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Learning objectives for medical student education--guidelines for medical schools: report I of the Medical School Objectives Project.
Abstract
Many observers of medicine have expressed concerns that new doctors are not as well prepared as they should be to meet society's expectations of them. To assist medical schools in their efforts to respond to these concerns, in January 1996 the Association of American Medical Colleges (AAMC) established the Medical School Objectives Project (MSOP). The goal for the first phase of the project--which has been completed and is reported in this article--was to develop a consensus within the medical education community on the attributes that medical students should possess at the time of graduation, and to set forth learning objectives that can guide each medical school as it establishes objectives for its own program. Later reports will focus on the implementation phase of the MSOP. In this report, each of the four attributes agreed upon by a wide spectrum of medical educators is stated and explained, and then the learning objectives associated with the school's instilling of that attribute are stated. The first of the four attributes is that physicians must be altruistic. There are seven learning objectives, including the objective that before graduation, the student can demonstrate compassionate treatment of patients and respect for their privacy and dignity. The second attribute is that physicians must be knowledgeable; one of the six learning objectives is that the student can demonstrate knowledge of the normal structure and function of the body and of each of its major organ systems. The third attribute is that physicians must be skillful; one of the eleven learning objectives is that the student have knowledge about relieving pain and ameliorating the suffering of patients. The last attribute is that physicians must be dutiful; one of the six learning objectives is that the student have knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies. The report ends by stating that (1) if a school's curriculum is shaped by the set of learning objectives presented in the report, the graduates will be well prepared to assume the limited patient care responsibilities expected of new residents and also will have begun to achieve the attributes needed to practice contemporary medicine; (2) schools should feel a sense of urgency in responding to the intent of the report; and (3) it is important to measure the outcomes of learning objectives, and better assessment methods should be developed, particularly ones to assess outcomes related to attitudes and values.
... 5,6 In 1998, the American Association of Medical Colleges outlined eight basic procedures that each medical student is expected to be proficient in upon graduation. 7 IV catheter placement was named along with venipuncture, arterial puncture, thoracentesis, lumbar puncture, nasogastric tube placement, Foley catheter insertion, and suturing of lacerations. 8 However, even 10 y after that report was published, it was found that students are not becoming proficient in these basic procedural skills and are either simply not performing them or do not feel confident in their skills. ...
... 4 If the physician fails to place a peripheral IV during life saving measures, a central venous catheter is often placed instead, which is associated with a 5%-10% complication rate. [6][7][8] The purpose of this study was to explore the factors that impact the success rate of IV placement and to determine how quickly students become proficient in this skill. We also investigated student perceptions and training experiences regarding the critical skill of IV cannulation. ...
... At a time when medical school enrollment is expanding and opportunities to practice procedural skills are being lost due to increasing oversight and changes in patient expectations, it will be important to hone in on procedural education and make sure that this fundamental aspect of patient care is not being lost amid the milieu of other critical clinical skills. 13 Previous research over the past 10 y has found that a significant fraction of students (30% of rising M4s) have never even attempted to place an IV despite the fact that it is one of eight basic procedures that all medical students are expected to be proficient in upon graduation [1][2][3]7 To delineate these trends, we should carry out larger, prospective, longitudinal studies. ...
Background:
Intravenous (IV) catheter placement is one of the most basic and essential medical procedures. However, IV placement can be a source of anxiety for medical students as it is often their first procedural patient care. We sought to investigate the factors that impact the success rate of this skill and to determine at what rate students improve.
Materials and methods:
A confidential web-based survey was distributed to a total of 367 third and fourth year students at Virginia Commonwealth University School of Medicine. The responses were collected over a 2-wk period in July 2015.
Results:
The response rate was 49.0% (180/367); 65.5% of the M3s and 21.8% of the M4s have never had an opportunity to place an IV. The success rate was higher in students with prior experience as laboratory researchers (86.6%, P = 0.014) as well as emergency medical technicians (81.4%, P = 0.038) when compared to students with no experience. Prior preparation such as reading, watching videos, or even lectures did not increase the success rate. Success rates rapidly improved from 47% for the first attempt to 86% for the fifth attempt.
Conclusions:
A significant percentage of students did not have opportunities to attempt IV catheter placement. We found prior experience, not only as an emergency medical technician but also as a laboratory researcher, significantly increased the success rate. Prior preparations did not improve success rate, and most of the students were successful after only five attempts.
... According to the Medical School Objectives Project (MSOP), established in January 1996 by the Association of American Medical Colleges to guide medical education, clinical experience is essential in creating memory connections between pathophysiological knowledge and clinical practice, enabling the student to reason flexibly around a case. [1] Bedside practice is critical during medical training as it creates experience in caregiving, diagnosis and therapeutics, and enhances the acquisition of knowledge. [1,2] This is supported by the finding that repeated written testing and testing with Standardized Patients (SPs) in simulations can enhance longterm retention of knowledge, suggesting that the same occurs with testing with real patients. ...
... [1] Bedside practice is critical during medical training as it creates experience in caregiving, diagnosis and therapeutics, and enhances the acquisition of knowledge. [1,2] This is supported by the finding that repeated written testing and testing with Standardized Patients (SPs) in simulations can enhance longterm retention of knowledge, suggesting that the same occurs with testing with real patients. [3] The widespread of Electronic Health Records (EHRs) and particularly of computerized provider order entry (CPOE) tools in University Hospitals has made them available to students during their clerkship rotations. ...
Objective:
To evaluate the impact of computerized provider order entry (CPOE) at the bedside on medical students training.
Materials and methods:
We conducted a randomized cross-controlled educational trial on medical students during two clerkship rotations in three departments, assessing the impact of the use of CPOE on their ability to place adequate monitoring and therapeutic orders using a written test before and after each rotation. Students' satisfaction with their practice and the order placement system was surveyed. A multivariate mixed model was used to take individual students and chief resident (CR) effects into account. Factorial analysis was applied on the satisfaction questionnaire to identify dimensions, and scores were compared on these dimensions.
Results:
Thirty-six students show no better progress (beginning and final test means = 69.87 and 80.98 points out of 176 for the control group, 64.60 and 78.11 for the CPOE group, p = 0.556) during their rotation in either group, even after adjusting for each student and CR, but show a better satisfaction with patient care and greater involvement in the medical team in the CPOE group (p = 0.035*). Both groups have a favorable opinion regarding CPOE as an educational tool, especially because of the order reviewing by the supervisor.
Conclusion:
This is the first randomized controlled trial assessing the performance of CPOE in both the progress in prescriptions ability and satisfaction of the students. The absence of effect on the medical skills must be weighted by the small time scale and low sample size. However, students are more satisfied when using CPOE rather than usual training.
