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1.  A clinical refresher course for medical scientist trainees 
Medical teacher  2014;36(6):475-479.
MD–PhD students experience a prolonged hiatus away from clinical medicine during their laboratory research phase and some have experienced difficulty transitioning back to clinical medicine during clerkship years. We developed a clinical refresher program that serves to rebuild clinical skills prior to re-entering the clinical clerkship years.
A nine-week program includes a combination of didactic and practical review in history, physical exam, presentation and clinical reasoning skills. The program uses multiple modalities from classroom-based activities to patient care encounters and includes a final assessment using standardized patients.
After seven years of experience, we have made modifications that result in our students scoring comparably well on a standardized patient exam to their second-year medical student colleagues. By the end of the course, all students reported feeling more comfortable completing a history and physical examination and some improvement in preclinical knowledge base. Review of clerkship scores showed a higher percentage of MD–PhD students scoring Honors in a clerkship in years after course implementation as compared to years prior to course implementation.
We describe a clinical refresher course for successfully retraining MD–PhD students to re-enter clinical medical training. It is effective at restoring clinical skills to a level comparable to their medical student contemporaries and prepares them to rejoin the medical student class at the conclusion of their research phase.
PMCID: PMC4270363  PMID: 24527799
2.  Relationship between medical student perceptions of mistreatment and mistreatment sensitivity 
Medical teacher  2012;35(3):e998-1002.
National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive.
The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity.
At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated.
Student perceptions of mistreatment were not statistically correlated with individual’s responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it “harsh” to be called incompetent during rounds (p <0.0005).
This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.
PMCID: PMC4399964  PMID: 23102103
3.  Promoting self-awareness and reflection through an experiential Mind-Body Skills course for first year medical students 
Medical teacher  2007;29(8):778-784.
This research examines student evaluations of their experience and attitudes in an 11 week mind-body skills course for first year medical students.
The aim is to understand the impact of this course on students’ self-awareness, self-reflection, and self-care as part of their medical education experience.
This study uses a qualitative content analysis approach to data analysis. The data are 492 verbatim responses from 82 students to six open-ended questions about the students’ experiences and attitudes after a mind-body skills course. These questions queried students’ attitudes about mind-body medicine, complementary medicine, and their future as physicians using these approaches.
The data revealed five central themes in students’ responses: connections, self discovery, stress relief, learning, and medical education.
Mind-body skills groups represent an experiential approach to teaching mind-body techniques that can enable students to achieve self-awareness and self-reflection in order to engage in self-care and to gain exposure to mind-body medicine while in medical school.
PMCID: PMC4372185  PMID: 17852720
4.  Introduction of Team-Based Learning (TBL) at Kilimanjaro Christian Medical University College: Experience with the Ectoparasites Module 
Medical teacher  2014;36(4):308-313.
Contemporary teaching in sub-Saharan African medical schools is largely through didactic and problem-based approaches. These schools face challenges from burgeoning student numbers, severe faculty shortages, faculty without instruction in teaching methods, and severe infrastructure inadequacies. Team-based learning (TBL) is a pedagogy which may be attractive because it spares faculty time. TBL was piloted in a module on ectoparasites at the Kilimanjaro Christian Medical University College (KCMU Co).
TBL orientation began 6 weeks before starting the module. Students were issued background readings and individual and group readiness assessment tests, followed by module application, discussion, and evaluation. At completion, student perceptions of TBL were assessed using a 5-point Likert scale evaluating 6 domains, with a score of 5 being most favorable. Strength of consensus measures (sCns) were applied. Final examination scores were compiled for 2011 (didactic) and 2012 (TBL).
158 students participated in the module. The mean student scores across the 6 domains ranged from 4.2–4.5, with a high degree of consensus (range 85–90%). The final examination scores improved between 2011 and 2012
KCMU Co student perceptions of TBL were very positive, and final exam grades improved. These observations suggest future promise for TBL applications at KCMU Co and potentially other schools.
