ABSTRACTS
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PSYCHACCESS: AN INTERACTIVE WWW-BASED QUESTION AND ANSWER PROGRAM Debbie Miller Ph.D., Celia Jenkins M.D., Tony Frisbie Ed.D., and John Z. Sadler M.D. The University of Texas Southwestern Medical Center at Dallas This World Wide Web-based computer program consists of over 600 psychiatry
questions previously used in pre-clinical behavioral science courses at
the University of Texas Southwestern Medical Center in Dallas. The
purpose of the program is to provide students with high-quality assessment
items with immediate feedback on their performance. Students can
review specific topics from the basic behavioral sciences or clinical psychiatry.
The topic areas include, for example, the mental status examination, human
psychoemotional development, mood disorders, learning theory, psychological
measurement, as well as a variety of other mental disorders. Several
videotaped patient segments from the Psychiatry Vignettes, Second Edited
Version (APA Task Force for Educational Activities for DSM III-R, 1989)
have been added to the program. Students view the pop-up video patient
vignettes and then answer questions about the diagnosis and relevant treatment.
The other questions are in a text-based format within an expandable (able
to add new questions) software shell. Students access this
web program through a password-protected UT Southwestern URL. The
demonstration will illustrate use of the program over the Web.
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IMPROVING THE QUALITY OF EDUCATION AT MARMARA UNIVERSITY VOCATIONAL SCHOOL OF ALLIED HEALTH PROFESSIONS Sanda CALI, S¸ha YALCIN, Nursel ERDOGAN, Ozlem SARIKAYA, Sibel KALACA, Istanbul, Turkey A series of long-term studies was conducted to improve the quality of education at Marmara University Vocational School of Allied Health Professions. After these studies were completed, the 1998-1999 academic year began with a competency-based educational approach that involved student-centered, interactive, entertaining and humanistic educational techniques. The first step of the improvement process was to give trainers courses
on "Improving Educational Skills". During the time that these courses were
conducted, the objectives, contents and duration of each course and department
were re-evaluated. In addition, the physical environment was rearranged
and teaching aids were obtained in order to establish a positive learning
atmosphere. Objective assessment techniques were also introduced.
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SUCCESSES, FAILURES AND LESSONS LEARNED FROM A WEB-PAGE TO TEACH SOPHOMORE PATHOLOGY Robert N. McLay, Ph.D., Eric M. Meihoff, B.S. and Sanda Clejan, Ph.D. Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA. Prior to the 1998-1999 school year the Department of Pathology made
a concerted effort to expand its web page and integrate use of the Internet
into the curriculum for the sophomore pathology course. Students
were able to use the web page for specifically-designed, computer-learning
sessions and as a general aid for study. After the first exam,
students were given a survey form in which they were asked to provide information
about themselves, their use of the web page, and their opinions of the
pathology course and its web page. Responses indicated that students
did make use of the web page, showed considerable computer savvy, and had
positive attitudes about web-based learning. A majority of students
gave a positive or very positive rating to the pathology web page.
Despite these positive factors, use of the page did not significantly correlate
with test scores. In the surveys, students described several
reasons why the web page had not been as helpful as had been hoped; summed
up in two words: accessibility and applicability. Based on
the input we received from students we revamped the page: new material
was placed on the web in the same order as which it is presented in the
lectures. To ensure that students receive a coherent message about
what they should be learning from the web page, we are trying to bring
more of the faculty who are providing the lectures and test questions directly
into the process of web design. Many of our revisions may sound like
an attempt to over simplify, but this is not the case. Simple
and accessible use by the students is a priority, but we are not
removing material. We want the web page to serve as a comprehensive
resource beyond just the needs of the class. We also want high quality
images and applications to be available to those who can use them.
We are, however, making sure that the presentation is more uniform,
that small files are available in addition to larger images, and that the
web page calls attention to the most important material. A new survey
at the end of the final pathology examination will correlate again the
use of the website with test scores and measure if the implementation solutions
were useful.
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U-SCALE: HUMAN GROSS ANATOMY Marcel D'Eon, University of Saskatchewan U-SCALE is the University of Saskatchewan Computer Aided Learning Environment to aid the learning and understanding of the fundamental concepts of human gross anatomy. This multimedia program contains text, interactive 2D images, rotatable 3D models, animations of clinical procedures and conditions, and review questions. Components are linked by an icon based menu system, with information accessed by either regional anatomy or digital media. The program has been translated into Hypertext markup, javascript, and Java languages, to allow cross-platform use and multimodal delivery (local hard disk, CD-ROM, or web/intranet server). Modules and relevant clinical procedures have been developed for
three body regions: a. Thoracic (pleural tap, pericardiocentesis,
breast self examination, auscultation) b. Head and Neck (mandibular nerve
anesthesia, temporomandibular joint movement, cranial injuries) and c.
Abdominal (portal hypertension, hernia, abdominal imaging). Other
modules are under development.
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STUDENT CENTERED LEARNING OF ANATOMY Narga Nair M.D., Assistant Professor, Department of Anatomy, KMC, Manipal 576119 India In accordance with the Medical Council of India regulations
in 1997, our institution the Kasturba Medical College situated in Manipal
in South India, adopted the new (reduction) 1 year course in the basic
medical sciences (as opposed to the earlier 1? year course in Anatomy,
Biochemistry and Physiology). The reduction in the allotment of time
for the first year of Medicine has not coincided with a corresponding decrease
in the course content - resulting in the obvious, attendant problems for
both students and faculty.
