Medical Education

The process of problem-based learning: what works and why

2011-08-30T11:11:00.001+07:00

Objectives In this review, we portray the process of problem-based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation–elaboration hypothesis and a situational interest hypothesis.

Methods Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new ‘micro-analytical’ methodology was used to trace the process of PBL in the natural classroom setting.

Conclusions We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small-group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long-term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to ‘hard’ scaffolding represented by, for instance, worksheets or questions added to problems. Small-group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self-study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.

From: Medical Education 2011: 45: 792–806

Test-enhanced learning in medical education

2011-07-15T23:07:00.002+07:00

Context In education, tests are primarily used for assessment, thus permitting teachers to assess the efficacy of their curriculum and to assign grades. However, research in cognitive psychology has shown that tests can also directly affect learning by promoting better retention of information, a phenomenon known as the testing effect.

Cognitive psychology research Cognitive psychology laboratory studies show that repeated testing of information produces superior retention relative to repeated study, especially when testing is spaced out over time. Tests that require effortful retrieval of information, such as short-answer tests, promote better retention than tests that require recognition, such as multiple-choice tests. The mnemonic benefits of testing are further enhanced by feedback, which helps students to correct errors and confirm correct answers.

Application to medical education Medical educational research has focused extensively on assessment issues. Such assessment research permits the conclusion that clinical expertise is founded on a broad fund of knowledge and effective memory networks that allow easy access to that knowledge. Test-enhanced learning can potentially strengthen clinical knowledge that will lead to improved expertise.

Conclusions Tests should be given often and spaced out in time to promote better retention of information. Questions that require effortful recall produce the greatest gains in memory. Feedback is crucial to learning from tests. Test-enhanced learning may be an effective tool for medical educators to use in promoting retention of clinical knowledge.

Medical Education
Volume 42, Issue 10, pages 959–966, October 2008

เมื่อครูพร้อมศิษย์ก็เกิด จากบทเรียนของก๊วยเจ๋งสู่การเรียนการสอนนักศึกษาแพทย์และบัณฑิต

2011-06-20T10:07:00.008+07:00

ย่อจาก http://www.manager.co.th/Entertainment/ViewNews.aspx?NewsID=9540000074094

ครูชุด 7 ตัวประหลาดนั้นมีปัญหาอย่างหนักทีเดียวกับการให้การศึกษาแก่เด็กพิเศษอย่างก๋วยเจ๋ง พ่อและแม่ในยุคนี้ควรดูไว้นะครับ เพราะตามท้องเรื่องนั้น 6 ตัวประหลาดแกไม่ได้ดูเลยว่า มันสมองระดับที่ก๋วยเจ๋งมีสามารถที่จะเรียนรู้และรับรู้อะไรได้บ้าง

พังเพยของตะวันตกว่าเอาไว้...เมื่อครูพร้อมศิษย์ก็เกิด แต่เมื่อครูไม่พร้อมศิษย์จะเกิดได้อย่างไร?

ความไม่พร้อมและไม่พอของ 7 ตัวประหลาด ตั้งแต่การกระหน่ำสอนวิชาตามความถนัดของตัวเองมีให้แก่ก๋วยเจ๋งแบบไม่บันยะบันยัง นั่นแปลว่าเด็กไอคิวต่ำแบบเขาจะต้องมารองรับวิชาที่ตั้งแต่ทื่อมะลื่อที่สุดยันวิชาล้วงกระเป๋าที่พริ้วไหวที่สุด...ลองนึกดูเอาเองว่ามันจะเกิดอะไรขึ้นแก่ก๋วยเจ๋ง

สภาพเช่นนั้นเกิดมาตลอด 10 ปี การศึกษาเรื่องหมัดมวยโดยอาจารย์ประหลาดนั้นเกิดขึ้นในภาคกลางคืน แต่เป็นเรื่องน่าแปลกใจเหมือนกันนะครับที่ในภาคกลางวันนั้นก๋วยเจ๋งก็ยังคงฝึกในเรื่องของการควบม้า ยิงธนู ควบคุมทหารในกองทัพ จัดกระบวนทัพ คุมทหารเข้าทะลวงแนวต้านอย่างไร ซึ่งก๋วยเจ๋งก็ทำได้ดีเทียบเท่าเซลุยซึ่งเป็นบุตรของเตมูจินเจงกิสข่าน กิมย้งบรรยายว่า เตมูจินเห็นว่าวิชาหมัดมวยใช้แค่ต่อสู้ป้องกันตัว ไม่เพียงพอที่จะแสดงอาณุภาพในสนามรบสร้างชื่อเสียงป้องกันดินแดนและกลืนกินดินแดนได้ อาจารย์สอนยังคงเป็นเทพเกาทัณฑ์เจอเปอยู่นั่นเอง

...ประเด็นคือว่า ถ้าก๋วยเจ๋งโง่ดักดานเกินเหตุ เขาไม่น่าจะเรียนวิชาทางการทหารแบบนี้ได้ ซึ่งการเป็นแม่ทัพนั้นต้องมองเห็นความเปลี่ยนแปลงต่างๆ ในสนามรบได้ เพราะฉะนั้นปัญหาจึงน่าจะอยู่ที่ตัวครูมากกว่าที่ไม่ได้ป้อนในสิ่งที่ถูกต้องให้แก่ลูกศิษย์ หรือ ป้อนกับผิดวิธีทางใดทางหนึ่ง

กิมย้งบรรยายถึงความไม่เอาอ่าวของหกประหลาดว่า แต่ละคนนั้นฝึกวิชาได้ระดับนี้ เพราะใช้เวลายาวนานคร่ำเคร่งฝึกปรือ แต่จะให้ก๋วยเจ๋งใช้เวลาไม่กี่ปีฝึกฝนจนชำนาญในทุกวิชาของทั้งหมด แม้นับเป็นคนฉลาดปราดเปรื่องยังยากยิ่งจะกระทำ อย่าว่าแต่ก๋วยเจ๋งมีสติปัญญาต่ำกว่าธรรมดามาก

ผู้แต่งคนเก่งของเรายังบอกเอาไว้ว่า ยิ่งเร่งสอน ยิ่งเร่งที่จะยัด (เพราะกลัวลูกศิษย์จะแพ้ทำให้ตัวเองเสียหน้าต่อคูชู่กีพรตอมตะ) ความก้าวหน้าในเชิงวิชาบู๊ของก๋วยเจ๋งกลับยิ่งถดถอย “จะเร็วกลับไม่บรรลุ ตะกรามเคี้ยวไม่ละเอียด” แต่แทนที่จะมานั่งดูว่าตัวเองสอนผิดวิธีหรือเปล่า บรรดาตัวประหลาดทั้งหลายกลับยิ่งเคี่ยวเข็ญหนักกว่าเดิมเป็นสองเท่าสามเท่า...

