Clinical work sampling A new approach to the problem of in-training evaluation.
(41/2809)
OBJECTIVE: Existing systems of in-training evaluation (ITE) have been criticized as being unreliable and invalid methods for assessing student performance during clinical education. The purpose of this study was to assess the feasibility, reliability, and validity of a clinical work sampling (CWS) approach to ITE. This approach focused on the following: (1) basing performance data on observed behaviors, (2) using multiple observers and occasions, (3) recording data at the time of performance, and (4) allowing for a feasible system to receive feedback. PARTICIPANTS: Sixty-two third-year University of Ottawa students were assessed during their 8-week internal medicine inpatient experience. MEASUREMENTS AND MAIN RESULTS: Four performance rating forms (Admission Rating Form, Ward Rating Form, Multidisciplinary Team Rating Form, and Patient's Rating Form) were introduced to document student performance. Voluntary participation rates were variable (12%-64%) with patients excluded from the analysis because of low response rate (12%). The mean number of evaluations per student per rotation (19) exceeded the number of evaluations needed to achieve sufficient reliability. Reliability coefficients were high for the Ward Form (.86) and the Admission Form (.73) but not for the Multidisciplinary Team (.22) Form. There was an examiner effect (rater leniency), but this was small relative to real differences between students. Correlations between the Ward Form and the Admission Form were high (.47), while those with the Multidisciplinary Team Form were lower (.37 and .26, respectively). The CWS approach ITE was considered to be content valid by expert judges. CONCLUSIONS: The collection of ongoing performance data was reasonably feasible, reliable, and valid. (+info)
Cognitive development after the Fontan operation.
(42/2809)
BACKGROUND: Patients with a single ventricle have multiple risk factors for central nervous system injury, both before and after the Fontan procedure. METHODS AND RESULTS: A geographically selected cohort was invited to undergo standardized testing, including age-appropriate measures of intelligence quotient (IQ) and achievement tests. Historical information was obtained by chart review and patient questionnaires. Of the 222 eligible patients, 133 (59.9%) participated. Median age at testing was 11.1 years (range, 3. 7 to 41.0 years), 6.0 years (range, 1.6 to 19.6 years) after surgery. Mean full-scale IQ was 95.7+/-17.4 (P<0.006 versus normal); 10 patients (7.8%) had full-scale IQ scores <70 (P=0.001). After adjustment for socioeconomic status, lower IQ was associated with the use of circulatory arrest before the Fontan operation (P=0.002), the anatomic diagnoses of hypoplastic left heart syndrome (P<0.001) and "other complex" (P=0.05), and prior placement of a pulmonary artery band (P=0.04). Mean composite achievement score was 91.6+/-15. 4 (P<0.001 versus normal); 14 patients (10.8%) scored <70 (P<0.001). After adjustment for socioeconomic status, independent risk factors for low achievement scores included the diagnoses of hypoplastic left heart syndrome (P=0.004) and "other complex" (P=0.003) or prior use of circulatory arrest (P=0.03), as well as a reoperation with cardiopulmonary bypass within 30 days of the Fontan (P=0.01). CONCLUSIONS: Most individual patients palliated with the Fontan procedure in the 1970s and 1980s have cognitive outcome and academic function within the normal range, but the performance of the cohort is lower than that of the general population. (+info)
Assessment of medical courses in Brazil using student-completed questionnaires. Is it reliable?
(43/2809)
INTRODUCTION: Debates about the quality of medical education have become more evident in the recent past, and as a result several different assessment methods have been refined for that purpose. The use of questionnaires filled out by medical students to assess the quality of lectures is one of the most common methods employed in our milieu. However, the reliability of this investigation method has not yet been systematically tested. The authors present the reliability of a specific form applied to the fourth grade medical students during the clinical psychiatry course. METHOD: Eighty-one fourth grade medical students were instructed to complete a form immediately after each clinical psychiatry lecture. Thirty-four students (42%) failed to turn in the forms after the final lecture. These students were given an identical form to assess the lectures in a retrospective fashion. The grades given by both groups of students for each performed lecture and the number of students who have graded an unperformed lecture were compared. Statistical significance for both groups was determined by means of the chi-square test (p< 0.05). RESULTS: Eighteen out of the 34 students who filled out the forms retrospectively (53%) rated the unperformed lecture, whereas only 5 out of the 47 students who filled out the forms during the course (11%) did so. This is statistically significant (p< 0.05). There was no statistical difference for the grades given to the lectures that were actually performed. DISCUSSION: The authors concluded the low reliability rate of the retrospective evaluation warrant a continuous assessment method during the course. (+info)
Variables that may enhance medical students' perceived preparedness for computer-based testing.
(44/2809)
OBJECTIVE: To identify variables that may enhance medical student's preparedness for computer-based administration of the United States Medical Licensing Examination (USMLE). DESIGN: A cross-sectional survey of 301 medical students who completed a self-administered questionnaire. MEASUREMENTS: The questionnaire was designed to obtain information about students' computer resources, personal experience with computers, computer expertise, opinions about computers, experience with computer-based testing, perceived preparedness for the computer-based USMLE, and demographic variables. Variables related to students' perceived preparedness for the computer-based USMLE were identified by ordinal logistic regression. RESULTS: A significant regression model yielded four significant predictors: perceived preparedness for USMLE content (P: < 0.0001), opinions about computers (P: < 0.0012), gender (P: < 0.0001), and a gender by computer-based testing experience interaction (P: < 0. 0004). Computer resources, personal experience with computers, computer expertise, age, race, and year of medical school were not significant predictors. CONCLUSION: Students' perceived preparedness for computer-based administration of high-stakes examinations may be facilitated by preparing them for examination content, by enhancing their opinions about computers, and by increasing their computer-based testing experiences. (+info)
Does the site of postgraduate family medicine training predict performance on summative examinations? A comparison of urban and remote programs.