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AN E-MAIL TUTORIAL TO TEACH PROBLEM SOLVING IN PHARMACOLOGY Joseph Goldfarb, Department of Pharmacology, Mount Sinai School of Medicine, New York, NY 10029 An elective e-mail tutorial was instituted in the second year
pharmacology course to enhance the teaching of problem solving and to allow
students to individually engage in a discussion with faculty beyond that
possible in small-group sessions. On Thursdays, a problem is
e-mailed to the entire class. Problems are based on clinical case
scenarios, or real or prototypic experimental or pharmacokinetic
data. Students use these data to calculate dosage regimens, explain the
mechanisms of drug effects or rationalize pharmacotherapy options based
on pharmacokinetic and pharmacodynamic principles. Most problems have multiple
sections. Students are given 4 days to submit an initial reply to the e-mail
in which they are expected to either solve the problem, stating the assumptions
they made and the reasons for their answers, or to indicate explicitly
aspects of the problem they don't understand. Faculty feedback is
individualized for each student; standardized responses are avoided.
Assumptions students make are discussed and questioned and errors of fact
or of method are corrected. In some cases, when it is clear that
there are major deficiencies students are given some basic principles or
a suggested approach and asked to rethink the problem and try again.
Once a student-faculty dialog is initiated it can continue for as many
iterations as the student wishes. Participation is voluntary, and students
may elect to participate on a week to week basis. Examples of problems,
student replies and faculty feedback will be presented. In the 1998
pharmacology course, 9 weekly tutorials were offered, 6 of them before
the mid-term exam. Out of a class of 110 students, 51 participated
at least once. Post hoc analysis of midterm exam grades revealed
that 24 of the 28 students who answered 3 or more of the 6 pre-midterm
e-mails had exam grades above the class median, whereas only 10 of 21 students
who did only 1 or 2 e-mails were above the median. Comparison of
performance on the 12 questions on the midterm most closely related to
the topics in the e-mail tutorial versus performance on the remaining 58
questions, showed that students who did 3 or more pre-midterm e-mails did
better on both sections of the exam, but the magnitude of their improved
performance was greater on the e-mail-related questions (ANOVA, P<0.02)
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SimBioSys: A REALISTIC SIMULATION OF HUMAN PHYSIOLOGY Gregory Schmidt, M.D., Critical Concepts, Inc., Chicago, IL The power of personal computers has created the opportunity to replace
live animals in the teaching of cardiovascular physiology. Advantages of
a computer simulation include the ability to repeat the intervention many
times, accessibility of the simulator for self study, and the ability to
access and alter variables in isolation (e.g., arterial vascular compliance)
that are not easily adjusted in vivo. We have developed a highly
realistic real-time simulation of human physiology, based on state-of-the-art
models of cardiovascular dynamics, lung mechanical and gas exchange behavior,
autonomic reflexes, and renal function. We compared a traditional
cardiovascular physiology demonstration by a skilled faculty member using
an anesthetized dog with the software simulation running on a desktop personal
computer in a first graduate year medical physiology course. Students
in a single class attended both sessions and were asked to rate the two
learning experiences. Both laboratories were rated highly.
When students were asked to rate the usefulness of each laboratory “in
complementing the lectures and text,” on a scale of 1 to 5 ( 1= not useful,
5= very useful), the animal laboratory received a mean score of 3.78 ?
1.12, with a median score of 4. Overall, 39/46 students rated it with a
score of 3 or better so most students found it useful. The computer
laboratory received a mean score of 4.78 ? 0.72 and a median score of 5;
all students rated it with a score of 4 or better. When asked if
they recommended offering both labs again for next year’s class (1= “not
recommended”; 5= “highly recommended”), the computer simulation received
a score of 4.89 ? 0.31, with a median of 5. The animal laboratory received
a score of 3.35 ? 1.33 with a median of 3.5 Eleven of 46 students
recommended that the animal demonstration be discontinued next year, as
judged by a score of 2 or less on that question. Of these 11, most disliked
the animal lab but a few rated it very highly yet suggested stopping it.
When asked to choose between the two labs if only one could be offered,
16/47 selected the animal demonstration whereas 31/47 chose the computer
lab.
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OSCE/TRIPLE JUMP COMBINATION EXAM TO ASSESS SEVERAL COMPETENCIES: INNOVATIONS IN A COMPETENCY CURRICULUM AT INDIANA UNIVERSITY P. W. Bankston, V. Hoftiezer, G. Lonnak, J. Vanden Berge and W. Marshall
Anderson, Northwest Center for Medical Education, Indiana University
School of Medicine, 3400 Broadway, Gary, IN 46408.
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THE ANATOMY OF THE BRACHIAL PLEXUS: A MULTIMEDIA PROGRAM EMPHASIZING EMBRYOLOGICAL DERIVATION Gould, Douglas J., Spawn, C., and Cooper, M. Department of Anatomy & Neurobiology and Medical Arts and Photography, University of Kentucky Chandler Medical Center, Lexington, KY. There exists a natural relationship between embryology and gross
anatomy that can be utilized when teaching adult anatomy. The objective
of the present study is to use current multimedia technology to simplify
the structure and function of the brachial plexus and to relate the adult
form to its embryological origins. The program uses a combination
of novel illustrations, animations, explanatory text, and a set of printable
sample questions to provide an easy to understand tutorial for the brachial
plexus. The course of each of the five terminal branches of the brachial
plexus are illustrated and accompanied by a general pathway description.
Muscles receiving motor innervation from each terminal branch are listed
and shown diagrammatically in a separate set of images. In addition,
the cutaneous patterns of sensory innervation are illustrated. One
of the most advantageous aspects of the program is an animation showing
the development of the brachial plexus from its embryological origins that
illustrates limb rotation and the resulting adult anatomy and dermatomal
arrangement. The program, which will run on either Macintosh or PC
platforms and requires Quicktime 3.0, is packaged on CD-ROM. Student
evaluation of the program highlights is ease of use, clear and intuitive
navigation, and validation that the use of illustrations and animations
were extremely beneficial to their understanding and retention of the material.