เรื่องมาโอละพ่อเอาตอนนี้ครับ...และเป็นจุดเปลี่ยนแปลงที่ทำให้เจ้าทึ่มก๋วยเจ๋งกลายเป็นจอมยุทธก๋วยขึ้นมา********************************

ครูสำนักที่สามที่เข้ามาตบให้พื้นฐานและสัญชาติญาณของร่างกายมีชื่อว่า “ เบ๊เง็ก” หนึ่งใน 7 อริยเจ้าแห่งสำนักสัจธรรมไพบูลย์หรือช่วนจิน และเป็นศิษย์คนโตของเฮ้งเต๊งเอี๊ยงปรมาจารย์ผู้ก่อตั้งสำนัก ตัวเฮ้งเต้งเอี๊ยงนั้นตามตำนานอีกเหมือนกันบอกว่า สุดท้ายเมื่อสำเร็จมรรคผลแล้วก็ขึ้นไปอยู่บนสวรรค์ ขณะที่ลูกศิษย์ทั้ง 7 ก็ขึ้นไปเป็นเทพอยู่บนสวรรค์เช่นกัน

กิมย้งผูกเรื่องว่า เบ๊เง็ก รู้สึกรำคาญใจกับการที่คูชู่กีศิษย์น้องของตัวเองยังยึดติดอยู่กับเรื่องเอาแพ้เอาชนะกับเจ็ดตัวประหลาด แถมทำท่าว่าจะชนะเสียด้วย เพราะลูกศิษย์ของคูชู่กีนั้นฉลาดล้ำจริงๆ อีกทั้งยังส่งศิษย์ในทางพรตคนหนึ่งขึ้นรมาย้ำนัดแห่งการประลองนั้นด้วย ศิษย์ของท่านคูชู่กีก็คือ อี้จี้เพ้ง ซึ่งใช้ไม่กี่ท่าก็สยบก๋วยเจ๋งได้สำเร็จ

เบ๊เง็กทราบเรื่องดังกล่าวก็เลยเดินทางขึ้นมาเหนือเพื่อมาสอนวิชาและสิ่งที่ก๊วยเจ๋งยังขาดอยู่ แต่ทว่าท่านรู้โดยความฉลาดหรือโดยญาณของท่านว่า ขืนเดินเข้าไปสอนวิชาช่วนจินเอาดื้อๆ ความที่พกโมหะจริตไว้เต็มเหนี่ยวของ 6 ตัวประหลาดก็จะไม่ยอมให้ก๊วยเจ๋งได้เรียนวิชาของช่วนจินอยู่ดี เบ๊เง็กก็เลยต้องมาสอนก๊วยเจ๋งแบบลับๆ บนยอดเขาสูง 2 ต่อ 2 เป็นเวลาสองปีเต็มโดยที่ 6 ตัวประหลาดไม่มีระแคะระคายเลย

“ซือแป๋ทั้งหกของท่านล้วนเป็นบุคคลอันดับเยี่ยมของยุทธจักร ท่านเพียงฝึกวิชาของผู้ใดผู้หนึ่งสำเร็จก็พอจะแสดงฝีมือให้มีชื่อในแผ่นดินได้แล้ว และท่านเองก็มิใช่ไม่มานะพยายามฝึกปรือ แต่ไฉนสิบกว่าปีนี้จึงมีความสำเร็จน้อยนิด ท่านทราบหรือไม่เพราะเหตุใด?” เบ๊เง็กตั้งคำถามกับก๊วยเจ๋งในคราวที่สนทนากันบนยอดเขา

“นั่นเพราะข้าพเจ้าโง่เขลาเกินไป บรรดาซือแป๋ทั้งหมดต่างทุ่มเทจิตใจฝึกสอนก็ฝึกไม่เป็นเสมอมา” ก๋วยเจ๋งตอบ

“นั่นมิใช่สิ้นเชิง แต่เป็นการสอนโดยไม่เข้าใจหลัก ฝึกโดยไม่ถูกทาง” เบ๊เง็กกล่าว “เพราะถ้าถกถึงหลักวิชาบู๊ธรรมดา พลังการฝึกปรือของท่านในตอนนี้นับว่าไม่เลวอย่างยิ่ง แต่เมื่อลงมือครั้งแรกกลับโดนี้จี้เพ้งนักพรตน้อยพิชิตพ่ายแพ้ ในใจจึงเกิดท้อแท้รันทด เข้าใจว่าตัวเองใช้ไม่ได้ ฮาฮา นั่นนับว่าผิดพลาดโดยสิ้นเชิงแล้ว...นักพรตน้อยนั้นเอาชนะท่านได้ เพราะล้วนอาศัยกำลังพลิกแพลงเข้าเอาชัย หากถกถึงกำลังประจำตัวมันไม่แน่จะเข้มแข็งเหนือท่าน เยี่ยงนี้เถิด ศรัทธาที่บริสุทธิ์จริงใจของท่านและเราท่านต่างมีวาสนาร่วมกันอยู่ เราจะถ่ายทอดวิธี หายใจ นั่งลง ลุกเดิน และ นอนหลับแก่ท่าน”

กิมย้งอ้างคำพูดของเบ๊เง็กในเคล็ดที่สอนหายใจแก่ก๊วยเจ๋งว่า “ความคิดแน่วแน่ ใจไม่ฟุ้งซ่าน กายผ่อนคลาย เลือดลมปลอดโปร่ง หัวใจสงบ สติปัญญาเปรื่องปราดแจ่มใส ปฏิฐานเพิ่ม นิเสธลด ก่อนนอนต้องให้สมองว่างเปล่าแจ่มใส ไม่มีความคิดฟุ้งซ่านซักน้อยนิด จากนั้นเอนกายตะแคง ผ่อนลมหายใจยาวๆ ช้าๆ ใจไม่คิดวุ่นวาย สติไม่ออกรวนเร”

ก๋วยเจ๋งฝึกหายใจอย่างที้ว่าอยู่ครึ่งปีเศษ เมื่อฝึกวิชาในตอนกลางวันกลับพบว่าร่างกายเบาขึ้นแต่มือเท้าหนักหน่วงกว่าเดิม กำลังที่ไม่สามารถใช้ได้ในกาลก่อนตอนนี้พอยืดมือก็ก่อเกิดพลังพิศดารขึ้นเองตามธรรมชาติ จนหกตัวประหลาดต่างเข้าใจว่าก๋วยเจ๋งสูงวัยและมีความมานะพยายามจนเข้าใจหลักเคล็ดวิชาขึ้นมาเอง

สิ่งที่ก๋วยเจ๋งฝึกนั้น เราเรียกมันในยุทธจักรว่า กำลังภายใน!!