... The 2013 Liaison Committee on Medical Education Standards state that accredited medical schools must ensure that their graduates ''exhibit general professional competencies that are appropriate for entry to the next stage of their training and that serve as the foundation for lifelong learning and proficient medical care.'' 1 The 1999 Medical School Objectives Project (MSOP) of the Association of American Medical Colleges is cited in the Liaison Committee on Medical Education Standards as a consensus statement about the competencies and skills that medical students should have at graduation. 2 This report outlines specific physician attributes including altruism, knowledge, and professionalism. It also lists specific patient care competencies including the ability to (a) perform an accurate medical history and physical examination; (b) interpret common diagnostic tests and procedures; (c) perform routine technical procedures; (d) recognize patients with immediate life-threatening conditions and institute initial therapy; and (e) communicate effectively with patients, families, and colleagues. 2 Despite the publication of the MSOP, concerns remain about the undergraduate preparation of medical trainees. ...
... It also lists specific patient care competencies including the ability to (a) perform an accurate medical history and physical examination; (b) interpret common diagnostic tests and procedures; (c) perform routine technical procedures; (d) recognize patients with immediate life-threatening conditions and institute initial therapy; and (e) communicate effectively with patients, families, and colleagues. 2 Despite the publication of the MSOP, concerns remain about the undergraduate preparation of medical trainees. Lypson et al 3 studied incoming postgraduate year 1 (PGY-1) residents from multiple specialties at the University of Michigan. ...
Medical school graduates are expected to possess a broad array of clinical skills. However, concerns have been raised regarding the preparation of medical students to enter graduate medical education. We designed a simulation-based "boot camp" experience for students entering internal medicine residency and compared medical student performance with the performance of historical controls who did not complete boot camp.
This was a cohort study of a simulation-based boot camp educational intervention. Twenty medical students completed 2 days (16 hours) of small group simulation-based education and individualized feedback and skills assessment. Skills included (a) physical examination techniques (cardiac auscultation); technical procedures including (b) paracentesis and (c) lumbar puncture; (d) recognition and management of patients with life-threatening conditions (intensive care unit clinical skills/mechanical ventilation); and (e) communication with patients and families (code status discussion). Student posttest scores were compared with baseline scores of postgraduate year 1 (PGY-1) historical controls to assess the effectiveness of the intervention.
Boot camp-trained medical students performed significantly better than PGY-1 historical controls on each simulated skill (P < 0.01). Results remained significant after controlling for age, sex, and US Medical Licensing Examination step 1 and 2 scores (P < 0.001).
A 2-day simulation-based boot camp for graduating medical students boosted a variety of clinical skills to levels significantly higher than PGY-1 historical controls. Simulation-based education shows promise to help ensure that medical school graduates are prepared to begin postgraduate training.
... However, medical students -despite of their high exposure to and experience with electronic media -still need specific training in electronic health care systems as they rate their ability to use such clinical information systems pretty low [3,13,14]. The need for training is also mirrored by the fact that accreditation bodies and national catalogues of learning objectives expect medical graduates to be able to communicate clearly orally and in written including the documentation process in medical charts [15][16][17]. However, so far there is not enough clarity on how and when such training on EHR usage should be integrated into the medical curriculum and which specific competencies should be reached [3,[18][19][20]. ...
BACKGROUND
Electronic Health Records (EHR) are used widely for state of the art co-working on patient cases within multidisciplinary hospital teams. Therefore, medical students need to be trained for using health information technologies within this environment from the early stages of their education on.
OBJECTIVE
As little is known about the effects of specific training within the medical curriculum, we aimed to develop a course module and provide evaluation for it in order to offer best practice teaching to today’s students. Moreover, we looked at the acceptance of new technologies such as EHR.
METHODS
N = 104 5th year medical students of the University of Tuebingen took part in a standardized training procedure about the possibilities and pitfalls of EHR and performed their own EHR entries on standardized patient cases in a safe practice environment thereafter. Additionally, questionnaires – standardized and open questions – were administered to assess students’ experiences with the new teaching module, the newly developed EHR simulator, the acceptance of the health technology as well as their attitudes towards it before and after training.
RESULTS
Students rated the benefit of EHR training for their medical knowledge significantly higher after the teaching session than before but had also more doubts about the long-term benefit of EHR for multidisciplinary co-working after training. The special training with a simulation software was rated helpful to prepare students but they still didn’t feel safe in all aspects of EHR.
CONCLUSIONS
We assume that by specifically training students for the usage of EHR, besides gaining more and helpful knowledge, students become more aware of the risks and challenges in patient-doctor and doctor-team communication thus showing more critical thinking after training. Overall, students welcomed the new training module and supported the integration into the medical curriculum. Further studies are needed to optimize training modules that can be used in a safe environment by the students who seem to show high acceptance and openness towards new health technologies.
... Empirical evidence in studies with health professions students and practitioners showed that a number of personal quality measures that are conducive to relationship building were positively correlated with JSE scores, including emotional intelligence (Arora et al. 2010;Austin et al. 2005;Kliszcz et al. 2006); cooperativeness (Hong et al. 2011); desirable professional behavior (Brazeau et al. 2010); patient-centered care and orientation toward integrative patient care (Hojat et al. 2015a); positive social influence measured by peer nomination (Hojat et al. 2015b); and clinical and humanistic excellence measured by peer nomination (Pohl et al. 2011). Burnout resiliency measured by scores on the Personal Accomplishment of the MBI (Maslach 1993) was found to be inversely correlated with the JSE scores in medical students (Hojat et al. 2015c). ...
The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning of the 2017-2018 academic year which included the JSE, a scale to detect "good impression" responses, and demographic/background information. Usable surveys were received from 6009 students enrolled in 41 college campuses (median response rate = 92%). The JSE mean score and standard deviation for the sample were 116.54 and 10.85, respectively. Item-total score correlations were positive and statistically significant (p < 0.01), and Cronbach α = 0.82. Significant gender differences were observed on the JSE scores in favor of women. Also, significant differences were found on item scores between top and bottom third scorers on the JSE. Three factors of Perspective Taking, Compassionate Care, and Walking in Patient's Shoes emerged in an exploratory factor analysis by using half of the sample. Results of confirmatory factor analysis with another half of the sample confirmed the 3-factor model. We also developed a national norm table which is the first to assess students' JSE scores against national data.
... Currently, doctors' communication skills are mainly being evaluated by three methods: 9 (1) checklists of observed behaviors during the interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. This study selected the first protocol because: (1) it retains high fidelity to the evaluation on communication and 1. Physician introduced himself and let me know his role in therapeutic procedures. ...
Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects.
... This vagueness in defining the term "medical professionalism" made the case for a normative definition based on common observable behaviors instead of "key values" [3]. Such behaviors were the foundation stone for the project of Association of American Medical Colleges (AAMC) to incorporate professionalism into medical student outcomes and accreditation and re-accreditation processes [11]. The American Board of Internal Medicine used this same set of behaviors in its "Project Professionalism" [12]. ...