We plan to incorporate other multimedia aspects to provide clinical photographs
of related pathologies, photographs of dissections from the gross anatomy
lab, and video clips of laboratory dissections to further enhance the clinical/functional
aspects of the brachial plexus. As the program continues to evolve
it will provide a premiere ancillary for the complete study of the brachial
plexus for those students in a lab-based course as well as provide a stand-alone
substitute for students in courses without a lab component. In addition,
it will be unique in its presentation of anatomy by presenting the embryologic
formation of adult structures.
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PATHOGENIC PUZZELS™ ON THE COMPUTE: A SERIES OF PROBLEM-SOLVING CASES FOR MEDICAL EDUCATION Created by: Dr. Stuart Nelson at Wright State University, Software Design by: Mark D. Anderson Titles in this series include:
Each case is a medical story with key information purposely deleted
by creating blanks. Each blank has a different theme, e.g. symptom,
lab value, complication, diagnostic aid, management procedure, mechanism
of action, pathologic lesion, side effect, etc. Most of the cases
contain a scenario with 8 blanks. Below the story are 8 groups, each
group containing 4 items.
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OUTCOMES-BASED APPROACHES TO CURRICULAR PLANNING THE COBMES REVOLUTION
This paper presents a detailed overview of the numerous outcomes-based
approaches from our Community Based Medical Educational Services (COBMES)
at the Ogun State University's Obafemi Awolowo College of Health Sciences
which via its constantly progressive evaluation of the programme
and its resultant unequivocal outstanding outcomes has revolutionised the
planning of the pre-clinical (basic medical sciences and behavioural sciences)
and clinical curricular especially in primary health care with a positive
impact on both local, state and national health care system.
Learning by reflecting on experiences from evaluated outcomes on an educational
programme may well be the most effective means of ensuring the success
of change. A careful analysis of priority health problems (societal
needs) available resources and ensuring a matching health care system with
an appropriate distribution of tasks and related manpower are amount the
prerequisites for planning truly acceptable, effective an efficient medical
education curricular for the next millennium. Faculties of
Health Sciences should have an "intelligence unit" whose task it would
be to monitor the changing health situation in the jurisdiction served
by the medical school and present the resulting analysis for the purpose
of guiding academic planning (based on the evaluated outcomes).
This paper ends with some proposals for further collaboration between medical
educators and curriculum planners.
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DEVELOPMENT OF A MULTIMEDIA INTERACTIVE CARDIOLOGY WORKSHOP
R.C. Sexton, and R.T. Dowell. Lake Erie College of Osteopathic Medicine, Preclinical Education Division, Erie, PA 16509.
DESIGN: A simulated emergency room (ER) scenario was designed for small groups of students acting as ER physicians. A lab section of 40 students was divided into 8 ER groups. An unconscious patient was presented to each group with: (1) a possible myocardial infarction (MI) requiring intensive care treatment; (2) a hypoglycemia requiring only glucose treatment; or (3) an asphyxiation due to toxic fumes requiring inhalation therapy. ER groups performed selected clinical laboratory assays from simulated patient samples and then used these values in combination with history and physical data to formulate a diagnosis and recommend treatment. INTERACTIVE METHODS: Students accessed the workshop materials in advance through the LECOM intranet homepage. Case materials described an unconscious, diabetic patient who sustained muscle injuries after falling from a ladder while working in a fume-filled room. In the lab, each section initially viewed a 20-minute video that introduced the relative merits of different myocardial markers used to diagnosis MI. A correct diagnosis would lead either to the patient being admitted into a hospital care unit or being discharged. The negative aspects of an incorrect diagnosis on patient safety and hospital liability were also presented. Each ER group then performed three assays on simulated plasma: 1) kinetic creatine kinase (CK) on five serial samples; 2) glucose stat assay; and 3) qualitative cardiac troponin-t. Each ER group was given a different simulated plasma set having: 1) total CK with or without an after admission peak at 18 hours; 2) hypo, eu-, or hyperglycemic; and 3) troponin-t either positive or negative. OUTCOMES: Based on lab outcomes and the case scenario, each ER group made an oral presentation of their diagnosis with considerations for treatment. The workshop was well received by medical students. Plans are to develop the workshop as an interactive, multimedia program for CD. Sample workshop materials will be available at the IAMSE symposium.
A17
THE INNOVATIVE CURRICULUM OF UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER
Esperanza C. Lansang, M.D., Aurora Boulevard, Quezon City, Philippines,
The new curriculum of the College of Medicine has the following characteristics:
- integrated horizontally and vertically with
liitle departmental barrier
- community-oriented with a variety of educational
settings
- student-centered with self-directed learning
activities
The teaching-learning activities fall under three categories:
- tutorial and correlates which cover the main
course content
- selectives which cover important topics which
are not included in the tutorial and correlated, and
- patient-doctor which deals with development
of communication and clinical skills and humanistic
attributes for medical practice
The principal teaching strategy is problem-based learning approach in
small group tutorial sessions centering on solving clinical problems as
stimuli and reason for learning. This is complimentedby lecturettes,
microscopy, laboratory exercises and demonstrations, film showings, slide
projections, computer-assisted learning, and other learning activities.
The curriculum has three (3) phases: 1. Level I Integrated Human
Organ System - ten (10) months
2. Level II Disease and Medicine
- fifteen (15) months
3. Level III Clinical Clerkship
- sixteen (16) months
Level I deals mainly with normality in the healthy child and adult. Patient-doctor introduces the students to the role ofdoctoring and to communications in medicine. Selectives include history of and perspectives in medicine and applied epidemiology.
Level II introduces the students to the ailing person and the family and community with sick individuals. The principal subject matter is the recognition and management of the ailing person. Patient-docotr II consists of history taking and physical examination. Selectives are principles of surgery, concepts of disability, and medical rehabilitation, medical ethics, public health administration, research method, medical jurisprudence, and teaching principles. Students are required to finish their researchprojects (in groups) before clinical clerkship.