หนังสือ "อาจารย์แพทย์"

2009-09-01T18:35:00.004+07:00

สั่งซื้อได้ที่ เบอร์ 083-919-9139 ราคาเล่มละ 200 บาท (ฟรีค่าจัดส่ง)

Video: Problem-based Learning With Technology

2006-11-13T20:39:00.000+07:00

Video: Development of Nervous System

2006-11-13T20:35:00.000+07:00

Video: Anatomy - Skeletal System

2006-11-13T20:31:00.000+07:00

Video: Anatomy - Organization of Body

2006-11-13T20:27:00.000+07:00

Video: Anatomy Lab Practical Exam

2006-11-13T20:21:00.000+07:00

Video: "Teaching Teaching & Understanding Understanding"

2006-11-13T19:56:00.000+07:00

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

2006-05-01T00:18:00.000+07:00

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?

Read more...

Staff development for clinical teachers

2006-05-01T00:00:00.000+07:00

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?

Read more...

Learning to teach and teaching to learn

2006-04-30T23:30:00.000+07:00

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?

2006-04-30T21:40:00.000+07:00

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

2005-10-30T06:36:00.000+07:00

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

2005-10-02T21:11:00.000+07:00

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.

Download PDF of this article

Problem-Based Learning: From where to where?

2005-10-02T21:07:00.000+07:00

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.

Download PDF of this article

How to set up an OSCE

2005-10-02T21:04:00.000+07:00

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.

Download PDF of this article

How to lead effective group discussions

2005-10-02T21:00:00.000+07:00

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.

Download PDF of this article

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

2005-09-04T03:12:00.000+07:00

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

2005-09-04T03:03:00.000+07:00

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

2005-08-31T03:46:00.000+07:00

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

2005-08-20T03:44:00.000+07:00

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.

What motivates senior clinicians to teach medical students?

2005-08-03T02:07:00.000+07:00

From BMC Medical Education 2005, 5:27

Background
This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers.

Methods
The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia). Their motivations to teach medical students were assessed applying Q methodology.

Results
Of the 75 participants, 18 (24%) were female and 57 (76%) were male. The age distribution was as follows: 30-40 years = 16 participants (21.3%), 41-55 years = 46 participants (61.3%) and >55 years = 13 participants (17.3 %). Most participants (n=48, 64%) were staff specialists and 27 (36%) were visiting medical officers. Half of the participants were internists (n=39, 52%), 12 (16%) were surgeons, and 24 (32%) were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41-55 year age group. The participating clinicians were moderately homogenous in their responses. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time.

Conclusion
This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

Tutoring in problem-based learning medical curricula: the influence of tutor background and style on effectiveness

2005-08-02T22:32:00.000+07:00

From BMC Medical Education 2005, 5:20

Background
Evidence for the superiority of particular characteristics in PBL tutors in medical curricula is generally inconclusive. Most studies have investigated the effectiveness of content experts compared with that of non-experts as measured either by student satisfaction or academic achievement. A few have compared academic staff tutors with student tutors. The purpose of this study was to investigate the relationship between students' perception of overall tutor effectiveness, particular tutor behaviours, clinical qualifications and academic appointment.

Method
A questionnaire designed to evaluate particular aspects of PBL tutoring technique, related either to subject-matter knowledge or to process-facilitation skill, as well as overall effectiveness, was distributed to students in first year of a PBL medical program at the end of each of three tutor terms. A total of 76 tutor terms were included in the study. Data analysis compared clinical with non-clinical tutors, and staff with non-staff tutors.

Results
Clinically qualified tutors used their subject-matter knowledge significantly more than non-clinical tutors and were seen as being more empathic with their students. Staff tutors placed more emphasis on assessment than non-staff tutors and were seen as having greater skill in establishing and maintaining an environment of cooperation within their PBL groups than non-staff tutors.

Conclusion
These results suggest that both subject-matter knowledge and process-facilitation skills are necessary but not individually sufficient characteristics of effective tutors.

Teaching Evidence-Based Medicine: Should We Be Teaching Information Management Instead?

2005-08-02T02:33:00.000+07:00

From Academic Medicine (2005) 80: 685-689.

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients as well as being valid. The authors discuss the need to teach the applied science of information management along with, or perhaps even instead of, teaching the basic science of evidence-based medicine. All students, residents, and practicing physicians need three skills to practice the best medicine: the ability to select foraging—"keeping up"—tools that filter information for relevance and validity, the skill to select and use a hunting—"just in time"—information tool that presents prefiltered information easily and in a quickly accessible form at the point of care, and the ability to make decisions by combining the best patient-oriented evidence with patient-centered care, placing the evidence in perspective with the needs and desires of the patient. This teaching of information management skills will prepare students and residents for a practice of medicine that requires lifelong learning.

The Role of Basic Science Knowledge and Clinical Knowledge in Diagnostic Reasoning

2005-08-02T02:24:00.000+07:00

The Role of Basic Science Knowledge and Clinical Knowledge in Diagnostic Reasoning: A Structural Equation Modeling Approach

From Academic Medicine (2005) 80: 765-773.

Purpose
To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning.

Method
In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning.

Results
Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately.

Conclusion
The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

The Roles of Cadaver Dissection and Radiologic Imaging in Teaching Anatomy

2005-08-02T02:17:00.000+07:00

Viewpoint: Exploring the Human Interior: The Roles of Cadaver Dissection and Radiologic Imaging in Teaching Anatomy

For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy. The authors briefly review the historical forces behind this transition, and then explore the advantages and drawbacks of each approach. Cadaver dissection offers an active, hands-on exploration of human structure, provides deep insights into the meaning of human embodiment and mortality, and represents a profound rite of passage into the medical profession. Radiological imaging permits in vivo visualization, offers physiologic as well as anatomic insights, and represents the context in which contemporary practicing physicians most frequently encounter their patients' otherwise hidden internal anatomy. Despite its important strengths, radiology cannot simply substitute for cadaver dissection, and the best models for teaching gross anatomy will incorporate both cadaver dissection and radiological imaging.

From Academic Medicine (2005) 80: 745-749.

What, nurses training doctors?

2005-05-29T01:04:00.000+07:00

Senior nurses could have their unofficial role in junior doctor training formalised under NHS modernisation plans.