PMCID: PMC4116798  PMID: 24491164
5.  Virtual patient simulations and optimal social learning context: A replication of an aptitude–treatment interaction effect 
Medical teacher  2014;36(6):486-494.
Virtual patients (VPs) offer valuable alternative encounters when live patients with rare conditions, such as cranial nerve (CN) palsies, are unavailable; however, little is known regarding simulation and optimal social learning context.
Compare learning outcomes and perspectives between students interacting with VPs in individual and team contexts.
Seventy-eight medical students were randomly assigned to interview and examine four VPs with possible CN damage either as individuals or in three-person teams, using Neurological Examination Rehearsal Virtual Environment (NERVE). Learning was measured through diagnosis accuracy and pre-/post-simulation knowledge scores. Perspectives of learning context were collected post-simulation.
Students in teams submitted correct diagnoses significantly more often than students as individuals for CN-IV (p = 0.04; team = 86.1%; individual = 65.9%) and CN-VI (p = 0.03; team = 97.2%; individual = 80.5%). Knowledge scores increased significantly in both contexts (p<50.001); however, a significant aptitude–treatment interaction effect was observed (p = 0.04). At pre-test scores ≤25.8%, students in teams scored significantly higher (66.7%) than students as individuals (43.1%) at post-test (p = 0.03). Students recommended implementing future NERVE exercises in teams over five other modality-timing combinations.
Results allow us to define best practices for integrating VP simulators into medical education. Implementing NERVE experiences in team environments with medical students in the future may be preferable.
PMCID: PMC4097175  PMID: 24738550
6.  A "T-index" for the evaluation of teaching performance of medical university staff? 
Medical Teacher  2013;35(5):425.
PMCID: PMC3984142  PMID: 23464898
Employee Performance Appraisal; methods; Faculty, Medical; Humans; Teaching
7.  Just enough, but not too much interactivity leads to better clinical skills performance after a computer assisted learning module 
Medical teacher  2012;34(10):10.3109/0142159X.2012.706727.
Well-designed computer-assisted instruction (CAI) can potentially transform medical education. Yet little is known about whether specific design features such as direct manipulation of the content yield meaningful gains in clinical learning. We designed three versions of a multimedia module on the abdominal exam incorporating different types of interactivity.
As part of their physical diagnosis course, 162 second-year medical students were randomly assigned (1:1:1) to Watch, Click or Drag versions of the abdominal exam module. First, students’ prior knowledge, spatial ability, and prior experience with abdominal exams were assessed. After using the module, students took a posttest; demonstrated the abdominal exam on a standardized patient; and wrote structured notes of their findings.
Data from143 students were analyzed. Baseline measures showed no differences among groups regarding prior knowledge, experience, or spatial ability. Overall there was no difference in knowledge across groups. However, physical exam scores were significantly higher for students in the Click group.
A mid-range level of behavioral interactivity was associated with small to moderate improvements in performance of clinical skills. These improvements were likely mediated by enhanced engagement with the material, within the bounds of learners’ cognitive capacity. These findings have implications for the design of CAI materials to teach procedural skills.
PMCID: PMC3826788  PMID: 22917265
8.  Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude 
Medical teacher  2012;35(1):e876-e884.
Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients.
To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation.
Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation.
An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively).
The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.
PMCID: PMC3770843  PMID: 22938679
9.  Medical education: Changes and perspectives 
Medical Teacher  2013;35(8):621-627.
As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history.
PMCID: PMC3741015  PMID: 23631405
10.  Admission selection criteria as predictors of outcomes in an undergraduate medical course: A prospective study 
Medical Teacher  2011;33(12):997-1004.
In 1998, a new selection process which utilised an aptitude test and an interview in addition to previous academic achievement was introduced into an Australian undergraduate medical course.
To test the outcomes of the selection criteria over an 11-year period.
1174 students who entered the course from secondary school and who enrolled in the MBBS from 1999 through 2009 were studied in relation to specific course outcomes. Regression analyses using entry scores, sex and age as independent variables were tested for their relative value in predicting subsequent academic performance in the 6-year course. The main outcome measures were assessed by weighted average mark for each academic year level; together with results in specific units, defined as either ‘knowledge'-based or ‘clinically’ based.