Level III is full clinical clerkship with rotations in teh community
and industrial settings as well as the hospital and its out-patient
unit.
A18
PRESENTATION OF PHARMACOLOGY IN AN ORGAN-SYSTEM BASED MULTIDISCIPLINARY BASIC/CLINICAL SCIENCE INTEGRATED SOPHOMORE MEDICAL CURRICULUM
George A. Dunaway and Carl L. Faingold, Department of Pharmacology, Southern Illinois University School of Medicine (SIUSM), P.O. Box 19629, Springfield, IL 62794-9629
A multidisciplinary integrated format is utilized to present major parts
of the SIUSM sophomore medical curriculum to 48-50 students in the "standard
track". The I ntegrated portion of the curriculum includes the endocrine,
infectious disease and central nervous system "organ system" blocks. The
format is case-based, including real patients, patient families, simulated
patients, videotaped patients, and paper patient cases that address important
disease types in each of these blocks. Typically, 2-5 discipline
faculty jointly present a 2 hour integrated session. Many sessions
integrate Pathology, Pharmacology and Introduction of Clinical Medicine.
Some also include input from Immunology, Radiology and/or Epidemiology.
Usually, discipline-specific sessions in each organ system are used to
introduce basic concepts. Each integrated session is built around
multiple paper cases on a specific topic (e.g. thyroid disease or seizures)
given to the students in advance with instructions to develop a differential
diagnosis. The initial portion of the session is introduced by a
clinician with expertise in the topic, who discusses each case and the
rationale for diagnosis. The subsequent session elements vary with
the topic. Sessions typically continue with a presentation of the classification
of the types of the specific disorder. The pathophysiology of the
disorder is discussed, generally, by the Pharmacology or Pathology faculty.
The pharmacology of drugs to treat this class of disorders is then presented,
which typically addresses the following subjects termed the PHARMACOLOGY
MENTAL ALGORITHM (A-J). A B Available drugs that have the desired
pharmacological actions required to treat the pathophysiology of the medical
problem; B - Mechanism(s) of drug action; C - Factors which influence drug
pharmacokinetics (including drug-drug interactions); D - Potential adaptation
processes altering target cell responsiveness (e.g. tolerance, desensitization,
dependence); E - Usefulness of the specific drug(s) relative to the therapeutic
goals established for the patient; F - Contraindications (absolute and
relative); G - Adverse (side) effects; H B Other drug effects, including
those related to drug abuse, that can be mistaken for disease symptoms;
I B Drug-related alternations of clinical laboratory tests: J - Risk/Benefit
ratio of therapy (therapeutic index). If possible, a brief patient
video before and after the treatment is presented. Typically, the
clinician ends the session discussing the application of the basic science
concepts to clinical medicine and additional clinically relevant factors,
including non-pharmacological treatments. Standardized and fixed
finding patients are utilized, and small group (6-7 students) tutor groups
follow up on each standardized patient. The integrated evaluation
is based on case vignettes with input on each question from each relevant
discipline. A separate practical evaluation of student patient examination
skills is performed by clinicians.
A19
ALBUMIN AS A N EXAMPLE OF WORKSHOPS IN THE TEACHING OF BIOCHEMISTRY
Cecilia I. Díaz V., Department of Biochemistry and Nutrition, Faculty of Medicine, University of Panama, Panama, Republic of Panama
Biochemistry is being taught at the fourth semester of the MD degree
program at the University of Panama Medical School. It is an
eight credits course. The input is in the form of lectures, workshops and
practicals. The workshops handouts include a list of key words,
general objectives, several specific objectives, activities,a bibliography
and schemas. The subjects of the workshops reinforce the material
of lectures. The workshop on Albumin is presented as an example
of a learning strategy. The structure and function of alpha
aminoacids is a requisite for this workshop. To relate the
primary structure of the albumin with its physical properties and physiological
functions the team of students has to do several activities.
Once the team has examined the sequence, the students determine albumin
net charge, solubility and the interactions with ligands. Finally,
the team look for an explanation of the oncotic pressure of albumin.
Once the assignment is completed, one student of each team presents the
discussion for the whole class. The teacher acts as a facilitator.
Rather than rote memorization of albumin functions, this workshop stimulates
the learning by meaning, reinforces lectures on proteins and contributes
to the development of self study skills.
A20
ANATOMY INTERACTIVE: AN INFORMATION PORTAL FOR USE IN MEDICAL EDUCATION
James J. Walker1,2, Aaron D. Booth, and J. Leslie Booth2. 1Lafayette Center for Medical Education, Indiana University School of Medicine and 2Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907
The study of anatomy is an integral part of the training of medical
students worldwide and remains one of the most extensive and demanding
basic science disciplines due to its immense knowledge base and diversity
of components. In recent years anatomy courses have become more expansive
in an effort to integrate basic structure with various imaging modalities
and clinical correlates. The result is that students are faced with
managing larger volumes of learning resources that come from widely dispersed
sources and in a variety of formats. Thus, we saw an immediate need
to help students and medical educators find a way to quickly and efficiently
access anatomy-related resources. We have developed Anatomy Interactive
as an academic portal designed to provide students with a common Web-based
interface through which they can acquire information about the anatomical
sciences. We have developed an interactive educational environment
that blends the use of conventional text-based materials with enriched
animations, streaming video, audio, virtual tours, and in-line scripting
formats. The content and interactive elements are constructed using
multimedia development software tools from such companies as Macromedia,
Adobe, Tribeworks, Live-Picture and RealPlayer. At this Web-site
(HYPERLINK http://www.vet.purdue.edu/bms/cadup http://www.vet.purdue.edu/bms/ai)
we have created a dynamic electronic newsletter with an interactive, content-driven,
organizational structure that provides effective information retrieval
and promotes active learning. For example, through Anatomy Interactive
students have access via a single starting point to; (1) the local information
portal for students and faculty at the Lafayette Center for Medical Education
(LCME Anatomy), Indiana University School of Medicine and Purdue University;
(2) Professional Development resources including conferences and academic
societies; (3) Links to hundreds of topic-specific anatomy sites across
the Internet; (4) General Information pertaining to recent journal articles
and medical news; and (5) Educational Resources related to anatomy textbooks,
interactive software programs, and academic publishers. Moreover,
we envision Anatomy Interactive to be an information portal that can be
used to share anatomy-related resources across the Indiana statewide regional
medical campuses, as well as nationally and internationally. The
aim of this project is to enhance the effectiveness of student learning
by developing functional education resources that students use on a regular
basis. (Funded by a grant from the MIDC)
A21
PROBLEM BASED ASSESSMENT
Willis Ochieng, MSc, DPharm, Moi University, Kenya
It is increasingly becoming clear that students in problem based medical
schools may need to be evaluated by problem based assessment as opposed
to assessment methods used in traditional schools. Analysis of students
performance showed a significant improvement when medical students
taught by problem based approach were assessed by problem based questions.