The proposals, by NHS Education for Scotland (NES) researchers, are likely to prove controversial even among nurses, but NES research and training officer Jo Vallis, education development officer Ann Hesketh and Scotland's south east regional dean Stuart Macpherson suggest existing inadequacies in pre-registration house officer (PRHO) training need to be tackled using imaginative solutions.

Download PDF of this full article

Are you answering your students' "why" questions?

2005-05-29T00:46:00.000+07:00

Background
Medical and pre-professional health students ask questions about human health that can be answered in two ways, by giving proximate and evolutionary explanations. Proximate explanations, most common in textbooks and classes, describe the immediate scientifically known biological mechanisms of anatomical characteristics or physiological processes. These explanations are necessary but insufficient. They can be complemented with evolutionary explanations that describe the evolutionary processes and principles that have resulted in human biology we study today. The main goal of the science of Darwinian Medicine is to investigate human disease, disorders, and medical complications from an evolutionary perspective.

Discussion
This paper contrasts the differences between these two types of explanations by describing principles of natural selection that underlie medical questions. Thus, why is human birth complicated? Why does sickle cell anemia exist? Why do we show symptoms like fever, diarrhea, and coughing when we have infection? Why do we suffer from ubiquitous age-related diseases like arteriosclerosis, Alzheimers and others? Why are chronic diseases like type II diabetes and obesity so prevalent in modern society? Why hasn't natural selection eliminated the genes that cause common genetic diseases like hemochromatosis, cystic fibrosis, Tay sachs, PKU and others?

Summary
In giving students evolutionary explanations professors should underscore principles of natural selection, since these can be generalized for the analysis of many medical questions. From a research perspective, natural selection seems central to leading hypotheses of obesity and type II diabetes and might very well explain the occurrence of certain common genetic diseases like cystic fibrosis, hemochromatosis, Tay sachs, Fragile X syndrome, G6PD and others because of their compensating advantages. Furthermore, armed with evolutionary explanations, health care professionals can bring practical benefits to patients by treating their symptoms of infection more specifically and judiciously. They might also help curtail the evolutionary arms race between pathogens and antibiotic defenses.

From BMC Medical Education 2005, 5:16 [pdf]

A Snapshot of the Status of PBL in US Medical Schools, 2003-04

2005-04-01T02:40:00.000+07:00

From Academic Medicine (2005) 80: 300-301
Purpose
Although the use of problem-based learning (PBL) is widespread in U.S. medical schools, its true prevalence is unknown. This study examined the prevalence of PBL in preclinical curricula.
Method
In 2003, a Web-based questionnaire was sent to education deans or directors of medical education at the 123 Liaison Committee on Medical Education-accredited medical schools in the United States. The respondents indicated whether or not they were using PBL and what percentage of faculty-student contact hours in the preclinical years used PBL.
Result
All 123 schools responded. Of them, 70% used PBL in the preclinical years. Of schools using PBL, 45% used it for less than 10% of their formal teaching, while 6% used it for more than half of their formal teaching. Of the 30% of schools not using PBL, 22% had used it in the past, and 2% had plans to incorporate it in the future.
Conclusions
Use of PBL is widespread in the preclinical curricula of U.S. medical schools. That use is limited, however, since fewer than 6% of programs use it for more than 50% of their instruction.

How is the PBL situation in Thailand?

Problem-Based Learning Outcomes: The Glass Half-Full

2005-04-01T02:33:00.000+07:00

From Academic Medicine (2005) 80: 294-299.
Purpose
To compare the characteristics and outcome data of students from a single institution with a two-track, problembased learning (PBL) and standard (STND) curriculum.
Method
PBL and STND students from nine graduating classes at Southern Illinois University School of Medicine were compared using common medical school performance outcomes (USMLE Step 1, USMLE Step 2, clerkship mean ratings, number of clerkship honors and remediation designations, and the senior clinical competency exam), as well as common admission and demographic variables.
Results
PBL students were older, and the cohort had a higher proportion of women. The two tracks had similar USMLE Step 1 and 2 mean scores and pass rates. Performance differences were significant for PBL students in two clerkships as well as in the clerkship subcategories of clinical performance, knowledge and clinical reasoning, and noncognitive behaviors. In addition, the proportion of PBL students earning honors was greater.
Conclusions
The traditional undergraduate educational outcomes for the PBL and STND students are very positive. In several of the clerkship performance measures, the PBL students performed significantly better, and in no circumstance did they perform worse than the STND students.

Do students have sufficient knowledge of clinical anatomy?

2005-03-08T03:49:00.000+07:00

Introduction Comparisons of anatomy knowledge levels of students from various curricula show either no differences or small differences to the detriment of innovative schools. To pass judgement on the general level of students' anatomy knowledge, we need an absolute standard. The purpose of this study was to compare students' levels of anatomy knowledge as measured by a case-based anatomy test with standards set by different groups of experts.

Methods A modified Angoff procedure was used to establish an absolute standard against which the students' results could be evaluated. Four panels of 9 anatomists, 7 clinicians, 9 recent graduates and 9 Year 4 students, respectively, judged 107 items of an anatomy test. The students' results on these items were compared with the standards obtained by the panels.

Results If the standard established by the panel of Year 4 students was used, 64% of the students would fail the test. The standards established by the anatomists, clinicians and recent graduates would yield failure rates of 42%, 58% and 26%, respectively.

Conclusion According to the panels' standards, many students did not know enough about anatomy. The high expectations that the Year 4 students appeared to have of their peers may contribute to students' uncertainty about their level of anatomy knowledge.

From: Medical EducationVolume 39 Issue 3 Page 326 - March 2005

Perceptions of dissection by students in one medical school

2005-03-08T03:38:00.000+07:00

Perceptions of dissection by students in one medical school: beyond learning about anatomy. A qualitative study

Introduction The practice of dissection, as part of undergraduate medical education, has recently resurfaced in the public eye. This paper focuses on a number of important learning outcomes that were reported by Year 15 medical students in a British medical school, during the dissection sessions in the first 2 years of their training, as part of a wider qualitative research project into undergraduate medical education.

Methods A group of 29 students was selected by quota sampling, using the whole student population of the medical school as the sampling frame. Qualitative data were collected by 1 : 1 interviews with students and from formal non-participatory observations of dissection sessions.

Results Apart from learning to cope with the overt 'emotional confrontation' with the cadavers which assists anatomical learning, 7 additional covert learning outcomes were identified by the students: teamwork, respect for the body, familiarisation of the body, application of practical skills, integration of theory and practice, preparation for clinical work, and appreciation of the status of dissection within the history of medicine.

