A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.
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BACKGROUND: Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE: To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. PARTICIPANTS AND METHODS: Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students' estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. RESULTS: The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. CONCLUSION: A carefully designed, but traditionally administered, short course could not improve the students' abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the "rule-in conscious paradigm." (+info)
A predoctoral clinical geriatric dentistry rotation at the University of the Pacific School of Dentistry.
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Predoctoral dental students from University of the Pacific School of Dentistry provide initial and yearly dental evaluations for participants of On Lok Senior Health Services on site at On Lok centers. Student dentists also complete some dental procedures including denture fabrication, adjustments and repairs, hard and soft relines, scaling/root planing, polishing, and limited restorative treatments. A wide range of age-prevalent oral conditions such as candidiasis and xerostomia are identified and treated or managed. Students may also be called upon to present patient needs weekly to a member of the interdisciplinary team for discussion. Students periodically review instructions and devices for oral health care with the On Lok staff. The program is intended to be mutually beneficial to the participants of On Lok and Pacific student dentists. While the majority of comprehensive and emergency services are provided by On Lok staff dentists and contract specialists, the student dentist program has broadened the scope of the oral health program at On Lok and has been well integrated with the other day services. Meanwhile, Pacific students gain experience identifying and managing the complex social, economic, and health needs of frail elders in San Francisco. (+info)
University of Alberta dental students' outreach clinical experience: an evaluation of the program.
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In a 25-year-old satellite dental program, advanced dentistry and dental hygiene students provide highly supervised dental treatment for patients in government-funded clinics in 3 under-serviced communities in northern Alberta. Analysis of the performance data of the 2003 University of Alberta dentistry students in their fourth and final year was used to evaluate this program. The data showed that the undergraduate students did numerous diverse general dental procedures during the 2-week rotation, most of which were basic treatments. Students could participate in the program up to 3 times. In subsequent rotations, students tended to do fewer preventive measures, and more restorative treatment and dental extractions. Available grading data for all students indicated that treatment objectives were fulfilled in the vast majority of cases. Such community-based field experience may significantly add to the competence of students entering private practice. (+info)
An integrated community based approach in undergraduate medical teaching of maternal and child health--an experiment.
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The batch of 147 undergraduate medical students (Group I) were trained in maternal and child health (MCH) by allotting them families study wherein either pregnant lady or a new born child was present. The students were made to follow up these mothers and their children for three years on periodic basis by paying home visits and motivating the mothers to attend under five clinic in the community. The students educated the mother regarding child rearing with the help of medical teacher. Another batch of 140 undergraduate medical students (Group II) who did not undergo such community based training but only didactic lectures in MCH were studied as control. The knowledge and attitudes of students in both the groups were tested and compared and significantly higher knowledge and favourable attitude were found in Group I. The attendance of patients of Group I in under five clinics was compared with other children who were not adopted by medical students. The comparison was made between their weight gain, immunizational status and episodes of illness. The beneficiaries in students families had better, attendance and immunizational coverage, more weight gain and less episodes of illness. The difference was found to be statistically significant. (+info)
The RAFT approach to academic detailing with preceptors.
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We have adapted "academic detailing" as a method to deliver real-time faculty development to nearly all community preceptors, both rural and urban, using the RAFT technique (Rapport-building, Assessment, Focused preceptor development, Thanks/Trinkets). The method is expensive in terms of faculty time and can be difficult to schedule. However, it has proven to be a valuable, learner-centered method that reaches preceptors missed by traditional faculty development workshops. Preceptors experience support, both student and preceptor problems are identified and addressed early, and academic faculty gain a better understanding of the preceptor environment. (+info)
Medical students' perceptions of rural practice following a rural clerkship.
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BACKGROUND AND OBJECTIVES: Evidence suggests that rural experiences can positively influence students' preferences for rural practice. This study examined changes in students' perceptions toward rural primary care following a required rural clerkship. METHODS: Third-year students completed pre- and post-clerkship questionnaire items assessing their beliefs about primary care physicians who practice in rural communities in comparison with their urban/suburban counterparts. A factor analysis was performed, and pre- and post-clerkship scale means were calculated to determine differences. RESULTS: A total of 428 (88%) students completed these questionnaires. There was a significant increase in students' perceptions of rural primary care physicians' primary care service features and medical expertise. Students perceived the physicians' work demands more positively, and there was no change in students' perceptions of the physicians' income potential. CONCLUSIONS: Results suggest that the rural primary care clerkship positively influenced students' perceptions toward rural primary care. (+info)
Patients' views on the training of medical students in Australian general practice settings.
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AIM: To explore patients' views on training medical students in their general practice. METHOD AND SETTING: Consenting patients attending eight urban teaching practices completing a self administered survey before and after the consultation. RESULTS: One hundred and four patients attended for appointments: 94 consented to the involvement of a medical student, 88 completed surveys before and after their consultation (response rate 85%), 80% said the main reason for consenting was to benefit the student, and 70% said they would never refuse the presence of a medical student. Student involvement was less than that consented to: only 18 (20%) patients reported that the student independently conducted any of the consultation; 52 (59%) would accept this level of involvement in the future. DISCUSSION: Patients are a willing, but potentially under used resource for training medical students in general practice. Improved collaboration with patients would provide better teaching opportunities for students at all levels. (+info)
Using a formative simulated patient exercise for curriculum evaluation.
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BACKGROUND: It is not clear that teaching specific history taking, physical examination and patient teaching techniques to medical students results in durable behavioural changes. We used a quasi-experimental design that approximated a randomized double blinded trial to examine whether a Participatory Decision-Making (PDM) educational module taught in a clerkship improves performance on a Simulated Patient Exercise (SPE) in another clerkship, and how this is influenced by the time between training and assessment. METHODS: Third year medical students in an internal medicine clerkship were assessed on their use of PDM skills in an SPE conducted in the second week of the clerkship. The rotational structure of the third year clerkships formed a pseudo-randomized design where students had 1) completed the family practice clerkship containing a training module on PDM skills approximately four weeks prior to the SPE, 2) completed the family medicine clerkship and the training module approximately 12 weeks prior to the SPE or 3) had not completed the family medicine clerkship and the PDM training module at the time they were assessed via the SPE. RESULTS: Based on limited pilot data there were statistically significant differences between students who received PDM training approximately four weeks prior to the SPE and students who received training approximately 12 weeks prior to the SPE. Students who received training 12 weeks prior to the SPE performed better than those who received training four weeks prior to the SPE. In a second comparison students who received training four weeks prior to the SPE performed better than those who did not receive training but the differences narrowly missed statistical significance (P < 0.05). CONCLUSION: This pilot study demonstrated the feasibility of a methodology for conducting rigorous curricular evaluations using natural experiments based on the structure of clinical rotations. In addition, it provided preliminary data suggesting targeted educational interventions can result in marked improvements in the clinical skills spontaneously exhibited by physician trainees in a setting different from which the skills were taught. (+info)