Different groups of an average of 50 forth year medical students were presented
with a three hour written examination paper for the three consecutive
years at the department of Forensic Medicine and Toxicology.
Each examination paper consisted of 100 multiple choice questions (MCQs),
two short answer questions and one long essay. Some of the examination
questions including MCQs were conventional and similar to those normally
set in medical schools which use lecture methods for teaching to serve
as control. The rest were based on written problems or hypothetical
cases presented with the examination papers. This finding encourages schools
using problem based system to use more and more problem based questions
for the assessment of students whose future professional practice depends
on skills.
A22
USMLE SCORES FROM STUDENTS INA PROBLEM BASED CURRICULUM AT INDIANA UNIVERSITY SCHOOL OF MEDICINE, NORTHWEST CENTER FOR MEDICAL EDUCATION
William Baldwin, Patrick Bankston, W. Marshall Anderson, and P. G. Iatridis. Indiana University School of Medicine. Northwest Center for Medical Education, 3400 Broadway, Gary 46408
In 1989, the Northwest Center began a Problem Based Learning (PBL) curriculum
loosely based on the Harvard New Pathway Curriculum. The Northwest
Center system (also called the Alternate Pathway) had as its major emphasis
6 hours of weekly case studies that were organized to lead the student
through the discipline in question. No more than 2 hours per day
were scheduled for lectures and in some courses (steps) no lectures were
scheduled. When USMLE Part one scores are compared to the USMLE scores
predicted by linear regression using grade point average (GPA) and MCATs,
the results were better than predicted. Over the period between 1991
(91 being the first class using PBL) and 1998 (the most recent exam) the
mean residual from multiple regression totaled +60. You would expect
a 0 from this regression if the students scored as expected and a negative
if the students scored below their predicted level. The large positive
residual argues that the PBL curriculum as used at the Northwest Center
allows the students to achieve better results on Part One of USMLE than
predicted using GPA and MCAT when compared to the national mean.
We feel these results are important because many schools experience decreases
in USMLE scores when implementing a PBL curriculum. Details of the
curriculum will be presented at the poster session.
A23
USING COMPUTER AND MULTIMEDIA TECHNOLOGY TO DEMONSTRATE PHYSIOLOGICAL
PRINCIPLES IN THE LECTURE HALL.
Harold D. Schultz, Ph. D. and Kurtis G. Cornish, Ph. D., Department
of Physiology & Biophysics, University of Nebraska College of Medicine,
Omaha, NE, 68198.
The most effective method by which physiology is learned is through
active participation in laboratory experimentation and analysis. However,
physiology laboratory experiences have been severely restricted or eliminated
in the curriculum of many medical schools. The lack of facilities, funds,
equipment, and manpower have contributed to their demise. In the past four
years, we have provided laboratory exercises in cardiovascular and pulmonary
physiology to first-year medical students in the form of multimedia demonstrations
in the lecture hall. For the cardiovascular demonstration, the baroreflex,
cardiac cycle, coronary reactive hyperemia, adrenergic drugs, cardiac arrhythmias,
and the Bezold-Jarisch reflex are illustrated using digitized data and
video clips collected from a prior research experiment on a dog. The students
observe left ventricular pressure, aortic pressure, left atrial pressure,
left circumflex coronary flow, cardiac output, ECG, and heart rate in simulated
real time by playing back the digitized data on a computer whose monitor
output is projected onto a large screen in the lecture hall. For the pulmonary
demonstration, lung volumes, a forced vital capacity maneuver, and the
ventilatory and cardiovascular effects of stationary-cycle exercise are
demonstrated using the same multimedia facilities with data collected in
real time from student volunteers and a patient volunteer with COPD. A
physiology instructor, using a discussion format in which students are
asked to interpret the laboratory data, leads the demonstrations. The demonstrations
can be conducted in either large or small groups. Student evaluations
of these demonstrations will be discussed along with the advantages/disadvantages
of this format vs. traditional small group laboratory exercises.
A24
CORRELATION OF FACILITATOR ASSIGNED GRADES AND WRITTEN EXAM GRADES IN PROBLEM-BASED LEARNING
Carol F. Whitfield, Ph.D, and Sharon X. Xie, Ph.D. Pennsylvania State University College of Medicine
Assessment of student learning or performance by facilitators
in problem-based learning sessions is important in the hybrid curriculum.
Facilitators assessments are deemed "too subjective" by many faculty.
We investigated the degree of correlation between assessment of student
knowledge base by facilitators in problem-based learning, and the scores
achieved by the students on written exams assessing the same material.