Discussion A number of medical schools have either removed the practical, hands-on aspect of dissection in the medical undergraduate curriculum or are seriously considering such a measure, on financial and/or human resource grounds. This study highlights the fact that dissection can impart anatomical knowledge as well as offer other relevant, positive learning opportunities to enhance the skills and attitudes of future doctors.

From: Medical EducationVolume 39 Issue 3 Page 318 - March 2005

Sicily statement on evidence-based practice

2005-02-06T00:54:00.000+07:00

BMC Medical Education 2005, 5:1

Background
A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC").

Discussion
Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources.
Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available.

Summary
All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

Teaching statistics to medical students using PBL: the Australian experience

2005-02-04T04:06:00.000+07:00

BMC Medical Education

Background
Problem-based learning (PBL) is gaining popularity as a teaching method in UK medical schools, but statistics and research methods are not being included in this teaching. There are great disadvantages in omitting statistics and research methods from the main teaching. PBL is well established in Australian medical schools. The Australian experience in teaching statistics and research methods in curricula based on problem-based learning may provide guidance for other countries, such as the UK, where this method is being introduced.
Methods
All Australian medical schools using PBL were visited, with two exceptions. Teachers of statistics and medical education specialists were interviewed. For schools which were not visited, information was obtained by email.
Results
No Australian medical school taught statistics and research methods in a totally integrated way, as part of general PBL teaching. In some schools, statistical material was integrated but taught separately, using different tutors. In one school, PBL was used only for 'public health' related subjects. In some, a parallel course using more traditional techniques was given alongside the PBL teaching of other material. This model was less successful than the others.
Conclusions
There are several difficulties in implementing an integrated approach. However, not integrating is detrimental to statistics and research methods teaching, which is of particular concern in the age of evidence-based medicine. Some possible ways forward are suggested.

Comments from a Thai Doctor on World Class University Ranking

2005-01-31T03:31:00.000+07:00

Dr. Kai, a Thai doctor of a university hospital, gave some comments after having known that "our university" is not ranked in the 200-top list in 2004, focussing on why university doctors have fewer publications than scientists do, and his view for resolving the problems. (Dr. Kai is still at UCL, UK for his training in neuromuscular diseases.)
....
I think that's because they (scientists, pdharma's editing) do not have exhuasted clinical service job to do ( I mean they have more time to concentrate on research without doing more boring administrative and clinical job and that's because the basis of work structure is different between the faculty) and they have many PhD or MSc students and teams like a man have 10 limbs to help their projects. Like Queen Square, the good quality research publication is run by PhD students and postdocs as it's a pre-requisite for futher SpR (Specialist Registrar. pdharmas's editing) training and the academic lecturer staff concentrates on research only and service is mostly run by hospital clinical staff. And they are co-operative with each other well. Unlike in thailand, they are just competitive among the others and lack of co-operation and everyone want to be the first author because the system of academic promotion is just score on the first author. For example, Fac of Science and Rama are not cooperative well in doing co-research and you have mentioned before Fac of Science sometimes feel that Rama just use fac of science as a techician! In my opinion, research that could be applied in clinical use or can answer to clinical problem (the clinician know this question but need some basic research support) are worth to do. Not just the research that scientists just want to do to fulfil their satisfaction and the result is just kept on the shelf and cannot apply like many theses of Mahidol. How many of them are referred to and used in practice. Only some of the trop med that are useful esp Malaria and tropical disease. But in the future, I think the trend will be like in Queen Square as there will be more clinician-scientist (2 in one), this basic + clinical research needed will be less problem.

I have raised the policy of dividing staff physician into research-oriented team ( for those who favorite and keen on doing research but do not like teaching or service), and clinical service with teaching oriented (for those who do like teaching and see the patient) and of course the criteria of positional promotion must be totally different criteria. This will booster the research publication.Only researchers will concentrate the research all days and do not worry about the service. But it's impossibles as Rama want 3 in one policy : good teacher, good service and good researcher at the same time so nothing is excellent in each item. I believe a guy can do the best job if that job is his favourite and he has time to concentrate on and under the appropriate circumstance without any distracting factors. Different person has different ability to do his different job.
---------------------------END
It does not mean that I (pdharmas) agree with all of Dr. Kai's comments. My point is that we have to learn from different ideas in order to understand the real problems that might be a blockage for cooperation in the future. I do know that most of our senior staff realize and know about the problems very well and have been trying so hard to improve the situation. Please click comments to see pdharmas's.

Critical Thinking

2005-01-24T05:47:00.000+07:00

Critical thinking and problem solving engage three interdependent components: knowledge base, processing skills, and insight (metacognition).

Critical thinking is the art of asking questions.

Which questions should I ask? Should I question the answers to the questions that I ask? Should I question the question? Are some questions better to ask than others? How do I recognize a useful as opposed to an unhelpful question? If thinking is something I do inside my head and I ask all these questions do I have to come up with the answers?”

Tips to start critical thinking
1. Describe – state what it is
2. Analyse – Break it down into its component parts and
3. Name the parts
4. Look at the relationships between the parts
5. What are the possible problems/issues with these relationships?
6. Evaluate the ‘problems’ is it an important issue/ why do you think that?
7. Imagine an alternative
8. Apply steps 1-7 to the alternative.

Another way to organize these eight steps is to use the general categories of
WHAT: background, context, part
HOW: Relationships ofparts, to each other and to the whole
WHY: The meaning of it:Why are the relationships between the parts structured that way
WHY NOT: Alternatives:How could it be different? What would it look like if it was different?

From Julia Hobson’s Critical Thinking workshop, Murdoch University, 2002.

World Class University Ranking Criteria

2005-01-24T03:26:00.000+07:00

As we know, there are two main organizations which analyse and report rankings of universities over the world.
1. Times Higher Education Supplement, THES, (for 200-top list)
2. Institute of Higher Education of Shanghai Jiao Tong (SJT) University (for 500-top list)

We already know whether we are on the 2004 list. It is "Law of Karma". Wrong policies never give good results. And now we are given another new policy (about how to give a budget to universities), which I do not think it would make us be in the World Class University List. However, it is beyond a scope of this post that is about ranking criteria.