The increased attention that "medical professionalism" has received lately exposes the deficit in our educational system and indicates the need for more work to be done to ensure an effective teaching and assessment of this competency. The concerted efforts made by many reputable organizations are great steps in the right direction. Nonetheless, many medical schools are still lagging behind. Literature has been clear about the importance of formal teaching in establishing professional behaviors in the medical school graduates; failing in this regard is certain to have unfavorable outcomes. Furthermore, current literature suggests many teaching strategies and assessment tools that can help in achieving this goal. However, many inadequacies are still there. Teaching professionalism requires, in addition to an explicit core curriculum that spans the continuum of medical education, special efforts in terms of imparting the non cognitive skills as well. Respectable role-models play a major part in this process. Helping students to reflect on the real life encounters in a safe environment is, probably, one of the most effective tools at our disposal. Many obstacles that may hinder this educational endeavor have been described in the literature. Negative role models and the "hidden curriculum" are among the most dreaded ones and they deserve an extra effort to overcome.
... Empathy is an important component of medical professionalism [1,2] and has been frequently associated with improvements in the health outcomes and the quality of care in clinical practice [3,4]. Empathy is the ability to share, understand and respond with care to the experiences of others [5]. ...
Background:
We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout.
Method:
A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.
Results:
Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d ≥ 0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = -0.18) and perspective taking (β = -0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = -0.26; p<0.001) scores.
Conclusions:
Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.
... (page 2) [3], whilst in the USA doctors should have the ability to …..‘communicate effectively, both orally, and in writing, with patients, patients’ families, colleagues, and others who physicians must exchange information in carrying out their responsibilities.’ (page 7) [4]. ...
All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools.
The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication.
Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills.
It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.
... The rationale was to take holistic care into consideration. Physicians must seek to understand in the context of patients’ beliefs, and family and cultural values
[10] and the personal health care should include physical, mental, emotional and social concerns
[11]. The contents and subjects of our program also encompassed the six realms of meaning suggested by Phenix
[12] and the five topic groups in medical humanities proposed by Evans
[13]. ...
The effect of visual arts interventions on development of empathy has not been quantitatively investigated. A study was conducted on the effect of a visual arts-based program on the scores of the Jefferson Scale for Physician Empathy (JSPE).
A total of 110 clerks (n = 92) and first-year postgraduate residents (PGY1s) (n = 18) participating in the program were recruited into this study. The 4-hr program covered the subjects of learning to interpret paintings, interpreting paintings relating to medicine, illness and human suffering, the related-topics of humanitarianism and the other humanities fields and values and meaning. The JSPE was completed at the beginning (pretest) and the end (posttest) of the program.
There was no significant difference between the pretest and posttest JSPE scores. The average of the scores for the pretest was lower in the subgroup of PGY1s than the subgroup of clerks (p = 0.0358). An increased but not significantly mean posttest JESPE score was noted for the subgroup of PGY1s. Neither the females nor the males had higher posttest JSPE scores than the pretest scores.
Although using a structured visual arts-based program as an intervention may be useful to enhance medical students' empathy, our results failed to show a positive effect on the JSPE Scores for a group of clerks and PGY1s. This suggests that further experimental studies are needed if quantitative evaluation of the effectiveness of visual-arts based programs on empathy is to be investigated.
... There has been a global move for change in medical education with key documents coming from the Association of American Medical Colleges, the General Medical Council in the U.K. (2009) and from the Irish Medical Council [1][2][3]. In response our School of Medicine at the National University of Ireland, Galway introduced a new 5-year curriculum which is a student-centered, systems-based curriculum with emphasis on integration, interactive learning and professionalism. ...
Evaluation of a new systems-based curriculum in an undergraduate Irish Medical School was carried out with the validated Dundee Ready Educational Environment (DREEM) inventory. Comparison was made with the results from a previous DREEM study in the old curriculum.
DREEM was administered to 225 medical students enrolled in the new curriculum. Data analysis was carried out using SPSS 17.0 and the Student unpaired t test.
Increased mean scores supported greater satisfaction with the educational environment in the new curriculum. Students perceived better opportunities to develop interpersonal skills, ask questions and learn about empathy. Areas of concern included timetabling, support for stressed students and provision of feedback. Clinical students perceived their overall environment more positively. Pre-clinical students were more confident about passing exams and felt better prepared for clinical practice. Male students were more positive about the environment and found the teaching more stimulating. Female students perceived greater development of their problem-solving skills. Non-Irish students no longer perceived the atmosphere and their social self-perceptions more negative than Irish students, as was the case in the old curriculum.
DREEM is a valuable tool in evaluating the educational environment and monitoring the impact of curricular change.
... Surveys of experts suggest that there are some skills that all physicians should have. [70][71] There are also some medical specialty-specific procedural competencies. [72][73] Of particular relevance to planning a medical student procedural curriculum are those needs assessments that define what skills should have been mastered as the student enters graduate medical education. ...
... Esta es una de las razones por la cual la educación médica en el mundo está experimentando cambios, con la idea central de recuperar la imagen del médico como un profesional compasivo. La mayoría de las escuelas de medicina ha modificado o están en proceso de modificación de sus currícula, incluyendo temas humanistas, alentando la autonomía del estudiante y un cambio de rol en el docente 17,[21][22][23] . ...
Background:Even though studying Medicine and perceiving abuse seem to be two opposite situations, recent investigations in Chile and abroad find that this is a frequent and pervasive combination. These studies also report the negative effects in the lives of students as well as the impact on the profession as a whole. Aim: To ascertain the perception of abusive situations in medical students during training at the University of Chile. Material and Methods: Descriptive and cross sectional study in which a questionnaire was applied to all the students enrolled in 2nd, 3rd, 5th and 7th year during 2001 and 2002. Using short vignettes, they were asked if they had experienced verbal, psychological, physical and sexual abuse, at least once, during their training, by whom and the eventual effects derived from it. Results: We obtained 757 questionnaires. Of the surveyed students, 91% reported having perceived at least one abusive episode during training. Teachers and fellow students were identified as the main offenders. Among the effects of such behavior, 32% mentioned that they considered dropping out of the career as a consequence of this experience. Discussion: The perception of abuse in medical students is common and has adverse effects. Efforts should be made to draw attention to this problem to prevent it
... During this decade, it is the authors' perspective that the prevalence of CMLs expanded due to two educational initiatives. First, the Association of American Medical Colleges (AAMC) formally recognized that physicians must engage in lifelong learning [12]. Second, the Accreditation Council for Graduate Medical Education (ACGME) developed the competency, ''practice based learning and improvement,'' for all physicians in training [13]. ...
The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service.
A prospective study was performed with two internal medicine in-patient teams. Team 1 included a CML who accompanied the team on daily rounds. The CML answered questions posed at the point of care immediately or in emails post-rounds. Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population. Numerous clinical and library metrics were gathered on each question.
Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group. Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group.
This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds. This approach may serve as a model for further studies to define when and how CMLs are most effective.
... Although the objectives of curricula acknowledge the importance of interpersonal skills and personal characteristics ('soft' skills), most formal medical school admission systems tend to primarily assess academic achievement in science domains and cognitive abilities such as verbal reasoning. [1][2][3][4][5][6] Therefore, a 'more holistic and sophisticated approach to selection -based on predictors of care that are both valid and patient-relevant -needs to be developed and applied'. 7 Over the years, a variety of approaches for measuring soft skills (e.g. ...
Context:
Today's formal medical school admission systems often include only cognitively oriented tests, although most medical school curricula emphasise both cognitive and non-cognitive factors. Situational judgement tests (SJTs) may represent an innovative approach to the formal measurement of interpersonal skills in large groups of candidates in medical school admission processes. This study examined the validity of interpersonal video-based SJTs in relation to a variety of outcome measures.
Methods:
This study used a longitudinal and multiple-cohort design to examine anonymised medical school admissions and medical education data. It focused on data for the Flemish medical school admission examination between 1999 and 2002. Participants were 5444 candidates taking the medical school admission examination. Outcome measures were first-year grade point average (GPA), GPA in interpersonal communication courses, GPA in non-interpersonal courses, Bachelor's degree GPA, Master's degree GPA and final-year GPA (after 7 years). For students pursuing careers in general practice, additional outcome measures (9 years after sitting examinations) included supervisor ratings and the results of an interpersonal objective structured clinical examination (OSCE), a general practice knowledge test and a case-based interview.
Results:
Interpersonal skills assessment carried out using SJTs had significant added value over cognitive tests for predicting interpersonal GPA throughout the curriculum, doctor performance, and performance on an OSCE and in a case-based interview. For the other outcomes, cognitive tests emerged as the better predictors. Females significantly outperformed males on the SJT (d = -0.26). The interpersonal SJT was perceived as significantly more job-related than the cognitive tests (d = 0.55).
Conclusions:
Video-based SJTs as measures of procedural knowledge about interpersonal behaviour show promise as complements to cognitive examination components. The interpersonal skills training received during medical education does not negate the selection of students on the basis of interpersonal skills. Future research is needed to examine the use of SJTs in other cultures and student populations.
... The core values associated with patient care, including compassion, empathy, altruism and honesty, are presently understood under the term medical professionalism. In 1999 the Association of American Medical Colleges (AAMC) recommended that all medical schools include professionalism in the core curriculum of medical education
[1]. The Royal College of Physicians and Surgeons (Canada) in 2000 developed the core competencies, CanMEDS, which were revised in 2005, with ‘The Professional’ as one of the core physician competencies and this role includes ethics, professionalism as now understood, and care of self
[2]. ...
Background
Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medical curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role. The purpose of this study was to determine student perception of professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education.
Methods
Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the Faculty of Medicine, University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA). Chi-square and Fischer’s exact test (for cell count less than 5) were used to derive p-values for categorical variables by level of student learning.
Results
The response rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (preclerkship). Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing interprofessional interactions and the creation of special awards to staff and students to “celebrate” professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information on how to report lapses and breaches was highlighted in the answers to the open ended questions.
Conclusions
Students identify the need for strong positive role models in their learning environment, and for effective evaluation of the professionalism of students and teachers. Medical school leaders must facilitate development of these components within the MD education and faculty development programs as well as in clinical milieus where student learning occurs.
... As medical education focuses more on self-directed and lifelong learning [2] and as governing associations and accrediting bodies are adding information literacy and retrieval competencies to their objectives [3][4][5], the need to measure the success of literature search skills training becomes critical. This literature review will focus on articles that attempt to answer the question ''how effective is the training we are offering?'' ...
This literature review examines the effectiveness of literature searching skills instruction for medical students or residents, as determined in studies that either measure learning before and after an intervention or compare test and control groups. The review reports on the instruments used to measure learning and on their reliability and validity, where available. Finally, a summary of learning outcomes is presented.
Fifteen studies published between 1998 and 2011 were identified for inclusion in the review. The selected studies all include a description of the intervention, a summary of the test used to measure learning, and the results of the measurement.
Instruction generally resulted in improvement in clinical question writing, search strategy construction, article selection, and resource usage.
Although the findings of most of the studies indicate that the current instructional methods are effective, the study designs are generally weak, there is little evidence that learning persists over time, and few validated methods of skill measurement have been developed.
... altruistic behaviors among residents and medical students. 1,2 Previous studies have shown that students' altruistic attitudes towards underserved patients decreases as medical school training progresses, 3 but why students' attitudes change and how they relate to subsequent behaviors during residency training and practice are unclear. Additionally, while resident physicians are often the front line of care for underserved patients, little is known about their attitudes and behaviors regarding these populations. ...
Resident physicians often encounter underprivileged patients before other providers, yet little is known about residents' attitudes and behaviors regarding these patients.
To measure US resident physician attitudes regarding topics relevant to medically underserved patients, their behaviors (volunteerism) with underserved patients, and the association between attitudes and behaviors.
In 2007 and 2008, 956 surveys on resident attitudes and behaviors about underserved patients were distributed to 18 residency programs in the United States. Survey content was based on existing literature and an expert needs assessment. The attitude assessment had 15 items with 3-point scales (range 0-1). The behavior assessment evaluated volunteering for underserved patients in the past, present, and future.
A total of 498 surveys (response rate = 52%) were completed. Attitudes regarding underserved patients were generally positive and more favorable for women than men (overall attitude score 0.83 versus 0.74; P = < .001). Rates of volunteering for underserved patients were high in medical school (N = 375, 76%) and anticipated future practice (N = 409, 84%), yet low during residency (N = 95, 19%). Respondents who volunteered regularly had more favorable attitudes than those who did not volunteer (overall average attitude score of 0.81 versus 0.73; P = <.001). Relationships between hours volunteered per-week and favorable attitudes about topics related to the underserved were significant across all 15 items in medical school and anticipated future practice (P value range of .035 to <.0001).
This survey revealed that US residents' attitudes towards topics regarding medically underserved populations are generally favorable. Rates of volunteerism for underserved patients were higher in medical school than during residency, and resident's anticipated rates of volunteerism in future practice volunteerism were approximately the same as rates of volunteerism in medical school. Resident attitudes are strongly correlated with volunteerism.
... The Association of American Medical Colleges (AAMC) has also recognized the importance of educating medical students in documentation stating that medical students should be able to "communicate effectively, both orally and in writing, with patients, patients' families, colleagues, and others with whom physicians must exchange information in carrying out their responsibilities." 5 The United States Medical Licensing Examination (USMLE) evaluates a student's ability to write notes as part of the USMLE Step 2 Clinical Skills Exam. 6 Furthermore, medical record documentation is a skill that is expected of residents and the Accreditation Council for Graduate Medical Education (ACGME) specifically states that residents are expected to "maintain comprehensive, timely, and legible medical records." ...