Facilitator-assigned grades and written exam grades were collected
from 156 students and 61 facilitators, over the second year (four blocks)
of the problem-based learning track at the Penn State University College
of Medicine. Facilitators assessed students' acquisition and comprehension
of knowledge in depth and breadth, and their ability to apply knowledge
and integrate concepts. Written exams were 75% comprehensive essay
and 25% objective. Data were analyzed by the Spearman correlation
test and by a mixed-effects linear model after adjusting for covariates
such as year, gender, facilitator specialty, and block.
We found that the facilitator's score is strongly and positively
associated with the student's exam grade (p = .0001). A 20 unit increase
in a facilitator's score is associated with a 4.4 unit increase in a student's
exam grade. On average, facilitator's grades are 8.65 units higher
than the exam grades. The facilitator's area of specialty (clinical
vs. basic science) is not significantly associated with exam grades (p
> .05).
Results show that facilitators of problem-based learning groups
are able to assess student's knowledge base in a relative manner, but their
scores are higher than the actual exam scores. Higher scores assigned
by facilitators may be related to the "halo" effect described for the small
group process.
A25
USE OF A COMPUTERIZED SIMULATED PATIENT TO ASSESS STUDENT PROGRESS IN A PROBLEM-BASED LEARING CURRICULUM
Carol F. Whitfield, Ph.D., Robert Zelis, M.D., Fred Stuppy, CCP,
and William Schwartz, M.D.
The Pennsylvania State University College of Medicine, and The University
of Pennsylvania School of Medicine
With increasing use of problem-based learning in the preclinical medical curriculum, it would be useful to have a way of giving students formative and summative information about their budding clinical reasoning skills. Although the emphasis of problem-based learning is to focus the students' learning on the basic science issues that form the basis for medical practice, it is desirable and inevitable that they are exposed to, and encouraged to practice clinical reasoning processes. The collective reasoning that occurs in small group sessions may not be representative of an individual student's thought processes. We now have an integrated curriculum, with a large component of problem-based learning for all students. We wanted to determine the feasibility of providing a computer-assisted simulated patient case exam for all students in the MII year (106 students).
A clinical case was prepared, using CAMPS, a case-authoring and exam software program designed by William Schwartz, M.D. and Ammar Anbari, University of Pennsylvania School of Medicine, Philadelphia. Our aim was to view the student results as scored by the computer program, and to analyze student choices as they processed the case. This method has strength in identifying the problem student, by looking for students with high variance from the majority of the group. The CAMPS program produces a score which compares the student with a faculty panel. It also produces subscores for history, physical, laboratory tests, costs and other minor scores. It identifies which items selected, and not selected were deemed important by the faculty. These scores and list of important items serve as a stimulation for students' further study.
A survey of student attitude toward this exam, and the use of
computer-presented clinical cases was highly positive. The number
of evaluation forms returned was 103. On a scale of 1 to 5, with
1 being strongly agree, the score for whether students like the case
on computer was 1.7?1.2; that it required their clinical reasoning
skills, 1.7?1.2; that the computer-presented case was consistent
with their PBL experience, 2.0?1.3;and that the computer patient problem
is a good way to learn, 2.1?1.4. Student comments strongly supported
use of computer-presented cases as a learning tool throughout the
curriculum. Analysis of student scores for the case, and choices
made during the case is proceeding. On the basis of student response,
the curriculum committee for the College of Medicine recommended that at
least one case be developed for formative use in each course.
A 26
OBSTACLES AND OPPORTUNITIES FOR WEB-BASED TEACHING OF PATHOPHYSIOLOGY
Thomas Fekete, MD, Temple University School of Medicine, Philadelphia PA 19140
In 1997, the syllabus for a 17 week, 150 hour course in pathophysiology
was modified and published on the World Wide Web (http://blue.vm.temple.edu/~pathphys/).
Nine handouts of roughly 100 pages each were distributed free to each student
and their content was restructured into a loose outline format and placed
on-line in rough synchrony with the lectures. In the subsequent two years,
the Web syllabus was updated and refined. The university was generous with
storage space for the content of the course and offered unlimited public
access for all potential users. By the third year, the total space needed
for the Web was roughly 15 megabytes for text and illustrations. There
was little support for development of the resource and the first year’s
product showed some inconsistency that was largely remedied by the second
year. Student acceptance of the Web version of the syllabus was initially
slow but was enhanced by the availability of previous years’ exams and
timely posting of exam answers. Students also took the opportunity to E-mail
the course director with questions and problems. Faculty support of the
Web resource was guarded and consisted of occasionally providing lecture
notes on floppy diskette in standard word processing formats. Most of the
syllabus was retyped directly into an HTML editor for consistency of formatting.
In turn, some sections of the course changed their handout to reflect the
actual document that was published on the Web. The foremost limitation
of the Web based teaching instrument was an uncertainty about the need
for this resource. Students and faculty were uncertain whether the potential
advantages of Web publication would be worth the inconvenience. Other limitations
included concerns about copyright protection, lack of computer availability
and expertise, clumsiness of printing for use in note-taking and a fear
of loss of control of material. Without additional value (e.g., hyperlinks,
better graphics, search technologies), Web based publishing offers little
more than photocopied handouts. Advantages of Web based syllabi include
links to outside sites, full color illustrations, more frequent updates,
faster turn-around time, access from any computer, lab normal values, and
old exams. All students have free E-mail accounts and access to the Internet
via the library, but students are not required to buy computers or show
proficiency with their use. The students are ahead of the faculty in computer
sophistication and enthusiasm, and they have used the Web site more each
year since its inception. A proposal to replace published handouts with
Web based content has not been well received by students who like the convenience
of booklets in which they can take notes before and after the lectures.