Criteria of THES:
- Peer Review Score
- Int'l Faculty Score
- Int'l Student Score
- Faculty/Student Score
- Citation/Faculty Score
You can find more detail at http://www.thes.co.uk/worldrankings/

For the criteria of SJT University, there are four criteria and six indicators.
1. Quality of Education
- Alumni of an institution winning Nobel Prizes and Fields Medals: 10%
2. Quality of Faculty
- Staff of an institution winning Nobel Prizes and Fields Medals: 20%
- Highly cited researchers in 21 broad subject categories: 20%
3. Research Output
- Articles published in Nature and Science: 20%
(For institutions specialized in humanities and social sciences, N&S is not considered, and the weight of N&S is relocated to other indicators.)
- Articles in Science Citation Index-expanded and Social Science Citation Index: 20%
4. Size of Institute
- Academic performance with respect to the size of an institution: 10%

And here are the data sources SJT University uses:
- Nobel laureates
- Fields Medals
- Highly cited researchers
- Articles published in Nature and Science
- Articles in Science Citation Index-expanded and Social Science Citation Index

It does not mean that all those criteria are perfect, but at least it gives us ideas how to improve our universities.

What are the Characteristics of our Medical Graduates?

2005-01-22T06:08:00.000+07:00

Medical graduates I am mentioning mean the graduates of the university I work for, in Thailand. I do know that our educators and high-ranked medical teachers have already had their goals for our graduate for years. Are those goals be reached properly?

Here are the key characteristics I agree with and would like our medical graduates to be.

1. Able to deliver effective patient-centered care.
2. Honest with high ethical standards
3. Knowledgeable in biomedical sciences, evidence-based practice, and societal and cultural issues
4. Critical thinker; problem-solver
5. Able to communicate with patients and others
6. Able to collaborate with patients and other members of health care team
7. Committed to improving quality and safety
8. Committed to life-long learning and information mastery

Skills to Enhance Problem-based Learning

2005-01-19T03:29:00.000+07:00

Medical and health professionals who have used PBL in the classroom have reported symptoms of weak group process and interaction skills among the students. These problems compromise the learning process. Hitchcock and Anderson identified five different small group dysfunctions:
Apathy, or lack of meaningful interaction.
· Limited or focused discussion that ignores other aspects of an issue.
· Dysfunctional group member who does not participate or perform work equally with others in the group.
· Scapegoated student, who becomes ignored by other group members.
· Domineering student who disrupts, or prevents others to learn through the process.
For faculty, poor interpersonal skills (as determined through informal interviews) can lead to:
· A class becoming hostile towards the instructor due to frustration over learning.
· An over-reliance on tutors and/or professor in solving problems and completing tasks.
To be a learning team, the learners need to have the interpersonal skills that will help them become an effective team.
The skills necessary for successful teaming include:

consensual decision making skills,
dialogue and discussion skills,
team maintenance skills,
conflict management skills, and
team leadership skills.

Without these skills being adequately developed, student learning can be frustrated.

For more details about how to develop these skill: Med Educ Online [serial online] 1997;2,3.

Comments from a Thai Doctor on PBL and Good Teacher

2005-01-14T03:21:00.000+07:00

I've received two e-mails from my friend, Kai, who is a medical doctor working and teaching at a university hospital in Bangkok, Thailand. He allows me to post his comments on this blog. His two comments occured after he read the article "Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense" that I sent to all of you.

1st Comment:
11/01/05- "I am happy to see this article as you know I have never agreed with PBL teaching since I was a medical student. I think the main problem is the teachers themselves who cannot teach the student effectively. They cannot select which parts of knowledge are essential and have to be emphasized. I see most the academic lectures in UK could summarise the essential fact of knowledge within 30 minutes of presentation. Thai lecturers or elsewhere will say the time is not enough for me to lecture. Some of Thai senior teachers in the University just want to follow US academic teaching system which was claimed to be modernised but it's a hell indeed. I am not surprised why basic clinical skill and knowledge (need to be taught and emphasized) of the old generation UK consultants are better than new generation of UK consultants and perhaps US consultant or doctors elsewhere (investigation dependent due to unsecure knowledge). Should we follow US with new teaching PBL?"

2nd Comment:
12/01/05- "However, what I believe (sound not scientific but you cannot refuse!) is only a good teacher will help medical student achieve the goal of medical learning (my personal experience of medical studying). Good medical teacher I mean is the one who pays attention to the students during teaching, who can make everything simple for student (no matter how foolish the student is except mental retard student which is not relevant here in reality) to understand, remember (without forget unless they are demented), and ability to think or solve problem by themself finally. Teachers must know the point that the students are usually not understand and clarify to them. Good teacher should have ability to teach or train poor medical student to be a good one. Moreover, good teachers must have ability to demonstrate how they can apply basic science knowlege into clinical practice (good basic science-clinical correlation).

In general (mean not everyone), PhD non-doctoral scientists who are never encounter in clinical practice are difficult to integrate that. On the contary, Research based doctor who, in their whole life, sit in the research laboratory and know everything in molecular detail well and do not see or touch the patient quite often may also have some difficuty to do so. Perhaps they possibly do not know what the students do not understand and they do not understand why students do not understand as they understand everything themselves too well but cannot explain in lay term. Clinical Medical consultants whose knowledge is excellent in every area but are not willing to teach, in my opinion, are rubbish and are not a medical teacher. However all of these are not significant if you are good teacher. Good teacher, probably rarely found nowadays indeed, is always a good teacher no matter how the curliculum will change. The student or learner will absolutely be the judgement. So, Have we ever shown a consideration to our medical students evaluation or complaint? I think medical teaching process is definitely not the same as other educations especially Su-ko-thai-thum-ma-ti-raj self study programme by post because it determines life and death of people.

Someone in this world will definiely not agree and do not want to hear or face the truth from a past medical student."
- - - - - - - - - - - - - - - - - - - - - - - - -END

What is my view (pdharmas's) is that PBL is inevitable for most of the universities in Thailand. What we have to do is to make it right. Is PBL we are running "REAL/PURE" or "modified" PBL? If it is the modified PBL, can we guarantee it will not cause damage? Problem-solving (content-based) skill is not the only one goal of REAL PBL. Communication and group-working skills are also the important goals. Even the moral aspect also can be cultivated during the scientific PBL classes; such as how students accept different ideas without hidden internal violence. All of these will help not only improve doctor-patient relationship when the students become a doctor, but also help society better. It would be a failure of PBL if it was only used to stimulate students to search how to solve the case, despite the student-centred, even though we have good content-based instructors.
Complaints from students are very important and should be recorded for further long-term follow-up (evidence-based) and course evaluation.

A Good Teacher....Am I?

