Educational Enhancement

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Teaching, digression, and implicit curriculum.

Bardes CL.

Weill Cornell Medical College, New York, New York, USA. clbardes@med.cornell.edu

BACKGROUND: Although medicine resides within contexts that have historical, cultural, and societal determinants, these are rarely addressed explicitly in current medical teaching. SUMMARY: The article describes a method of teaching in which mainstream biomedical learning is linked to digressions, which serve as the medium for considering the contexts of medicine, unmasking hidden messages, and broadening the scope of medical instruction. CONCLUSION: Teaching by digression encourages students to learn core clinical science while considering such otherwise neglected areas such as medical values, contexts, habits, and history. Integrating this consideration of the hidden assumptions of medical practice into mainstream medical learning allows students to understand modern biomedicine as a system that is historically, culturally, and socially conditioned.

PMID: 15294462 [PubMed - indexed for MEDLINE]

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Retention of basic science knowledge: a comparison between body system-based and clinical presentation curricula.

Woloschuk W, Mandin H, Harasym P, Lorscheider F, Brant R.

Undergraduate Medical Education, University of Calgary, Alberta, Canada. woloschu@ucalgary.ca

BACKGROUND: When the University of Calgary implemented the clinical presentation (CP) curriculum in 1994, it was prospectively decided to administer the National Board of Medical Examiner's Comprehensive Basic Science Exam (CBSE) as a measure of students' basic science knowledge retention. PURPOSE: The exam performance from 2 classes (1995, 1996) of the previous system-based (SB) curriculum was compared to exam performance of 2 classes (2000, 2002) of the CP curriculum. METHODS: Data analyses employed 2 statistical models (covariate multiple linear regression and hierarchical mixed effects), and effect sizes were computed. RESULTS: Differences between CBSE mean scores produced by students from the SB and CP curricula showed a curricular effect on students' retention of basic science knowledge. However, preexisting differences between groups were found to be in the small-to-medium range. CONCLUSION: Evidence supporting the potential of schemes within a CP curriculum and their relation to basic science knowledge retention was observed. Effect size for the CP curriculum on students' retention of basic science knowledge was substantial; however, a notable part of that difference can be accounted for by extraneous and confounding factors. Further research utilizing more rigorous designs to investigate the relation between schemes and basic science retention is warranted.

PMID: 15294459 [PubMed - indexed for MEDLINE]

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Evaluation of a surgical simulator for learning clinical anatomy.

Hariri S, Rawn C, Srivastava S, Youngblood P, Ladd A.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting. METHODS: Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure. RESULTS: The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02). CONCLUSION: Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.

Publication Types:
Evaluation Studies

PMID: 15271051 [PubMed - indexed for MEDLINE]

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Evaluating the impact of moving from discipline-based to integrated assessment.

Hudson JN, Tonkin AL.

Institute of Clinical Education, Peninsula Medical School, St. Luke's, Exeter EX 1 2LU, UK. nicky.hudson@pms.ac.uk

BACKGROUND: The move from discipline-based to problem-based learning (PBL) at Adelaide University in 2000 offered exciting opportunities to integrate the teaching and learning of the basic and clinical sciences for medical undergraduates. However, several cohorts of students still needed to progress through the first 3 years of the more traditional curriculum. Paradoxically, their readiness to function in the integrated learning and assessment environment of the last 3 years was assessed in 7 separate discipline-based examinations at the end of third year. When considerable examination-related stress was noted in the 1997 cohort and students petitioned formally for a reduced examination load, it was considered to be time for assessment to lead the way in integrating the disciplines. AIM: After introducing third year integrated written assessments in 1998, we aimed to develop an integrated practical examination (IPE) linking theory to practice, and evaluate its impact on staff and students. METHODS: After extensive staff collaboration, a structured objective multistation IPE was developed and administered in 1999 and 2000. Its utility was evaluated using a model proposed earlier. RESULTS: Assessment validity was maximised by an extensive item review process. Reliability, as measured by Cronbach's alpha, was 0.79 and 0.80 in 1999 and 2000, respectively. An independent evaluation yielded qualitative data on the examination's educational impact, cost and acceptability. CONCLUSIONS: Investing time in changing from discipline-based to integrated assessment, integrating theory and practice, resulted in gains in assessment reliability, validity and educational impact on both staff and students.

