Video: Problem-based Learning With Technology

Video: Development of Nervous System

Video: Anatomy - Skeletal System

Video: Anatomy - Organization of Body

Video: Anatomy Lab Practical Exam

Video: "Teaching Teaching & Understanding Understanding"

Teaching medical students clinical neurology: an old codger's view

By Charles Warlow, The University of Edinburgh

From The Clinical TeacherVolume 2 Page 111 - December 2005

Curtain rises on an outpatient clinic, two 4th year students are sitting rather tensely with the professor who is in shirt sleeves, and a patient

Professor (seeing a patient who has had a stroke some years ago and now complains of brief attacks in which the affected arm stiffens and rises in the air out of his control): What do you think is going on here?

Student (nervous, almost terrified): is it, er…a …stroke?

Professor (astonished): during a stroke do you think the arm goes up in the air or flops to the side? What do you think happens in an epileptic attack?

Student: um………

An hour or so later…………

Professor (after seeing a man with tricky epilepsy, and hoping to strike one of those vertical themes): do you know the difference between compliance, adherence and concordance?

Student (visibly cheering up): oh yes, concordance is when you and the patient agree together with a course of action…

Professor smiling as lights fade, curtain.

I am frustrated; the students seem to know so very little about neurology and how to sort out what is wrong with patients and yet they know so much about how to be nice to them. What on earth has gone wrong?

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Staff development for clinical teachers

From The Clinical TeacherVolume 2 Page 104 - December 2005

It goes without saying that no man can teach successfully who is not at the same time a student. Sir William Osler

The word 'doctor' is derived from the Latin, docere, which means 'to teach'.1 Interestingly, however, although all doctors are prepared for their roles as clinicians, very few are trained for their roles as teachers: 'the one task that is distinctively related to being a faculty member is teaching; all other tasks can be pursued in other settings; and yet, paradoxically, the central responsibility of faculty members is typically the one for which they are least prepared.'2

Professional development can help doctors to prepare for their roles as teachers, and is fundamental to career development and growth. Although the majority of doctors participate in continuing medical education activities, not all of them take part in staff development. My goal is to discuss staff development from the following perspectives:
•What is staff development?
•Why is staff development important?
•What are common goals and content areas?
•What are common formats?
•What is the evidence?
•How can clinical teachers devise a plan for staff development?

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Learning to teach and teaching to learn

BMC Medical Education 2006, 6:20

While an educational intervention for senior internal medicine residents leading morning report improved the educational experience of the audience, the teaching residents reported reduced confidence in their medical knowledge.

Background
Resident-led morning report is an integral part of most residency programs and is ranked among the most valuable of educational experiences. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the educational and teaching experience of morning report.
Methods
All senior internal medicine residents were invited to participate in this study as teaching participants. All internal medicine residents and clerks were invited to participate as audience participants. The educational intervention included reading material, a small group session and feedback after teaching sessions. The educational and teaching experiences were rated prior to and three months after the intervention using questionnaires.
Results
Forty-six audience participants and 18 teaching participants completed the questionnaires. The degree to which morning report met the educational needs of the audience was higher after the educational intervention (effect size, d = 0.26, p = 0.01). The perceptions of the audience were that delivery had improved and that the sessions were less intimidating and more interactive. The perception of the teaching participants was that delivery was less stressful, but this group now reported greater difficulty in engaging the audience and less confidence in their medical knowledge.
Conclusion
Following the educational intervention the audience's perception was that the educational experience had improved although there were mixed results for the teaching experience. When evaluating such interventions it is important to evaluate the impact on both the educational and teaching experiences as results may differ.

Are Neurology residents in the United States being taught defensive medicine?

From Clinical Neurology and Neurosurgery Volume 108, Issue 4 , June 2006, Pages 374-377

Objective
To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents’ attitudes.

Methods
Neurology residents in the US (n = 25) and, as a control group, Neurology residents training in Germany (n = 42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.

Results
Residents in both countries indicated that litigation is an “important problem”, although US residents stated this significantly more often (p < 0.001). Initiation of tests motivated mainly by fear of litigation (p = 0.004) and explicit teaching of defensive strategies by teaching physicians (p < 0.02) were reported more often by US residents.

Conclusion
Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.

Mistreatment of university students most common during medical studies

From BMC Medical Education 2005, 5:36

Background
This study concerns the occurrence of various forms of mistreatment by staff and fellow students experienced by students in the Faculty of Medicine and the other four faculties of the University of Oulu, Finland.

Methods
A questionnaire with 51 questions on various forms of physical and psychological mistreatment was distributed to 665 students (451 females) after lectures or examinations and filled in and returned. The results were analysed by gender and faculty. The differences between the males and females were assessed statistically using a test for the equality of two proportions. An exact two-sided P value was calculated using a mid-P approach to Fisher's exact test (the null hypothesis being that there is no difference between the two proportions).

Results
About half of the students answering the questionnaire had experienced some form of mistreatment by staff during their university studies, most commonly humiliation and contempt (40%), negative or disparaging remarks (34%), yelling and shouting (23%), sexual harassment and other forms of gender-based mistreatment (17%) and tasks assigned as punishment (13%). The students in the Faculty of Medicine reported every form of mistreatment more commonly than those in the Faculties of Humanities, Education, Science and Technology. Experiences of mistreatment varied, but clear messages regarding its patterns were to be found in each faculty. Female students reported more instances of mistreatment than males and were more disturbed by them. Professors, lecturers and other staff in particular mistreated female students more than they mistreated males. About half of the respondents reported some form of mistreatment by their fellow students.