2005-01-13T04:26:00.000+07:00

There are striking similarities about what good teachers say about teaching. On at least ten propositions, the contributors are in near or total agreement:

1. The teacher's main task is to guide students through the learning process, not to dispense information:
"Teaching is not about imparting information. Teaching is about giving students room to learn how to think for themselves." (Law)
". . . teaching is less a matter of professing than it is finding means for students to discover their own virtuousness." (Architecture)
". . . I am on hand not to argue positions or provide entertainment but to facilitate an encounter between texts and minds." (English)

2. The goal of teaching is to help students read, speak, write, and think critically—and to expect students to do these things:
". . . I see it as one of my prime duties as a scholar-teacher to stretch [students'] abilities, open their eyes, and require of them as much as I think they can produce." (Classics)
"The amount of information imparted in the classroom is less important than the dialogue we begin with our students, that collective intellectual enterprise in which we seek to foster critical thinking and experimentation with new ideas, in which we engage our students in that elusive pursuit of the truth, wherever it may lead." (History)

3. Learning is a "messy" process, and the search for truth and knowledge is open-ended:
"The very impossibility of ever arriving at an account of a tradition or of ways of looking for once and for all, the contingency of it all and yet the persistence of our attempts to do so is at the center of all my teaching." (Art History)
"In dealing with any really hard problem, most scholars will probably admit they do not know of a single right solution . . . Students should not be given the impression that they have arrived nowhere simply because no single right solution has been found." (Law)
"Just as in real life, my problems may have several answers. This irritates everyone; students want precise, tidy problems. But my job is to teach them how to take messy, vague questions and transform them into a precise model which can then be attacked." (Mathematics)

4. Good teachers love their subject matter:
"Here is my advice. Don't teach if you don't like the subject matter. If you love it, don't hide it. Wear your zeal on your sleeve, shout it, show it, sing it. The rest will take care of itself." (Economics)
"A short philosophy of teaching might be, 'Love your subject and convey that love; all else is secondary.'" (Physics)
". . . we have a unique power to make our classes come alive with the excitement of discovery and the love of creative learning that drive our own lives." (Chemistry)

5. Good research and good teaching go hand in hand. Students' engagement with the subject is enhanced by knowing about the teacher's own research, and the interaction with students often provides new insights into the research:
"My experience as a professor and as Chancellor contradicts the popular misconception that teaching and research conflict with one another. Exciting classes stimulate scholarship, and active research enriches teaching." (Mechanical Engineering)
"Presenting recent research in classes adds a sense that we are all still learning, not just reviewing knowledge, and student response has been enthusiastic." (Integrative Biology)
"The integration of research and teaching has been for me a two-way process. Not only have I involved students in my research and related my research to my teaching; I have also participated in and learned much from student research projects. Most of my work related to student research has been at the undergraduate level. I think undergraduate students are capable of doing original research and have encouraged them to participate in the advancement of knowledge." (Ethnic Studies)

6. The best teachers genuinely respect students and their intellectual capabilities:
"I insist upon taking students seriously—seriously enough to argue with them, seriously enough to snap their heads off if they cannot show me logical bases for their assertions, and seriously enough to retreat in open confusion when they disagree with me and show me I have in fact misunderstood the materials I have presented." (English)
"Few things can compete with the teaching of eager, talented, well-prepared and demanding students that crave, in fact, demand, precision and excellence . . . How lucky I really am." (Mechanical Engineering)

7. Good teachers are rarely satisfied with their teaching. They constantly evaluate and modify what they do:
"There is no room for complacency in teaching, and that's one of the things I love about it." (Environmental Science, Policy, and Management)
"At any given moment I may feel that I am not doing a good job in my courses, and feel my preparations are inadequate, or that I am giving students short shrift. I realize I have thought this about my teaching during every term of every year since I started to teach." (English)

8. Good teachers usually had good teachers, and they see themselves as passing on their own teachers' gifts to a new generation of students:
"As I watched my teacher think out loud, inviting us to think with him about the material, I suddenly got the point. Instead of trying to fit some new material into my scholarly bag of knowledge, or attempting to come up with a response, I allowed my teacher's passion, his sense of wonder, to inhabit me. That kind of experience is what I try to offer students in my teaching." (Economics)
"For many of us, it was the special things that happened with teachers that shaped our paths to success. My aim is to offer the best that I was served." (Psychology)

9. Good teachers treasure the small moments of discovery in the classroom and the more enduring effect they have on students' lives:
"But the true rewards, the point of it all, are those moments of insight when a student suddenly brightens with radiant excitement and says, 'Oh, now I get it!' and does 'get' something to which access had been blocked. A small miracle." (Political Science)
"Teachers live for moments . . . when realization glows like a cartoon lightbulb over a student's head." (Public Policy)
"I have watched students learn things I never knew while I was supposedly teaching them, and do things that may well be beyond my capabilities while I was supposedly directing their research. And I have watched them continue that performance for years after leaving Berkeley. There is an enormous satisfaction in that." (Materials Science and Mineral Engineering)

10. Good teachers do not see teaching as separate from other activities; rather, they see their lives as remarkably integrated:
"The activity of teaching seems to me particularly blessed, for it allows me to spend my time with what I love and gives a oneness to my life that students value—in the literal sense, appreciate. One might say that my business is my hobby—or that I have no hobbies. I am always working—or never working. Whatever the formulation, the result is a wholeness to one's intellectual, even one's physical life." (Music)
"Very few teachers can match their professional work and their classwork as near-perfectly as this. One of the great advantages of Berkeley, I believe, is that so many faculty members are able to lead intellectual lives as unified as mine." (Journalism)

Extracted from Office Educational Development, University of California, Berkeley

When is PBL not PBL?

2005-01-12T19:01:00.000+07:00

I've read this article of Gwendie Camp, and found it interesting.

QUOTE:

PBL fits with tenets of adult learning theory. Student autonomy, building on previous knowledge and experiences, and the opportunity for immediate application are all well-known to facilitate learning in adults.
Knowles, considered the "father" of adult learning theory, proposed that appropriate conditions for adults to learn effectively include the following: a learning environment characterized by physical comfort, mutual trust and respect, mutual helpfulness, freedom of expression, accepting of differences, where learners perceive the goals of the learning experience to be their own goals, where learners accept a share of responsibility for planning and operating the learning experience and therefore have a commitment to it, where learners participate actively, and sense progress toward their own goals.
Norman and Schmidt reviewed experimental evidence supporting possible differences in students' learning that could be attributed to PBL. They concluded that there is not yet any evidence that PBL curricula result in improvement in general (content-free) problem-solving skills, although they caution that problem-solving skills independent of content acquisition may not exist. However, there is evidence that PBL students retain knowledge much longer than students taught conventionally, although their initial learning may be less extensive. There is preliminary evidence that PBL students may be better able to transfer concepts to new problems. And lastly, it is evident that PBL does have a large impact on self-directed learning skills, and on students' motivation.
The reasons why PBL is "catching on" is the desire of faculty or administrators at schools which have not yet implemented PBL to avoid "missing the boat". In other words, there is a temptation to join the parade or get on the bandwagon so as to not be perceived as behind the times. Unfortunately, this motivation can too often lead to only half-hearted implementation of PBL, which does not capture the "spirit" of PBL.

