Evaluating medical student searches of MEDLINE for evidence-based information: process and application of results.
(17/2809)
OBJECTIVE: To evaluate the adequacy of the MEDLINE instruction routinely given to all entering medical students at the University of Miami School of Medicine and the ability of students to search effectively for and retrieve evidence-based information for clinical decision making by the end of their third-year. METHODOLOGY: The authors developed and implemented a strategy for evaluating the search strategies and articles selected by third-year students, who participated in the Objective Structured Clinical Examination (OSCE) in June 1996, 1997, and 1998, and reviewed the literature on evidence-based medicine and evaluation of medical student searches. RESULTS: A mean of 5% of the students' search strategies and a mean of 26% of articles selected were ranked "excellent" or "good"; a mean of 26% of search strategies were ranked "fair" and a mean of 69% were ranked "poor"; and a mean of 22% of articles selected were ranked "fair" and a mean of 52% were ranked "poor" based on the strategy developed to evaluate student searches. CONCLUSIONS: Evaluating medical student searches for evidence-based information is an effective way of evaluating students' searching proficiency, and, in turn, the adequacy of the instruction they receive. Based on the results of the OSCE test, the school of medicine expanded the library's educational role and the library implemented major changes in the training program. Information on evidence-based medicine is now incorporated into the MEDLINE instruction. Library faculty evaluate the required searches performed by students for evidence-based information during their first and second years; 30% of students are identified for follow-up, individualized instruction based on the evaluation; and a new case-based curriculum has been proposed with a fourteen-week problem-based learning (PBL) block. These developments are timely in light of the evidence-based competencies recently published by the Association of American Medical Colleges. (+info)
Clinical skills assessment.
(18/2809)
BACKGROUND: From September 1996, all GP registrars completing vocational training in the United Kingdom must demonstrate competence by means of a four-part assessment procedure. AIM: To look at the accuracy of one of the components of vocational training: the trainer's report. METHOD: Seventy-five registrars completing their general practice training at the end of July 1997 were invited to take part in a practical skills workshop. Eight stations were designed to test practical skills and diagnostic interpretations that were included in the trainer's report, and a clinical vignette accompanied each task. The marking schedule used was developed from the minimum standards required in the trainer's report. Twenty-nine registrars (38%) took part in the workshop. RESULTS: Only one registrar passed all eight stations. The maximum number of stations failed by any one individual was five and this doctor was the only one of the sample to ultimately fail summative assessment. The majority of registrars failed by being unable to interpret clinical findings. Twenty-five registrars (86%) responded to the follow-up questionnaire. Of these, only six felt that the stations were unrealistic. All but two registrars had spent at least six months in their hospital training doing obstetrics and gynaecology but, in spite of this, only 31% of registrars were above minimum competence for vaginal and speculum examination. CONCLUSION: With one exception, registrars passed all aspects of the trainer's report. Discrepancy was found between the trainer's report and the doctor's ability to carry out clinical procedures. There is an assumption that many of these clinical skills are being taught and assessed at undergraduate level and during the hospital component, but this cannot be taken for granted. Doubt must also be cast on whether the trainers are using the trainer's report appropriately, and whether this is a valid and reliable tool to identify skills deficient in registrars for summative assessment. (+info)
Scoring performance on computer-based patient simulations: beyond value of information.
(19/2809)
As computer based clinical case simulations become increasingly popular for training and evaluating clinicians, approaches are needed to evaluate a trainee's or examinee's solution of the simulated cases. In 1997 we developed a decision analytic approach to scoring performance on computerized patient case simulations, using expected value of information (VOI) to generate a score each time the user requested clinical information from the simulation. Although this measure has many desirable characteristics, we found that the VOI was zero for the majority of information requests. We enhanced our original algorithm to measure potential decrements in expected utility that could result from using results of information requests that have zero VOI. Like the original algorithm, the new approach uses decision models, represented as influence diagrams, to represent the diagnostic problem. The process of solving computer based patient simulations involves repeated cycles of requesting and receiving these data from the simulations. Each time the user requests clinical data from the simulation, the influence diagram is evaluated to determine the expected VOI of the requested clinical datum. The VOI is non-zero only it the requested datum has the potential to change the leading diagnosis. The VOI is zero when the data item requested does not map to any node in the influence diagram or when the item maps to a node but does not change the leading diagnosis regardless of it's value. Our new algorithm generates a score for each of these situations by modeling what would happen to the expected utility of the model if the user changes the leading diagnosis based on the results. The resulting algorithm produces a non-zero score for all information requests. The score is the VOI when the VOI is non-zero It is a negative number when the VOI is zero. (+info)
Active Learning Centre: utilization patterns of an interactive educational World Wide Web site.