The electronic health record (EHR) is an important advancement in health care. It facilitates improvement of health care delivery and coordination of care, but it creates special challenges for student education. This article represents a collaborative effort of the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE recognizes the importance of medical student participation in patient care including the ability of documentation. This article proposes guidelines that can be used by educators to establish expectations on medical student documentation in EHRs.
To provide the best education for medical students in the electronic era, ACE proposes to use the following as practice guidelines for medical student documentation in the EHR: (a) Students must document in the patient's chart and their notes should be reviewed for content and format, (b) students must have the opportunity to practice order entry in an EHR--in actual or simulated patient cases--prior to graduation, (c) students should be exposed to the utilization of the decision aids that typically accompany EHRs, and (d) schools must develop a set of medical student competencies related to charting in the EHR and state how they would evaluate it. This should include specific competencies to be documented at each stage, and by time of graduation. In addition, ACE recommends that accreditation bodies such as the Liaison Committee for Medical Education utilize stronger language in their educational directives standards to ensure compliance with educational principles. This will guarantee that the necessary training and resources are available to ensure that medical students have the fundamental skills for lifelong clinical practice.
ACE recommends that medical schools develop a clear set of competencies related to student in the EHR which medical students must achieve prior to graduation in order to ensure they are ready for clinical practice.
... To develop effective physician advocates, longitudinal skill development is essential from the outset of training [13]. The importance of this objective at the medical school level is outlined in the AAMC's Medical School Objectives Project (MSOP) [14] and there are several medical schools with novel health policy programs [15][16][17][18][19]. These programs are highly valued by the limited number of trainees able to access them [20]. ...
Background:
Advocacy is increasingly being recognized as a core element of medical professionalism and efforts are underway to incorporate advocacy training into graduate and undergraduate medical school curricula. While limited data exist to quantify physician attitudes toward advocacy, even less has been done to assess the knowledge, skills, and attitudes of future physicians. The purpose of this study was to assess students' experiences and attitudes toward legislative advocacy, cutting out using a convience sample.
Methods:
A paper survey based on previously validated surveys was administered to a convenience sample of premedical and medical student participants attending a National Advocacy Day in Washington, DC, in March 2011, both before and after their advocacy experiences. Responses were anonymous and either categorical ( or ordinal, using a 5-point Likert scale. Data were analyzed statistically to evaluate demographics and compare changes in pre- and post-experience attitude and skills.
Results:
Data from 108 pre-advocacy and 50 post-advocacy surveys were analyzed yielding a response rate of 46.3%. Following a single advocacy experience, subjects felt they were more likely to contact their legislators about healthcare issues (p = 0.03), to meet in person with their legislators (p < 0.01), and to advocate for populations' health needs (p = 0.04). Participants endorsed an increased perception of the role of a physician advocate extending beyond individual patients (p = 0.03). Participants disagreed with the statement that their formal curricula adequately covered legislative healthcare advocacy. Additionally, respondents indicated that they plan to engage in legislative advocacy activities in the future (p < 0.01).
Conclusions:
A one-time practical advocacy experience has a positive influence on students' knowledge, skills and attitudes towards legislative advocacy. Practical experience is an important method of furthering medical education in advocacy and further research is necessary to assess its impact in a broader population.
Objective: This study aimed to determine medical students' perceptions of their clinical teachers as role models during the clinical years of a medical program. Materials and Methods: In this cross-sectional study, a pre-validated questionnaire, Role Modeling Apperception Tool was used and completed by Final year medical students selected from affiliated medical institutions of Khyber Medical University , Peshawar i.e. four graduating cohorts, comprising about 600 students. Participants were selected following universal sampling and data was analyzed for descriptive and inferential statistics. Results: The response rate to Role Modeling Apperception Tool was 75.1% n=451. The total number of students participating in this study from Private sector medical colleges was 157 34.8% and Public Government was 294 65.2%. The mean age of the students was 23.71 years SD=0.77, Range=22-26. Male respondents comprised 42.4% n=191 and females were n=260 57.6% of the study sample. Altogether, 92.9% of students experienced positive role models while 72% had negative role models among academic staff in their medical colleges. Mostly, medical students perceived male clinical teachers as their role models in comparison to their female counterparts. Moreover, clinical teachers were more considered positive role models than basic sciences teachers. Private-sector medical college students rated their clinical teachers higher among all domains Clinical, Personal, and Teaching in comparison to Public sector medical college students. A strong positive correlation was noted among domains tested on Role Modeling Apperception Tool. Conclusion: Clinical instructors are inveterately considered by students as their role models in medical colleges and significance are conferred on their position. Altogether, doctors with teaching roles must be cognizant of their responsibilities and their influence on the professional growth and performance of students. Eventually, components related to Personal, Clinical, and Teaching attributes were suggested as major traits perceived in role models.
In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.
Empathy in medicine is often neglected due to various constraints imposed on the physician. Despite empathy being proven as beneficial to the patient health and outcomes, patients remain unsatisfied with the healthcare system and usually, in turn, their physicians. To instill empathetic patient-physician relationships, medical training has for some time focused on cognitive-behavioral empathy. This is taught through cognitive and behavioral skills, with expressions such as "I understand how you feel". Naturally, these skills are often forced and feel disingenuous. Hence, a cultural shift in medicine is required to effectively communicate the importance of empathy: a shift that cultivates altruistic properties most healthcare professionals bring to medicine in the first place.
Documentation is part of a critical foundation of skills in the undergraduate medical education curriculum. New compliance rules from the Centers for Medicare and Medicaid Services will impact student documentation practices. Common barriers to student documentation include limited access to the electronic medical record, variable clerkship documentation expectations, variable advice regarding utilizing the electronic medical record, and limited time for feedback delivery. Potential solutions to these barriers are suggested to foster documentation skill development. Recommendations are also given to mitigate compliance and legal risk. This article is protected by copyright. All rights reserved.
Abstract
Despite doubling of the lifespan because of scientific medical education; inequities in healthcare provision exist.Inadequate priority to
community’s health needs in undergraduate medical curricula could be one of the contributors. Aga Khan University, Pakistan pioneered
community-based undergraduate curriculum for addressing community’s health needs. This paper assesses relevance and appropriateness of
this undergraduate medical curriculum to community’s health needs.This study has used a framework, consisting of three major parameters
including public health concepts, major public health problems and attributes, to assess the relevance and appropriateness of Aga Khan
University’s undergraduate curriculum to community’s health needs.This assessment revealed that for relevance and appropriateness to
community’s health needs, the curriculum hasto be community-based.The community-based experiential learning helps students to identify
context-specific health needs and develop culture-sensitive practices. This approach is difficult to operationalize in developing countries where
national health systems focus curative care at tertiary hospitals primarily and community-based primary healthcare facilities are mostly nonfunctioning.