Conclusions
Students in the Faculty of Medicine reported the greatest amount of mistreatment. If a faculty mistreats its students, its success in the main tasks of universities, research, teaching and learning, will be threatened. The results challenge university teachers, especially in faculties of medicine, to evaluate their ability to create a safe environment conducive to learning.

Anatomy of failure

From The Clinical Teacher June 2005 issue

Katinka J A H Prince, Albert J A A Scherpbier, Henk van Mameren, Jan Drukker & Cees P M van der Vleuten. Do students have sufficient knowledge of clinical anatomy? Medical Education 2005: volume 39: issue 3 pages 326332

Almost two-thirds of medical students failed anatomy tests, according to certain judges.

The study of Dutch medical students found different groups of judges set varying benchmarks for an anatomy test with students setting the toughest standards compared to lecturers and doctors when assessing their peers' anatomy knowledge.

But the different standards meant making a true assessment of whether anatomy knowledge levels are adequate was difficult and suggested clearer guidelines were needed.

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Problem-Based Learning: From where to where?

From The Clinical Teacher June 2005 issue

Thirty-six years ago I was first caught up in problem-based learning (PBL) at McMaster University in Canada. PBL was the energising but controversial innovation of the time. Three recent occasions remind us that it remains so:

1. In The Clinical Teacher David Taylor described introducing PBL at Liverpool1. His title made it sound daunting: 'Reflections from the salt mines'.
2. Dr Pham Thi Tam from Can Tho University of Medicine and Pharmacy, Vietnam sought help from members of the Network: TUFH to establish PBL. Advice and experience was shared through the pages of its newsletter: 'If there is determination to do so, you should have no difficulty'.
3. At AMEE 2004 a review of the evidence for the value of PBL left some developing countries, committed to PBL, expressing new anxieties: 'Had they backed a loser? 'Is PBL a winner or a loser? Where did it come from, where may it go? The editor asked for my personal reflection.

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How to set up an OSCE

From The Clinical Teacher June 2005 issue

This article is not meant to be an exhaustive or in-depth analysis of OSCEs (Objective Structured Clinical Examinations) but rather a collection of useful advice, pointers and tips, gleaned from running OSCEs over many years. The use of OSCEs in the quantitative assessment of competence has become widespread in the field of undergraduate and postgraduate medical education since they were originally described, mainly due to the improved reliability of this assessment format. It offers in a fairer test of candidates' clinical abilities as all the candidates are presented with the same test.

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How to lead effective group discussions

From The Clinical Teacher June 2005 issue

An animated group discussion can stimulate thinking, promote deep engagement with subject matter, overcome misunderstandings and motivate learning. This is possible, in part, because learners in effective small groups are actively involved in the process of learning: articulating what they know, wrestling with the limits of their understanding, and engaging with others while seeking solutions to a problem. Small groups give learners the opportunity to share experiences and observations, ask questions, get feedback, and learn from their peers. Their active role in the learning process allows them to take more responsibility for their own learning. Because learners work together, group discussions can also foster collaborative and interactive skills, which is good preparation for future team work.

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Problem-based learning: future challenges for educational practice and research

From Medical EducationVolume 39 Issue 7 Page 732 - 2005

Context Problem-based learning (PBL) is widely used in higher education. There is evidence available that students and faculty are highly satisfied with PBL. Nevertheless, in educational practice problems are often encountered, such as tutors who are too directive, problems that are too well-structured, and dysfunctional tutorial groups.

Purpose The aim of this paper is to demonstrate that PBL has the potential to prepare students more effectively for future learning because it is based on four modern insights into learning: constructive, self-directed, collaborative and contextual. These four learning principles are described and it is explained how they apply to PBL. In addition, available research is reviewed and the current debate in research on PBL is described.

Discussion It is argued that problems encountered in educational practice usually stem from poor implementation of PBL. In many cases the way in which PBL is implemented is not consistent with the current insights on learning. Furthermore, it is argued that research on PBL should contribute towards a better understanding of why and how the concepts of constructive, self-directed, collaborative and contextual learning work or do not work and under what circumstances. Examples of studies are given to illustrate this issue.

Answering multiple-choice questions in high-stakes medical examinations

From Medical EducationVolume 39 Issue 9 Page 890 - September 2005

Objectives To examine whether changing initial answers during a multiple-choice question (MCQ) test in medicine brings about better overall test results, as has been shown in other academic fields.

Methods A total of 36 answer books from the German Second National Medical Board Examination, with 580 MCQs (where 1 answer out of 5 must be selected), were used for analysis.

Results We confirmed that high-stakes MCQ test scores in medicine did indeed improve when students changed their answers once. Further changes of answers did not improve the scores.

Conclusions In written, high-stakes medical examinations, we recommend that students be encouraged, after further reflection, to change their answers in MCQ tests for questions for which they had previously had doubts about the answers.

Teaching pathology to medical undergraduates

From Current Diagnostic Pathology, Volume 11, Issue 5, October 2005, Pages 308-316

Dramatic curricular reforms in undergraduate medical education mean that many pathologists now find themselves involved in courses that are significantly different from those which they encountered as medical students. Department-led didactic courses in pathology have been replaced by centrally managed, problem-based integrated curricula in which pathology may at first be difficult to identify. This article discusses how curriculum reform has changed the ways in which medical students encounter pathologists and pathology, and the way in which pathology teaching is managed. The various teaching modalities that can be used to convey a knowledge of pathology are considered, with special reference to the autopsy. Finally, consideration is given to the necessity for those involved in undergraduate medical education to be proficient both in their own discipline and in teaching. Pathologists have a continuing role at all levels of the curriculum, from design and management through to delivery.

Early practical experience and the social responsiveness of clinical education

From BMJ 2005;331:387-391

Objectives To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence.

Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001.

Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration.

Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication.

Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations.

Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.