Background

There is considerable uncertainty about the future of undergraduate medical education in the face of several important challenges. This paper highlights many of the complexities of the challenges facing medical school leadership today.

Discussion

A major challenge facing medical education in the United States is the erosion of the clinical environment, the loss of clinical revenues and all its attendant consequences, including pressures for increased faculty productivity in an environment that is increasingly managed. These pressures have squeezed the time for teaching out of the system. Another challenge is how to incorporate all the new and emergent domains of knowledge into the existing curriculum. There is also a need to incorporate technological advancements into the delivery of teaching.

Summary

Undergraduate medical education in the United States must respond to a multitude of challenges if it is to remain vibrant in the 21st century.

Background

Objective criteria for predicting residents' performance do not exist. The purpose of this study was to test the hypothesis that global assessment by an intern selection committee (ISC) would correlate with the future performance of residents.

Methods

A prospective study of 277 residents between 1992 and 1999. Global assessment at the time of interview was compared to subsequent clinical (assessed by chief residents) and cognitive performance (assessed by the American Board of Pediatrics in-service training examination).

Results

ISC ratings correlated significantly with clinical performance at 24 and 36 months of training (r = 0.58, P < .001; and r = 0.60, P < .001 respectively). ISC ratings also correlated significantly with in-service exam scores in the 1st, 2nd, and 3rd years of training (r = 0.35, P = .0016; r = 0.39, P = 0.0003; r = 0.50, P = 0.005 respectively).

Conclusions

Global assessment by an ISC predicted residents' clinical and cognitive performances.

Background

The Turkish Association of Medicine founded a Continuing Medical Education Accreditation Committee in 1993 to evaluate and accredit scientific meetings and publications. The aims of this project were to raise the standards of meetings and to introduce compulsory revalidation and re-certification for physicians in Turkey.

Discussion

Since the year 1994, 2348 applications to the Continuing Medical Education board have been made (mostly for scientific meetings), and 95% of these applications have been accepted. Physicians received 139.014 credits during this time. This number is increasing every year. Meeting organisers' demand for such a kind of evaluation is increasing, because participants increasingly request it.

Summary

Efforts for revalidation and re-certification of physicians have not been completely successful yet. In the near future the Co-ordination Council of Medical Speciality Societies is going to oblige member associations to establish speciality boards. This will be the first step to the conventional use of Continuing Medical Education credits in occupational evaluation. Time-limited re-certification of physicians is the principal goal of Turkish Medical Association. Efforts to implement this change in legislation are being made.

Background

Mortality rates in Western Europe have fallen significantly over the last 50 years. Maternal mortality now averages 10 maternal deaths per 100,000 live births but in some of the Newly Independent States of the former Soviet Union, the ratio is nearly 4 times higher. The availability of skilled attendants to prevent, detect and manage major obstetric complications may be the single most important factor in preventing maternal deaths. A modern, multidisciplinary, scenario and model based training programme has been established in the UK (Managing Obstetric Emergencies and Trauma (MOET)) and allows specialist obstetricians to learn or revise the undertaking of procedures using models, and to have their skills tested in scenarios.

Methods

Given the success of the MOET course in the UK, the organisers were keen to evaluate it in another setting (Armenia). Pre-course knowledge and practice questionnaires were administered. In an exploratory analysis, post-course results were compared to pre-course answers obtained by the same interviewer.

Results

All candidates showed an improvement in post-course scores. The range was far narrower afterwards (167–188) than before (85–129.5). In the individual score analysis only two scenarios showed a non-significant change (cord prolapse and breech delivery).

Conclusion

This paper demonstrates the reliability of the model based scenarios, with a highly significant improvement in obstetric emergency management. However, clinical audit will be required to measure the full impact of training by longer term follow up. Audit of delays, specific obstetric complications, referrals and near misses may all be amenable to review.

Background

Development of the reflective skills of medical students is an acknowledged objective of medical education.

Description

Description of an educational exercise which uses an email-based process for developing the reflective skills of undergraduate medical students. Student quotations illustrate learning outcomes qualitatively.

Discussion

The process described is immediate, direct, linked to learning objectives, enables rapid responses to be given to the students individually, and is followed by group sharing of learning. It provides a rigorous and robust feedback loop for students. It is relatively economic for teachers and incidentally benefits curriculum design and evolution. The approach supports development of a reflective approach to learning.

Background

The geographical distribution of publications as an indicator of the research productivity of individual countries, regions or institutions has become a field of interest. We investigated the geographical distribution of contributions to the two leading journals in the field of medical education, Academic Medicine and Medical Education.

Methods

PubMed was used to search Medline. For both journals all journal articles in each year from 1995 to 2000 were included into the study. Then the affiliation was retrieved from the affiliation field of the MEDLINE format. If this was not possible, it was obtained from the paper version of the journal.

Results

Academic Medicine published contributions from 25 countries between 1995 and 2000. Authors from 50 countries contributed to Medical Education in the same period of time. Authors from the USA and Canada wrote ca. 95% off all articles in Academic Medicine, whereas authors from the UK, Australia, the USA, Canada and the Netherlands were responsible for ca. 74% of all articles in Medical Education in the investigated period of time.

Conclusions

While many countries contributed to both journals, only a few of them were responsible for the majority of all articles.

Background

The effectiveness of teaching critical appraisal to students of Complementary and Alternative Medicine (CAM) has not been studied. In this study we attempt to determine if a workshop for final year students at a naturopathic college improved their ability to utilize critical appraisal concepts.

Methods

We assigned 83 Naturopathic Interns to two groups: Group A (n = 47) or Group B (n = 36). We conducted a baseline assessment of all subjects' critical appraisal skills. Group A was assigned to receive a 3 ½ hour workshop on Evidence Based Medicine (EBM) and Group B received a workshop on bioethics (control intervention). The groups critical appraisal skills were re-evaluated at this time. We then crossed over the intervention so that Group B received the EBM workshop while Group A received the bioethics workshop. Assessment of critical appraisal skills of the two groups was again performed.

Results

The students mean scores were similar in Group A (14.8) and Group B (15.0) after Group A had received the intervention and Group B had received the control (p = 0.75). Group scores were not significantly improved at the end of the trial compared to at the beginning of the study (Group A: 15.1 to 16.1) (Group B 15.6 to 15.9). Student's confidence in reading research papers also did not improve throughout the course of the study.

Conclusion

The final year is a difficult but important time to teach critical appraisal and evidence skills. Single, short intervention programs will likely yield negligible results. A multi-factorial approach may be better suited to implementing EBCAM than single short interventions.

Background

Little is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course.

Methods

Cross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students.

Results

Average total OSCE score was 57% (range 39–75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p < .0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p < .0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p < .0001).

Conclusions

Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.