But duplication of service in providing paper and digital versions of the
material is a continuing drain on resources. Occasional surveys of usage
show a large number of hits coming from sources outside the university
(even outside the country) as various Web search engines have found the
site and direct outside users to it. Undoubtedly Web based resources will
become standard teaching tools for medical education, but inertia, unfamiliarity
and a tradition of printed handouts may slow acceptance of digital resources.
A27
SIX YEAR EXPERIENCE WITH AN INTEGRATED AND INTERDISCIPLINARY FIRST YEAR BASIC SCIENCES CURRICULUM
Herbert Chase, Jr., M.D. Columbia University, NYC, NY.
We created an interdisciplinary core basic sciences curriculum
by merging the former courses of Biochemistry, Cell Biology of Tissues
and Organs, Genetics, and Physiology into a single, 325 hour course consisting
of 200 hours of lecture, 75 of histology lab and 25 of conference taught
by over 80 faculty members from seven departments. The material proceeds
from “Cells” to “Tissues” to “Systems.” “Cells” covers basic structure,
membranes and membrane transport, genes to proteins, energy, cell life-cycle,
and signaling. “Tissues” cover epithelia, connective tissue, cartilage,
bone, nerve, and muscle. “Systems” cover cardiovascular, metabolism, endocrine,
blood, genetics, reproduction, gastrointestinal, renal, respiratory, and
autonomic control.
As a result of integration over 100 hours of class time (30%)
have been eliminated. There were several factors that enabled the reduction.
First, redundancy was eliminated. For example, in each of the prior departmental
courses there was a lecture on G protein signaling. Now there is only one.
Second, the “Cell” block presents major themes that occur repeatedly in
many of the “Systems” sections of the course. For example, a single lecture
“Basic Principles of Epithelial Transport,” given early in the year, has
eliminated the need to cover these principles in detail in each of the
GI, Renal, and Respiratory sections. In the prior departmental courses,
principles of epithelial transport were covered in detail, often repeatedly
in each of those particular Physiology sections. Third, the course is designed
to provide a functional approach, rather than a disciplinary one. In doing
so, material is eliminated if it does not fit into a discussion of function.
In the prior Cell Biology course, for example, there was a lecture on “Mitochondria”
which included a detailed discussion of transport of proteins into the
matrix. In the new course, a functional approach to “ATP synthesis” was
created, in which a discussion of mitochondria subserved the main topic.
A detailed discussion on mitochondrial import proteins was no longer deemed
relevant, and eliminated.
There are, as yet, no objective measures to test if the course
is “more successful” than the former departmental courses. Nevertheless,
it is clearly more efficient; with 30% less time, the students appear to
be learning the material as well as in the past, as reflected by their
board scores, which are unchanged. Subjectively and anecdotally, however,
students and faculty enjoy the course far more than in the past.
A28
CONTINUUM: INTEGRATION OF BASIC SCIENCES INTO CLINICAL CLERKSHIPS
Ronald Portanova, Ph.D., Malcolm Modrzakowski, Ph.D., Dennis Baker, Ph.D., Michael Adelman, D.O., Barbara Ross-Lee, D.O. Ohio University College of Osteopathic Medicine, Athens, OH. 45701
The basic sciences are being integrated into clinical clerkships as
part of the development of a continuum of medical education at Ohio University
College of Osteopathic Medicine. The goal is to achieve a seamless
continuum that eliminates the traditional boundaries of discipline and
stage of training. The clinical training of our students has traditionally
occurred at affiliated community hospitals throughout Ohio. We have
developed a strategy to integrate a structured biomedical science course
as an integral component of the clinical clerkships for 21 students participating
in a problem-based curricular track called the Primary Care Continuum (PCC).
The biomedical sciences course is delivered to PCC students at the affiliated
hospitals via videoconferencing. Basic science topics are selected by faculty
and organized into modules for presentation. A typical module consists
of clinical case presentations, journal club discussions of selected papers,
and videoconferenced Socratic sessions among all regional sites.
At the completion of each module, student assessment occurs in the format
of a Grand Rounds Panel Session (GRPS) involving students, clinical faculty,
and a multidisciplinary panel of basic scientists with expertise in the
module topic. During the GRPS, a clinical moderator presents a case
that is “new to the students” but thematically related to the cases and
journal articles presented during the module. Panelists engage the
students in discussions on pertinent case-related pre-clinical and clinical
topics and evaluate the students' participation. The written evaluations
on each module are discussed with the students and ultimately used to determine
the student’s overall, final grade in the course.
A29
INTRODUCING STUDENTS TO PATIENT’S USE OF COMPUTER TECHNOLOGY: A LISTSERV PROJECT IN THE NEUROSCIENCES
R. Kriebel. Dept. of BioMedical Sciences, Philadelphia College of Osteopathic Medicine; Philadelphia, PA 19131.
Patients are becoming more knowledgeable, and in many cases
seek to understand what is happening to them or a person close to them.
It is likely that future physicians will encounter increasing numbers of
patients who are technologically astute. In Clinical & Basic Neurosciences,
an integrated block of all neuroscience related courses in our curriculum,
each student was asked to imagine - you have a patient and their significant
other(s) asking you, their physician, if there are any places that could
provide them with more information, support, or help dealing with their
particular problem. The assignment was to identify a listserv/mailing list/discussion-support
group dealing with one of the following neurological disorders: spinal
cord paralysis, autism, chronic pain, sleep disorder, Alzheimerís
disease, cerebral palsy. Students were given directions to identify the
list and its address; to “subscribe” for not less than 2 weeks; to review
daily; to participate silently; to “unsubscribe” at appropriate time. A
summary of their experience was submitted by e-mail or hard copy with the
following information: 1. the list/listserv address; 2. indicate how you
found the list: (search protocol; word of mouth; anonymous tip; etc); 3.
write a paragraph of no less and no more than 250-300 words indicating
your opinion on this particular list and its potential effectiveness in
meeting the needs of your patient in terms of a knowledge base on this
condition as well as information to help the patient live with or through
this particular neurological problem, include how the list is helpful in
understanding the basic and clinical neuroscience and the psychosocial
issues related to the disorder, identify the most common issues discussed
during the time you were on the “list”; 4. on a scale of 1-10 rate the
authoritativeness of the site (10 being the highest reliability), state
your rationale in selecting this rating (less than 100 words). Examples
will be displayed. Results from an outcomes assessment questionnaire will
be discussed.