Previous academic performance and female sex were the major independent positive predictors of performance in the course. The interview score showed positive predictive power during the latter years of the course and in a range of ‘clinically' based units. This relationship was mediated predominantly by the score for communication skills.
Results support combining prior academic achievement with the assessment of communication skills in a structured interview as selection criteria into this undergraduate medical course.
PMCID: PMC3267525  PMID: 21592024
11.  Cross-cultural medical education: Can patient-centered cultural competency training be effective in non-Western countries? 
Medical teacher  2008;30(7):719-721.
No evidence addresses the effectiveness of patient-centered cultural competence training in non-Western settings.
To examine whether a patient-centered cultural competency curriculum improves medical students’ skills in eliciting the patients’ perspective and exploring illness-related social factors.
Fifty-seven medical students in Taiwan were randomly assigned to either the control (n = 27) or one of two intervention groups: basic (n = 15) and extensive (n = 15). Both intervention groups received two 2-hour patient-centered cultural competency workshops. In addition, the extensive intervention group received a 2-hour practice session. The control group received no training.
At the end of the clerkship, all students were evaluated with an objective structured clinical examination (OSCE). Students in the extensive intervention group scored significantly higher than the basic intervention and control groups in eliciting the patient’s perspective (F = 18.38, p < 0.001, η2 = 0.40). Scores of both intervention groups were significantly higher than the control group in the exploring social factors (F = 6.66, p = 0.003, η2 = 0.20).
Patient-centered cultural competency training can produce improvement in medical students’ cross-cultural communication skills in non-Western settings, especially when adequate practice is provided.
PMCID: PMC3149814  PMID: 18777429
12.  Personality Testing May Improve Resident Selection in Anesthesiology Programs 
Medical teacher  2009;31(12):e551-e554.
Current methods of selecting future residents for anesthesiology training programs do not adequately distinguish those who will succeed from the pool of seemingly well-qualified applicants. Some residents, despite high exam scores, may struggle in the OR in stressful situations.
This study examined whether specific neuropsychological and personality measures can distinguish high competency residents from low competency residents to aid in resident selection.
25 residents enrolled in an anesthesiology program at a major academic institution were identified for participation. 13 were evaluated identified as “high competency” residents and 12 as “low competency ” by the department's clinical competency committee. Groups were evaluated on measures of fine motor dexterity, executive functioning, processing speed, attention, and personality using IPIP-NEO.
There were no significant differences between groups on measures of fine-motor dexterity, executive functioning, processing speed, or attention. High competency residents scored significantly higher than low competency residents on measures of cooperation, self-efficacy, and adventurousness, and lower on measures of neuroticism, anxiety, anger, and vulnerability.
Although measures of fine-motor dexterity, executive functioning, processing speed, and attention do not appear to distinguish between high- and low competency residents in anesthesiology, specific personality characteristics may be associated with future success in an anesthesiology training program.
PMCID: PMC2861414  PMID: 19995155
13.  Twelve tips for teaching diversity and embedding it in the medical curriculum 
Medical teacher  2009;31(11):990-993.
Despite growing recognition of the need to increase cultural diversity undergraduate education in the UK, the US and Canada, there is a lack of cohesion in the development and delivery of cultural diversity teaching in medical schools in these three countries. This article highlights 12 tips for developing cultural diversity education in undergraduate medical programmes by integrating it in institutional policies, curriculum content, faculty development and assessment. These tips can be used to help ensure that students gain needed knowledge, skills and attitudes consistent with a view of patients as complex individuals with unique needs.
PMCID: PMC2967223  PMID: 19909038
14.  Does medical student knowledge of anticoagulation differ by future intended practice? 
Medical teacher  2010;32(10):857-859.
The scope of medical student knowledge may differ by the student’s future intended specialty.
To determine whether medical student knowledge of and confidence with anticoagulation differed by perceived likelihood of managing anticoagulation in future practice.
