a common set of ethical principles and procedures guiding the conduct of research with human subjects. Some of these principles emphasize avoiding harm over maximizing benefit. In this paper we revisit the priority given to these ethical principles – particularly the principles that support a cautious approach to science – and propose a reframing of the ‘social contract’ between science and society that emphasizes reciprocity and meeting public needs.
Personalized medicine; Research ethics
Although the majority of scientific information is communicated in written form, and peer review is the primary process by which it is validated, undergraduate students may receive little direct training in science writing or peer review. Here, I describe the use of Calibrated Peer Review™ (CPR), a free, web-based writing and peer review program designed to alleviate instructor workload, in two undergraduate neuroscience courses: an upper- level sensation and perception course (41 students, three assignments) and an introductory neuroscience course (50 students; two assignments). Using CPR online, students reviewed primary research articles on assigned ‘hot’ topics, wrote short essays in response to specific guiding questions, reviewed standard ‘calibration’ essays, and provided anonymous quantitative and qualitative peer reviews. An automated grading system calculated the final scores based on a student’s essay quality (as determined by the average of three peer reviews) and his or her accuracy in evaluating 1) three standard calibration essays, 2) three anonymous peer reviews, and 3) his or her self review. Thus, students were assessed not only on their skill at constructing logical, evidence-based arguments, but also on their ability to accurately evaluate their peers’ writing. According to both student self-reports and instructor observation, students’ writing and peer review skills improved over the course of the semester. Student evaluation of the CPR program was mixed; while some students felt like the peer review process enhanced their understanding of the material and improved their writing, others felt as though the process was biased and required too much time. Despite student critiques of the program, I still recommend the CPR program as an excellent and free resource for incorporating more writing, peer review, and critical thinking into an undergraduate neuroscience curriculum.
peer review, writing to learn; web-based learning; learning technology; Calibrated Peer Review