When is PBL not PBL?
The characteristics of "pure" PBL:
- problem-based learning is active,
- adult-oriented,
- problem-centered,
- student-centered,
- collaborative, integrated, interdisciplinary,
- utilizes small groups and
- operates in a clinical context.
Then, any program which does not place students in tutorial groups of, say, 5-10 students is not "pure" PBL. If the program is "teacher-centered" rather than "student-centered," the heart of "pure" PBL has been lost.

When, then , is it not "pure" PBL? When it is discipline-specific, case-based (or problem-stimulated) but not student-centered, when much of the instruction is still in traditional formats such as lectures and labs, and when the assessment of student performance rests solely or primarily on content acquisition. When a PBL course must be buried within a surrounding set of traditional courses, it is not "pure" PBL, as students will have lost the time necessary for independent study.

From: Problem-Based Learning: A Paradigm Shift or a Passing Fad? MEO 1996;1:2

The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

2005-01-11T04:08:00.000+07:00

Medical EducationVolume 39 Issue 1 Page 107 - January 2005
Nicole N Woods, Lee R Brooks & Geoffrey R Norman

Conclusions Knowledge of basic science may have value in clinical diagnosis by helping students recall or reconstruct the relationships between features and diagnoses.

Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense

2005-01-10T20:52:00.000+07:00

BMJ 2004;329:92-94 (10 July), doi:10.1136/bmj.329.7457.92
Gareth Williams, Alice Lau

Summary points
1. Traditional medical training produces doctors with a sound knowledge base that allows them to practise across a broad spectrum of medicine
2. Reformers aim to cut the student's factual knowledge base, while replacing traditional teaching methods with student led and problem based approaches
3. There is no evidence that the "new" strategies will produce better doctors, and a risk that students with inadequate knowledge will become poor clinicians
4. A rigorous comparison of "traditional" versus "new" curriculums is urgently needed to determine the best strategy for training doctors

Comments
- Reform of undergraduate medical teaching in the United Kingdom: Evidence base for problem based learning is growing
Jill MorrisonBMJ 2004 329: 798-799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Unfunded reform always ends in reaction
Julian T HartBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Students are too many to be assessed individually in general hospitals
Charles FoxBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: "Problem based learning" v "traditional" is a false debate
Joshua D R PayneBMJ 2004 329: 799. [Letter]
- Reform of undergraduate medical teaching in the United Kingdom: Evangelism triumphs over common sense for ophthalmology
Michael P ClarkeBMJ 2004 329: 799-800. [Letter]

Collection of useful papers up to 2004

2005-01-10T20:49:00.000+07:00

Older J.
Anatomy: a must for teaching the next generation.Surgeon. 2004 Apr;2(2):79-90.

McLean M.
A comparison of students who chose a traditional or a problem-based learning curriculum after failing year 2 in the traditional curriculum: a unique case study at the Nelson R. Mandela School of Medicine.
CONCLUSIONS: C2001 students had clearly embraced PBL. They were now medical students, largely because of PBL activities underpinned by a sound educational philosophy. This unique case study has provided additional evidence that PBL students are generally more content with their studies than their conventional curriculum counterparts.Teach Learn Med. 2004 Summer;16(3):301-3.

Steinert Y.
Student perceptions of effective small group teaching.Med Educ. 2004 Mar;38(3):286-93.

Azer SA.
Becoming a student in PBL course: twelve tips for successful group discussion.Med Teach. 2004 Feb;26(1):12-5.

Hendry GD, Ryan G, Harris J.
Group problems in problem-based learning.Med Teach. 2003 Nov;25(6):609-16.

Herzig S, Linke RM, Marxen B, Borner U, Antepohl W.
Long-term follow up of factual knowledge after a single, randomised problem-based learning course.
CONCLUSION: A small-scale exposure to PBL, applied under randomized conditions but in the context of a traditional curriculum, does not sizeably change long-term presence of factual knowledge within the same discipline.BMC Med Educ. 2003 Apr 02;3(1):3.

Roche WP 3rd, Scheetz AP, Dane FC, Parish DC, O'Shea JT.
Medical students' attitudes in a PBL curriculum: trust, altruism, and cynicism.Acad Med. 2003 Apr;78(4):398-402.

Prince KJ, van Mameren H, Hylkema N, Drukker J, Scherpbier AJ, van der Vleuten CP.
Does problem-based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy.Med Educ. 2003 Jan;37(1):15-21.

Gilkison A.
Techniques used by "expert" and "non-expert" tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum.Med Educ. 2003 Jan;37(1):6-14.

Willis SC, Jones A, Bundy C, Burdett K, Whitehouse CR, O'Neill PA.
Small-group work and assessment in a PBL curriculum: a qualitative and quantitative evaluation of student perceptions of the process of working in small groups and its assessment.Med Teach. 2002 Sep;24(5):495-501.

Khoo HE.
Implementation of problem-based learning in Asian medical schools and students' perceptions of their experience.Med Educ. 2003 May;37(5):401-9.

Khoo HE, Chhem RK, Gwee MC, Balasubramaniam P.
Introduction of problem-based learning in a traditional medical curriculum in Singapore--students' and tutors' perspectives.Ann Acad Med Singapore. 2001 Jul;30(4):371-4.

Hay PJ, Katsikitis M.
The 'expert' in problem-based and case-based learning: necessary or not?
Clinical Trial
Randomized Controlled Trial
Med Educ. 2001 Jan;35(1):22-6.

Houlden RL, Collier CP, Frid PJ, John SL, Pross H.
Problems identified by tutors in a hybrid problem-based learning curriculum.Acad Med. 2001 Jan;76(1):81.

O'Neill PA.
The role of basic sciences in a problem-based learning clinical curriculum.Med Educ. 2000 Aug;34(8):608-13.

Yu HY, Wu ZA, Su MS, Yen DJ, Luk HR, Chao YC, Liao KK, Lin KP, Yu SM, Liu HC.
Problem-based, small-group tutorial learning in clinical neurology for second-year medical students.Zhonghua Yi Xue Za Zhi (Taipei). 2000 Aug;63(8):598-604.

Antepohl W, Herzig S.
Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study.
CONCLUSIONS: Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.Med Educ. 1999 Feb;33(2):106-13.

Comments and Suggestions

2005-01-10T06:21:00.000+07:00