Another challenge is training and retention of community-based teaching faculty. We recommend community-based medical
education so that; competencies are matched with population needs, primary care and community health are given priority and leadership and
team work skills are imparted among health professionals.
Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.
Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization—or cynicism—and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional, and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as “pathology of care relationship.” That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care.
To describe the measurement properties of instruments reported in the literature that faculty might use to measure professionalism in medical students and residents.
The authors reviewed studies published between 1982 and 2002 that had been located using Medline and four other databases. A national panel of 12 experts in measurement and research in medical education extracted data from research reports using a structured critique form.
A total of 134 empirical studies related to the concept of professionalism were identified. The content of 114 involved specific elements of professionalism, such as ethics, humanism, and multiculturalism, or associated phenomena in the educational environment such as abuse and cheating. Few studies addressed professionalism as a comprehensive construct (11 studies) or as a distinct facet of clinical competence (nine studies). The purpose of 109 studies was research or program evaluation, rather than summative or formative assessment. Sixty five used self-administered instruments with no independent observation of the participants' professional behavior. Evidence of reliability was reported in 62 studies. Although content validity was reported in 86 studies, only 34 provided strong evidence. Evidence of concurrent or predictive validity was provided in 43 and 16 studies, respectively.
There are few well-documented studies of instruments that can be used to measure professionalism in formative or summative evaluation. When evaluating the tools described in published research it is essential for faculty to look critically for evidence related to the three fundamental measurement properties of content validity, reliability, and practicality.
The United States healthcare system has been in a period of rapid evolution over the past decade, a trend that is anticipated to continue for the foreseeable future. Physicians are increasingly responsible for the quality of care they provide, and are being held accountable not just for the patient in front of them, but also for the outcomes of their patient panels, communities, and populations. In response to these changes, as well as the projected shortage of primary care physicians, the Warren Alpert Medical School of Brown University (AMS) developed the Primary Care-Population Medicine (PC-PM) program, which builds upon the traditional curriculum with major integrated curricular innovations. The first is a Master of Science Degree in Population Medicine that requires students to take nine additional courses over four years, complete a thesis project focused on an area of Population Medicine, and take part in significant leadership training. Another significant innovative element is the development of a Longitudinal Integrated Clerkship (LIC) during the 3rd year of medical school in which the students complete a longitudinal outpatient experience with the same preceptors and patients. During the LIC students will follow a panel of patients wherever care is provided, while focusing on population health and healthcare delivery issues, in addition to medical topics throughout their clinical and didactic experiences. Though several of the innovative elements are being piloted, the inaugural PC-PM class of up to 24 students will only begin in August 2015. While the outcomes from this program will not be known for many years, the potential impact of the program is significant for AMS, medical education, and the future of healthcare delivery. [Full article available at http://rimed.org/rimedicaljournal-2015-09.asp, free with no login].
The Process of globalization is increasingly evident in medical education and makes the task of defining global essential competences required by 'global physicians' an urgent matter. This issue was addressed by the newly established Institute for International Medical Education (IIME). The IIME Core Committee developed the concept of 'global minimum essential requirements' ('GMER) and defined a set of global minimum learning outcomes that medical school students must demonstrate at graduation. The 'Essentials' are grouped under seven broad educational domains with a set of 60 learning objectives. Besides these 'global competences, medical schools should add national and local requirements. The focus opt student competences as outcomes of medical education should have deep implications for curricular content as well as the educational processes of medical schools.
Seoul National University College of Medicine (SNUMC) introduced a multiple mini-interview (MMI) to assess the noncognitive ability of applicants in 2013. This study aims to examine whether students differ with regard to their personal career values and academic achievements by admission type.
We administered a survey about career values and self-perception of competencies. We then compared the survey results and academic achievements by admission type. Finally, the correlation coefficient between MMI score and academic achievement was calculated in the MMI group. The data were analyzed by t-test and correlation analysis.
There was no statistically significant difference in career values between groups. For self-perception of competency, only the 'interact in heterogeneous groups' domain was higher for those who entered through the MMI. The MMI group had a higher and broader level of academic achievement. Within the MMI group, there was a significant correlation between grade point average and MMI station scores.
The characteristics of students who entered through the MMI were more in accordance with the goals of SNUMC and the competency of future doctors. Considering the unique feature of premedical academic achievement, this result implies that such students have superior noncognitive abilities, such as self-development and internal motivation. How these differences change subsequently remains to be seen.
INTRODUÇÃO: Há pouca discussão na literatura
sobre quais procedimentos médicos o estudante de Medicina deve ser capaz de
realizar no final do curso de graduação e em qual momento do currículo escolar
eles devem ser inseridos. METODOLOGIA: Uma
comissão formada por especialistas de diversas áreas organizou uma lista de
possíveis procedimentos médicos diagnósticos e terapêuticos, sugerida por
estudos e debates do grupo e que estivessem de acordo com as Diretrizes Curriculares
Nacionais de 2001. Após consenso do grupo, mediante aprovação de mais de 75%
dos integrantes da comissão, os procedimentos que de fato deveriam integrar o
currículo foram definidos. RESULTADOS: Mais de
50 procedimentos médicos foram definidos, de acordo com o nível de complexidade
esperada para o aluno de graduação. Após esta definição, tais procedimentos
foram distribuídos na matriz curricular e divididos didaticamente em momentos
de aprendizagem de domínio cognitivo e domínio motor. CONCLUSÃO: O presente estudo apresentou uma proposta de definição das
competências e habilidades relativas aos procedimentos médicos a serem alcançadas
pelos estudantes de Medicina de graduação em nossa instituição e teve como
objetivo sistematizar a sua distribuição na matriz curricular.
The practice of medicine today is beset with unprecedented challenges which include public distrust in medical profession, increasing market force and strengthened management. Recently medical professional societies in UK & USA are overcoming these challenges in the way that medical professionalism is modernized in a changing society. They set 'a physician charter' and new definition of medical professionalism as a partnership. The principles of new medical professionalism are patient welfare, patient autonomy and social justice. It describes doctors' commitment to integrity, compassion, altruism, continuous improvement, excellence, working in partnership, just distribution of finite resources, maintaining trust by managing conflicts of interest and others. New professionalism support improvement of health care system for the welfare of society and the collective human dignity. Experience of rebuilding medical professionalism in UK and USA will give a lesson to Korean medical profession when they seek for solution to restore public confidence and take the leadership in Korean healthcare system.