One hundred twenty-three third and fourth year medical students (41% response rate) participated in a cross-sectional web-based survey. We assessed whether perceived likelihood of managing anticoagulation in future intended practice was associated with anticoagulation knowledge and confidence with managing anticoagulation.
Measurements and Main Results
Out of 24 questions assessing anticoagulation knowledge, the mean percentage correct was 58% (SD 29%). Anticoagulation knowledge did not differ by perceived likelihood of managing anticoagulation as part of their future practice. However, students predicting higher likelihood of managing anticoagulation in their future practice were significantly more confident about their ability to manage anticoagulation (p=0.005).
Using anticoagulation as a model, we did not find evidence that medical student knowledge differed by perceived scope of future practice. Future study will need to confirm whether range and depth of medical knowledge differs by medical students intended future practice and specialties.
PMCID: PMC2946377  PMID: 20854163
15.  The educational impact of assessment: A comparison of DOPS and MCQs 
Medical Teacher  2013;35(11):e1598-e1607.
To evaluate the impact of two different assessment formats on the approaches to learning of final year veterinary students. The relationship between approach to learning and examination performance was also investigated.
An 18-item version of the Study Process Questionnaire (SPQ) was sent to 87 final year students. Each student responded to the questionnaire with regards to DOPS (Direct Observation of Procedural Skills) and a Multiple Choice Examination (MCQ). Semi-structured interviews were conducted with 16 of the respondents to gain a deeper insight into the students’ perception of assessment.
Students’ adopted a deeper approach to learning for DOPS and a more surface approach with MCQs. There was a positive correlation between an achieving approach to learning and examination performance. Analysis of the qualitative data revealed that deep, surface and achieving approaches were reported by the students and seven major influences on their approaches to learning were identified: motivation, purpose, consequence, acceptability, feedback, time pressure and the individual difference of the students.
The format of DOPS has a positive influence on approaches to learning. There is a conflict for students between preparing for final examinations and preparing for clinical practice.
PMCID: PMC3809925  PMID: 23808609
16.  Twelve tips for designing and running longitudinal integrated clerkships 
Medical Teacher  2013;35(12):989-995.
Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs.
PMCID: PMC3836395  PMID: 23883396
17.  Developing questionnaires for educational research: AMEE Guide No. 87 
Medical Teacher  2014;36(6):463-474.
In this AMEE Guide, we consider the design and development of self-administered surveys, commonly called questionnaires. Questionnaires are widely employed in medical education research. Unfortunately, the processes used to develop such questionnaires vary in quality and lack consistent, rigorous standards. Consequently, the quality of the questionnaires used in medical education research is highly variable. To address this problem, this AMEE Guide presents a systematic, seven-step process for designing high-quality questionnaires, with particular emphasis on developing survey scales. These seven steps do not address all aspects of survey design, nor do they represent the only way to develop a high-quality questionnaire. Instead, these steps synthesize multiple survey design techniques and organize them into a cohesive process for questionnaire developers of all levels. Addressing each of these steps systematically will improve the probabilities that survey designers will accurately measure what they intend to measure.
PMCID: PMC4059192  PMID: 24661014
18.  Twelve tips for a successful interprofessional team-based high-fidelity simulation education session 
Medical Teacher  2014;36(10):853-857.
Simulation-based education allows experiential learning without risk to patients. Interprofessional education aims to provide opportunities to different professions for learning how to work effectively together. Interprofessional simulation-based education presents many challenges, including the logistics of setting up the session and providing effective feedback to participants with different backgrounds and mental models. This paper aims to provide educators with a series of practical and pedagogical tips for designing, implementing, assessing, and evaluating a successful interprofessional team-based simulation session. The paper is organized in the sequence that an educator might use in developing an interprofessional simulation-based education session. Collectively, this paper provides guidance from determining interprofessional learning objectives and curricular design to program evaluation. With a better understanding of the concepts and pedagogical methods underlying interprofessional education and simulation, educators will be able to create conditions for a unique educational experience where individuals learn with and from other specialties and professions in a controlled, safe environment.
PMCID: PMC4245993  PMID: 25023765

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