PMID: 15271043 [PubMed - indexed for MEDLINE]

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Comment in:
Med Educ. 2004 Aug;38(8):803-4.

Changing education, changing assessment, changing research?

Schuwirth LW, van der Vleuten CP.

Department of Educational Development and Research, University of Maastricht, PO Box 616m, 6200 MD Maastricht, The Netherlands. l.schuwirth@educ.unimaas.nl

BACKGROUND: In medical education, assessment of medical competence and performance, important changes have taken place in the last 5 decades. These changes have affected the basic concepts in all 3 domains. DEVELOPMENTS IN EDUCATION AND ASSESSMENT: In education constructivism has provided a completely new view on how students learn best. In assessment the change from trait-orientated to competency- or role-orientated thinking has given rise to a whole range of new approaches. Certain methods of education, such as problem-based learning (PBL), and assessment, however, are often seen as almost synonymous with the underlying concepts, and one tends to forget that it is the concept that is important and that a particular method is but 1 way of using a concept. When doing this, one runs the risk of confusing means and ends, which may hamper or slow down new developments. LESSONS FOR RESEARCH: A similar problem seems to occur often in research of medical education. Here too, methods--or, rather, methodologies--are confused with research questions. This may lead to an overemphasis on research that fits well known methodologies (e.g. the randomised controlled trial) and neglect of what are sometimes even more important research questions because they do not fit well known methodologies. CONCLUSION: In this paper we advocate a return to the underlying concepts and a careful reflection of their use in various situations.

PMID: 15271040 [PubMed - indexed for MEDLINE]

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Traditional teaching supported by computer-assisted learning for macroscopic anatomy.

Elizondo-Omana RE, Morales-Gomez JA, Guzman SL, Hernandez IL, Ibarra RP, Vilchez FC.

Department of Human Anatomy, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico. rod_omana@yahoo.com

Over the years we have observed that there is a very low passing rate for the Anatomy and Neuroanatomy courses in our department, and for that reason we decided to implement the use of student-learning resources. The objective of this study was to compare the results of traditional methodology with those obtained with the support of computer-assisted learning (CAL). We performed a retrospective and joint study for Anatomy and Neuroanatomy groups during the period of September 2001 to February 2003, to establish a comparison between traditional learning and traditional learning supported by CAL. In the Anatomy group, students who used the traditional method (n1 = 365) received an average final grade of 58 (SD = 14.94), while the average final grade for students who used the traditional method supported by CAL (n2 = 283) was 68 (SD = 14.56). In the Neuroanatomy group, the students who used the traditional method (n3 = 217) had an average final grade of 61 (SD = 14.51), while the students who used the traditional method supported by CAL (n4 = 134) received an average final grade of 68 (SD = 13.52). A z-test was conducted to determine the difference in averages between the two groups (alpha = 0.05), and the results showed that the averages were significantly different (P <.001). The modified traditional method with CAL support was shown to be the best option in comparison with the traditional method. Copyright 2004 Wiley-Liss, Inc.

PMID: 15170688 [PubMed - indexed for MEDLINE]

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Increasing active student participation in histology.

Black VH, Smith PR.

Department of Cell Biology at New York University School of Medicine, New York 10010, USA. blackv01@med.nyu.edu

As have many institutions, the New York University School of Medicine (NYUSM) has instituted curriculum revisions that allow for increased independent study but impose significant time constraints on laboratory courses. Challenged by decreased laboratory time, we sought creative solutions for our histology course, "Cell Biology of Tissues and Organs," using computer- and Web-based materials. While these solutions have facilitated independent study, they have not fostered the subtler lessons learned in the laboratory, such as communication skills and team approaches to learning. To retain these elements and enrich our course, we focused on increasing student participation in the laboratory through unit reviews presented by students, student-generated comprehensive reviews, and practice exams. The active engagement of students in the learning process has resulted in a more exciting laboratory experience for all. Copyright 2004 Wiley-Liss, Inc.

PMID: 15170687 [PubMed - indexed for MEDLINE]