(45/2809)
BACKGROUND: The location of postgraduate medical training is shifting from teaching hospitals in urban centres to community practice in rural and remote settings. We were interested in knowing whether learning, as measured by summative examinations, was comparable between graduates who trained in urban centres and those who trained in remote and rural settings. METHODS: Family medicine training programs in Ontario were selected as a model of postgraduate medical training. The results of the 2 summative examinations--the Medical Council of Canada Qualifying Examination (MCCQE) Part II and the College of Family Physicians of Canada (CFPC) certification examination--for graduates of the programs at Ontario's 5 medical schools were compared with the results for graduates of the programs in Sudbury and Thunder Bay from 1994 to 1997. The comparability of these 2 cohorts at entry into training was evaluated using the results of their MCCQE Part I, completed just before the family medicine training. RESULTS: Between 1994 and 1997, 1013 graduates of family medicine programs (922 at the medical schools and 91 at the remote sites) completed the CFPC certification examination; a subset of 663 completed both the MCCQE Part I and the MCCQE Part II. The MCCQE Part I results for graduates in the remote programs did not differ significantly from those for graduates entering the programs in the medical schools (mean score 531.3 [standard deviation (SD) 69.8] and 521.8 [SD 74.4] respectively, p = 0.33). The MCCQE Part II results did not differ significantly between the 2 groups either (mean score 555.1 [SD 71.7] and 545.0 [SD 76.4] respectively, p = 0.32). Similarly, there were no consistent, significant differences in the results of the CFPC certification examination between the 2 groups. INTERPRETATION: In this model of postgraduate medical training, learning was comparable between trainees in urban family medicine programs and those in rural, community-based programs. The reasons why this outcome might be unexpected and the limitations on the generalizability of these results are discussed. (+info)
Undergraduate medical education: comparison of problem-based learning and conventional teaching.
(46/2809)
OBJECTIVE: To review the literature on studies comparing all aspects of problem-based learning with the conventional mode of teaching. DATA SOURCES: Medline literature search (1980 through 1999) and the references cited in retrieved articles. DATA SELECTION: Studies and meta-analyses that compared the newer problem-based learning curriculum and the conventional lecture-based mode of teaching undergraduate medical students. Areas of comparison included the academic process; programme evaluation; academic achievement; graduates' performance, specialty choices, and practice characteristics; and the attitude of students and teachers towards the programmes. DATA EXTRACTION: Data were extracted independently by multiple authors. DATA SYNTHESIS: Students of the problem-based learning curriculum found learning to be "more stimulating and more humane" and "engaging, difficult, and useful", whereas students of the conventional curriculum found learning to be "non-relevant, passive, and boring". Students who used the problem-based learning method showed better interpersonal skills and psychosocial knowledge, as well as a better attitude towards patients. Students using the conventional model, however, performed better in basic science examinations. Teachers tended to enjoy teaching the newer curriculum. Although the two curricula encourage different ways of learning, there is no convincing evidence of improved learning using the problem-based learning curriculum. CONCLUSION: A combination of both the conventional and newer curricula may provide the most effective training for undergraduate medical students. (+info)
Medical school in Split: intentions and achievements.
(47/2809)
This paper describes the origins, aims, and current status of the Split University School of Medicine. Split University School of Medicine was founded several times anew (in 1806, 1944, and 1974), and eventually started to operate as an independent faculty on March 26, 1997. Conceived as a small and efficient medical school, each year it enrolls 50 freshmen at the most. The whole curriculum contains 27 courses (no "majors" or "minors"), each of around 200 class hours, which amounts to a total of 5,610 teaching hours. The teaching process aims at achieving skills and knowledge necessary in general medical practice, at establishing an intellectual basis for further education, and corresponding with the specific medical needs of the coastal area ("Adriatic orientation") Student/instructor ratio is close to 2.0 and the teaching goals are defined better than in older medical schools in the region. The first results are already tangible. (+info)
Physical activity of urban adult population: questionnaire study.
(48/2809)
AIM: To assess the level of physical activity of an urban population according to gender, age, smoking, and educational differences. METHODS: The sample comprised 594 men and women living and working in Zagreb, Croatia. Work, sport, and leisure-time activity indices were obtained by the Baecke's questionnaire. Significance of differences was tested by the Student's t-test. The relation between the indices and the education was determined by correlation analysis. RESULTS: Women had lower work and sport indices score, and higher leisure-time activity index. After the age of 50, women participated significantly more in sport activities than men. There was a negative correlation between the education and the work index, and a significantly positive correlation between the educational level and the sport activity index, regardless of gender and age. Women smokers participated to a significantly lesser extent in sport activities than women non-smokers. Such differences were not observed in men. CONCLUSION: People with lower educational level sustain more workload at their jobs than those with higher education. More educated people participate more in sport activities, although leisure time activity is not significantly related to education. In women, participation in sport activities negatively correlates with the smoking habit. (+info)