Methods:
The authors designed a survey instrument to examine the effect of involvement in a student-run free clinic project (SRFCP) on medical student self-reported attitudes toward the underserved and interest in primary care. From 2001-2010, first-and second-year medical students in an introductory service-learning elective course rated each of 15 statements on a seven-point Likert scale pre/post survey. Wilcoxon's signed rank test was performed on all matched pairs and an intent-to-treat analysis included unmatched pairs.
Results:
The response rate was 97.9%, with 914 of 934 students enrolled participating. Significant increases were seen in each of the 15 items in matched pre/post survey pairs, N = 433 (47.4%), or with an intent-to-treat analysis, N = 914 (p ≤ .002 for all).
Conclusions:
This study found that medical student involvement in a SRFCP improved student knowledge, skills, attitudes and self-efficacy with the underserved, interest in work with the underserved after graduation, and interest in primary care.
Background:
Evidence-based medicine (EBM) aims to provide skills that help physicians answer clinically important questions, determine new evidence, and incorporate the acquired knowledge in practice. EBM skills are necessary for the practice of modern medicine, since physicians should use up-to-date knowledge and information to justify their medical decisions.
Purpose:
We aimed to evaluate the EBM program implemented at Hacettepe University School of Medicine.
Methods:
In 2004, a spiral program for the teaching and practice of EBM was developed for the first 3 years of medical school. Following this program, a practice of EBM was included in the fourth year during the surgery clerkship, after an introductory lecture. The students worked within collaborative teams of 3-5 and practiced EBM with actual cases seen in the surgical service in which they were involved. Each student was asked to complete a questionnaire that evaluated the more theoretical program from the first 3 years and the practical application in the fourth year.
Results:
Nearly half of the students stated that the preclinical years of the EBM program were 'adequate', but only 30% of the students indicated that the program was practical. They stated that 'more practical approaches were used in the fourth year, whereas more theory-based approaches were used during the preclinical years'. More than 75% of the students declared that the practice of EBM in the fourth year was useful and appropriate for team-based learning.
Conclusions:
The EBM program was evaluated as 'adequate'. EBM courses should be included in the entire curriculum in an integrated manner. The students understand the main philosophy of EBM in the clinical year when involved in its practical application with actual patients.
An increased interest in professionalism has been reported in the field of medical education due to concerns regarding deterioration of humanism and professional values in the teaching and practice of medicine. The primary aim of this study was to assess attitudes of Pakistani and Pakistani heritage students at a medical college in Pakistan about important elements of professionalism that an ideal medical doctor should possess. A further objective of the study was to determine students' preferred ways of learning professionalism.
A written survey was distributed to undergraduate medical students at a public sector medical college at Karachi, Pakistan in 2011. Using the Penn State College of Medicine (PSCOM) Professionalism Questionnaire, attitudes of medical students of semester 1, 5, and 8 regarding professionalism were assessed anonymously.
The mean age of the students was 21.11 +/- 2.72 years. Forty-three percent of the respondents were male. Forty percent of the students held Pakistani citizenship. Thirty-five percent students were US citizens with Pakistani parents and twenty-five percent were Pakistani heritage students that had dual citizenships. No significant differences in the elements of professionalism (Accountability, Altruism, Duty, Excellence, Honesty & Integrity and Respect) mean scores or in the overall mean score of professionalism among the various classes were found. The total overall Cronbach alpha value for all elements of the professionalism in the selected classes was above 0.9. The most preferred methods for learning professionalism were role modeling by faculty, case based scenarios and role plays.
The students rated all the attributes of professionalism as important and there was no difference across the study years. The overall internal consistency of each element of professionalism was high in different classes. Faculty role models, case based scenarios and role plays may be used to teach professionalism. As a great majority of students were having a Pakistani heritage rather than complete Pakistani born and bred background, hence findings of the survey may not be taken as representative of typical Pakistani medical students.
In spite of the enormous progress of Western medicine during the past century there has not be a concomitant rise in the public's satisfaction with the medical profession. Much of the discontent relates to problems in physician-patient communication. The multiple advantages of good communication have been clearly demonstrated by numerous careful studies. While the past few decades have witnessed much more attention given to teaching communication skills in medical schools, there are a number of factors that create new problems in physician-patient communication and counteract the positive teaching efforts. The "hidden curriculum", the increased emphasis on technology, the greater time pressures, and the introduction of the computer in the interface between physician and patient present new challenges for the teaching of physician-patient communication.
Objective To seek the opinions of undergraduates using the operator-assistant pairs system.Design A five-year evaluation of third-, fourth- and fifth-year students using a short, anonymous questionnaireOutcome measures This study set out to evaluate, but does not attempt to formally assess, the system.Result Most students enjoyed working in pairs, citing mutual support and collaborative learning as being the main advantages. However, 67% of responding third- year students, 79% of fourth-year students and 54% of fifth-year students indicated that they did not know why paired working had been introduced.Conclusions The majority of students found the pairs system advantageous over teacher-led situations. It encouraged greater efficiency, mutual support and help and collaborative learning.
This study was done to identify the lacking in conducting MBBS course-curriculum of Bangladesh. For this purpose a descriptive survey was done among 30 MBBS doctors (Passed within 10 years) of Faridpur district. No internship doctors were included. Self-administered unstructured questionnaire was supplied to them and qualitative analysis of data was done. Majority doctors dissatisfied with (i) Gaining knowledge and skill (ii) Environment of medical colleges (iii) Teaching method (iv) Less MCQ (v) Existing viva-voce (vi) Library facilities (vi) Less clinical symposium.
Background: Professionalism should be included as a fundamental component in the curriculum of undergraduate as well as graduate students of Medicine. Future physicians should be aware of the attributes that a professional should possess. Aim: To analyze the ideal medical doctor attributes from the point of view of physicians and students of Medicine. Material and methods: One hundred four physicians (MD) and 47 students answered a free association test on the attributes they would assign to a good physician. The test was applied via Internet to professionals, and students were tested in group dynamics at the beginning of the class on Bioethics and Professionalism. Data were processed according to the Lexical Availability Model (LAM) which provides quantitative as well as qualitative evaluations. Results: The attributes with higher scores among MD's were honesty (0.379), regular academic updating (0.373), ability (0.325) and empathy (0.241). Among students, the selected attributes were excellence (0.625), empathy (0.511), responsibility (0.280) and ability (0.209). A general agreement was found among physicians and students, excepts by the fact that MD's consider continuing academic updating as the most important attribute. Conclusions: The attributes that physicians and medical students evaluate as essential in professionalism were identified using the LAM approach. At the beginning of the career, students have a definite humanistic approach to their future profession.
In September, 1996, Brown University School of Medicine inaugurated a new competency-based curriculum, known as MD2000, which defines a comprehensive set of competency requirements that all graduates are expected to attain. The medical students entering in 1996 and thereafter are required to demonstrate mastery in nine abilities as well as a comprehensive knowledge base as a requirement for graduation. Faculty use performance-based methods to determine if students have attained competence. We describe in this article the reasons why we developed the new curriculum, how we planned and structured it, and the significance we anticipate the curricular innovation will have on medical education.