(20/2809)
The advent of the World Wide Web (WWW) provides unique opportunities to transform medical education. Interactive computer assisted instruction has shown promising results but its growth has been impeded by logistical barriers. We designed an interactive WWW site--Active Learning Centre (ALC)--that offers a novel approach to these problems, combining remotely authored databases with computer-generated self-assessment tests. This study analyzes utilization and user assessment of the site. The site was found to be patronized mostly by students and health professionals from English-speaking countries. Users have been pleased with their experience and suggest further expansion of the ALC. Our data have also tentatively shown that their knowledge improved with repeated visits to the site. (+info)
Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human-computer interface.
(21/2809)
Acquiring laparoscopic surgical skills involves initial learning of cognitive and motor skills followed by refinement of those skills. The successful use of a virtual reality simulator depends on the quality of the interface for the human-computer interaction and this can be determined by the initial learning rate. MIST VR, a part-task virtual reality laparoscopic simulator, provides objective assessment of psychomotor skills and can generate an overall score for performance, based upon errors made and time taken for six different tasks. This study analysed the rate of early task/instrument/computer familiarization on consecutive scores achieved by surgically experienced and naive individuals. Eleven surgeons, 18 medical students and seven non-medical personnel were tested on the simulator up to ten consecutive times, within a 2-week period. Performance data from every task and repetition were analysed to obtain individual scores of task performance. The calculation of overall score penalized errors far more heavily than total time taken, with high scores indicating poor performance. The surgeon-computer interface generated a rapid and significant early familiarization curve up to the third session on the simulator, with significant reductions in both time taken and total contact errors made. These results suggest that MIST VR represents a high quality interface. Surgeons scored consistently and significantly better than other subjects on all tasks. For surgically naive individuals, it was possible to predict the level of laparoscopic skills performance that would be attained after overcoming initial simulator learning curve, by studying their initial score. Overall scores reflected surgical experience and suggest that the simulator is measuring surgically relevant parameters. MIST VR provides a validated and much needed method for objective assessment of laparoscopic skills, for a variety of surgical disciplines. (+info)
Learning physiology through service.
(22/2809)
A service-learning component has been successfully incorporated into an introductory physiology course at Wheaton College. In addition to regular course work, each of the 24 students spent 12 hours shadowing and assisting staff at Sturdy Memorial Hospital, Attleboro, MA, with 4 hours in the emergency room and 8 hours in two other departments. Every student kept a log of his or her observations, reactions, and learning in the field and wrote a paper on a pathophysiological condition encountered in the hospital. To compare and contrast the real hospital experience with a fictional one, the students also studied patients from the television show ER. Each week in lab, two students showed a short videotape of one particular patient and discussed the diagnosis, symptoms, treatments, and surgical procedures involved. Questionnaire evaluations indicated that this program is effective in helping students learn more physiology and exposing them to community service. Health workers and patients also agreed that providing social support to patients while shadowing and assisting hospital staff was a valuable service. (+info)
Predictors of success in undergraduate human physiology.
(23/2809)
This study tested the hypothesis that measurable attributes in students' backgrounds are related to their successful completion of an undergraduate human physiology course. Demographic, general academic performance, and science achievement data were obtained from student records for students enrolled during the 1995-1996 academic year, and additional demographic data were obtained from students enrolled during the 1996-1998 academic years. A hierarchical logistic regression analysis explored the relationship fo these variables to the percentage of students passing the human physiology course. Predicted passing versus failing showed a sensitivity of 85.5% and specificity of 69.7%. Two independent validations of the logistical regression equation correctly predicted the performance of subsequent groups of students 75.9% and 77.6% of the time. (+info)
Undergraduate students' misconceptions about respiratory physiology.
(24/2809)
Approximately 700 undergraduates studying physiology at community colleges, a liberal arts college, and universities were surveyed to determine the prevalence of our misconceptions about respiratory phenomena. A misconception about the changes in breathing frequency and tidal volume (physiological variables whose changes can be directly sensed) that result in increased minute ventilation was found to be present in this population with comparable prevalence (approximately 60%) to that seen in a previous study. Three other misconceptions involving phenomena that cannot be experienced directly and therefore were most likely learned in some educational setting were found to be of varying prevalence. Nearly 90% of the students exhibited a misconception about the relationship between arterial oxygen partial pressure and hemoglobin saturation. Sixty-six percent of the students believed that increasing alveolar oxygen partial pressure leads to a decrease in alveolar carbon dioxide partial pressure. Nearly 33% of the population misunderstood the relationship between metabolism and ventilation. The possible origins of these respiratory misconceptions are discussed and suggestions for how to prevent and/or remediate them are proposed. (+info)