Outcome-based education, a performance-based approach at the cutting edge of curriculum development, offers a powerful and appealing way of reforming and managing medical education.The emphasis is on the product-what sort of doctor will be produced-rather than on the educational process. In outcome-based education the educational outcomes are clearly and unambiguously specified. These determine the curriculum content and its organisation, the teaching methods and strategies, the courses offered, the assessment process, the educational environment and the curriculum timetable.They also provide a framework for curriculum evaluation. A doctor is a unique combination of different kinds of abilities. A three-circle model can be used to present the learning outcomes in medical education, with the tasks to be performed by the doctor in the inner core, the approaches to the performance of the tasks in the middle area, and the growth of the individual and his or her role in the practice of medicine in the outer area. Medical schools need to prepare young doctors to practise in an increasingly complex healthcare scene with changing patient and public expectations, and increasing demands from employing authorities. Outcome-based education offers many advantages as a way of achieving this. It emphasises relevance in the curriculum and accountability, and can provide a clear and unambiguous framework for curriculum planning which has an intuitive appeal. It encourages the teacher and the student to share responsibility for learning and it can guide student assessment and course evaluation. What sort of outcomes should be covered in a curriculum, how should they be assessed and how should outcome-based education be implemented are issues that need to be addressed.
Background:
There is a lack of consensus regarding the qualities possessed by the ideal doctor, and very limited research regarding the views of medical students on these qualities.
Aims:
To investigate the views of commencing medical students regarding the desirable qualities of doctors.
Methods:
A survey containing a set of proposed desirable qualities of doctors identified from the existing literature was completed by 158 first-year medical students.
Results:
The survey had a 75% response rate. Students rated the individual qualities of empathy, motivation to be a doctor, good verbal communication, ethically sound, integrity and honesty as the most important. A factor analysis identified six categories of qualities: methodical processing, cognitive capacity, people skills, generic work ethic, role certainty and warmth. Significant differences in factor scores were found across subgroups of students (international and domestic students, with and without prior tertiary studies) on the following factors: methodical processing, which was scored highest by domestic students with prior tertiary studies, cognitive capacity, which was scored highest by domestic students without prior tertiary studies and generic work ethic, which was scored highest by international students.
Conclusions:
Medical students identified a range of desirable personal qualities of a doctor which varied according to student characteristics, including their prior educational experience. Future research aiming to define such desirable qualities should include a broader range of stakeholders, including students at different training levels and institutions.
Demonstrating specific competencies in order to graduate from medical schools is essential for students and identifying ways to demonstrate students have had these competencies for medical schools. Medical education is making a fundamental transition from a focus on teaching to a focus on learning. Therefore, students and schools can be held increasing accountable for their learning outcomes and objectives. Establishing learning objectives to guide the design and content of an educational program is a very important principle which supported by educational theory and practice. The degree of applicability of numerical coding system needs to be described on block/system based integrated entire curriculum of faculty. Learning Objectives play roles as a guide and framework for medical students in their efforts on graduation from medical schools. These will assist students with understanding the scope of knowledge, skills, values and attitudes expected of them by the end of undergraduate medical education. Well-defined learning objectives will lead the faculty to development of appropriate systems of student evaluation.
This article presents guiding principles for the assessment of competence developed by the members of the American Psychological Association's Task Force on Assessment of Competence in Professional Psychology. These principles are applicable to the education, training, and credentialing of professional psychologists, and to practicing psychologists across the professional life span. The principles are built upon a review of competency assessment models, including practices in both psychology and other professions. These principles will help to ensure that psychologists reinforce the importance of a culture of competence. The implications of the principles for professional psychology also are highlighted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To investigate whether the introduction of a vertical subject on research in biomedicine and founding of The Cochrane Collaboration branch at the University of Split School of Medicine influenced students' knowledge and attitudes toward evidence-based medicine (EBM), including the use of research literature.
We used a 26-item questionnaire on EBM knowledge and attitudes to survey 1232 medical students of all study years in 3 medical schools in Croatia (Split, Rijeka, Osijek) and the Croatian-speaking medical school in Mostar (Bosnia and Herzegovina).
Students from the University of Split School of Medicine who had been exposed to the vertical subject on research in biomedicine and activities of The Cochrane Collaboration at the school had better knowledge and more positive attitudes toward EBM. In general, students rarely searched for evidence; 28% of students searched for evidence more than once a month and 96% of students used only textbooks in Croatian and teachers' handouts, even though 74% of students agreed that articles from scholarly journals were an important supplement for textbooks.
Building up an environment that fosters EBM may be beneficial for students' knowledge and attitudes toward EBM. Teachers should encourage and require using evidence during all the courses in medical school.
Background: Despite being among the best academically prepared of the country, many medical students have difficulties to communicate in writing. In 2005, the School of Medicine at the Pontificia Universidad Católica de Chile introduced a writing workshop in the undergraduate curriculum, to enhance the students' writing skills. Aim: To describe the workshop and its impact on the writing skills of 3 cohorts of students. Material and methods: This 30-h workshop used a participative methodology with emphasis on deliberate practice and feedback. Students worked in small groups with a faculty member specially trained in writing. The quality of the essays written before and after the workshop were compared. Essays were rated by a professional team that used an analytic rubric to measure formal aspects of text writing as well as more complex thinking processes. Results: There was a significant improvement in the quality of the texts written after the workshop; the main changes occurred in argumentation, and in paragraph and text structure. This improvement was inversely proportional to the initial level of performance, and independent of gender. Conclusions: A writing workshop based on deliberate practice and personalized feedback is effective to enhance the writing proficiency of medical students. Due to its design, this workshop could be useful for students of other careers and universities (Rev Méd Chile 2009; 137: 617-24). (Key words: Communication barriers; Narration; Students, medical) Recibido el 29 de diciembre, 2008. Aprobado el 29 de enero, 2009.
It is more crucial today than ever before that students are academically prepared to compete for knowledge and technology-based
jobs. For students who are not adequately prepared, the economic and social costs can be extremely high. Early withdrawal
from secondary school, for example, has been linked with higher levels of unemployment, lower earnings, and increased health
problems (Jimerson, Egeland, Sroufe, & Carlson, 2000; Reyes, Gillock, Kobus, & Sanchez, 2000; Rumsberger, 1995). Historically,
much of the work on predicting academic success, from elementary school to college, has focused on the impact of various cognitive
abilities, socio-demographic factors and economic variables (Parker, Summerfeldt, Hogan, & Majeski, 2004). The fact that much
of the variance in academic success remains unaccounted for by these variables has encouraged researchers to investigate additional
predictors, including personality and conative factors. In recent years there has been increased attention to the role emotional
and social competency has in academic success.
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