A30
STUDENT REPONSES TO THE GROSS ANATOMY LABORATORY IN A MEDICAL CURRICULUM.
*Charles E. Dinsmore, Ph.D., Steven Daugherty, Ph.D., and Howard J. Zeitz, M.D., *Rush Medical College, Chicago, IL
Several significant elements converge in learning gross anatomy over
and above the time commitment to the acquisition of content knowledge.
One is that dissection of the human cadaver may engender dilemmas or emotional
and/or psychological problems for some students. Working with cadavers,
whether through active dissection or examination of prosected specimens,
constitutes a potential stressor although there is no consensus on
its impact. Discussion of the psychosocial impact of human dissection on
medical students appears regularly in contemporary medical education literature.
Studies of medical students at several different colleges of medicine,
from Australia to the United Kingdom, Brazil to Canada, indicate that some
students suffer strong negative reactions to the dissection or necropsy
experience, or perhaps even to the idea of human dissection. Beginning
in the 1993-94 academic year and for four consecutive years we administered
a survey to the freshman medical students prior to (or for one class, at
the beginning of) their taking the Anatomical Sciences course in the Alternative
Curriculum at Rush Medical College. We asked students to identify their
feelings or emotional responses in anticipation of the gross anatomy lab
(e.g., fear/anxiety, neutral/not concerned, eager to begin/excited). We
distributed a follow-up questionnaire shortly after the students had completed
the Anatomical Sciences course. It asked the students to reflect on their
experience of the gross anatomy lab during the preceding quarter, using
a 5-point scale with 5 being the negative end, and to describe their feelings/emotions
in their own words. Our data suggest that while most students accommodate
without difficulty, there was a small percentage of students in our problem-based
learning (PBL) curriculum for whom human dissection initially may be a
traumatic experience.
A31
THE NATIONAL MEDICAL PHYSIOLOGY CORE CURRICULUM OBJECTIVES PROJECT
Robert G. Carroll*, L. Gabriel Navar# and Mordecai P. Blaustein^. *East Carolina University School of Medicine, Greenville, NC 27858, #Tulane University School of Medicine, New Orleans, LA 70112, ^University of Maryland School of Medicine, Baltimore, MD 21201.
The American Physiological Society (APS) and the Association of
Chairs of Departments of Physiology (ACDP) are collaborating to develop
a set of learning objectives for Medical Physiology Courses. These
objectives will identify the core material that students who have completed
the physiology portion of their medical school education should have mastered.
The project combines efforts begun separately by both the APS and ACDP.
In December 1998, objective authoring committees were formed for
each area of physiology, headed jointly by APS and ACDP members.
Each committee developed drafts of the core objectives by February, 1999.
In March of 1999, the objectives were edited for consistency and pedagogical
style, and returned to the committees for approval. The complied
objectives were distributed to all departments of physiology in May of
1999 through the ACDP for an open comment period which extends until July
1999. In August 1999, the revised objectives will be returned to
the department chairs for ranking of the objectives as to representing
“core” material. Each objective will have an “average” score, and
a cut-off point will be recommended to the ACDP at the December 1999 meeting.
Objectives ranked higher than the cut-off point will be regrouped, and
will represent the core curriculum for medical students in the USA.
Key components of the project design are 1) the broad base APS member support
both through the APS and through the ACDP, 2) involvement of content
experts in identifying core material, 3) editing for consistent pedagogical
style, and 4) open evaluation of objectives using mail and a www home page,
and 5) evaluating of the relevance of each objective by the chair
or course director at each of the USA schools of medicine.
Progress of this project can be followed at http://www.physiol.med.ecu.edu/objectiv/index.htm
A32
INTEGRATING BASIC SCIENCE INTO THE CLINICAL CURRICULUM: THE BAYLOR COLLEGE OF MEDICINE EXPERIENCE
Garrett R. Lynch, M.D., Department of Medicine, Baylor College of Medicine, 3524 Garrott St., Houston, TX 77006
In 1995, a Mechanisms and Management of Disease Course was added to Baylor Curriculum. This required, 4th year course of 28 weeks duration integrated basic sciences with clinical topics. Basic science material not covered in the pre-clinical curriculum was included in the course. Each class consisted of a 3-hour module based on a clinical entity such as asthma, shock, pain, and trauma. The module format consists of a PBL-modeled small group discussion of a case related to the topic, followed by a lecture integrating the basic and clinical aspects of the topic and related case. The basic science aspects of the disease process and its relation to treatment is stressed in the lecture. Student are evaluated by a pretest, homework assignments, and a mid-term and final examination, which are case-based essay in format.
Students and faculty acceptance of the course has been positive.
Pitfalls in introducing a required 4th year basic science course will be
discussed.
A33
STUDENT KNOWLEDGE OF CURRICULUM, THEME TOPICS (WOMEN’S HEALTH AND PAIN), IMPACT OF THE MECHANISMS AND MANAGEMENT OF DISEASE COURSE
Garrett R. Lynch, M.D., Department of Medicine, Baylor College of Medicine, 3524 Garrott St., Houston, TX 77006
Mechanisms and Management of Disease (MMD) is a required fourth-year medical school course at Baylor developed with the objective to integrate the basic and clinical sciences. The course consists of 28 modules of 3-hours duration, with each module covering a different topic. Students are evaluated with a pretest, a midterm and a final examination. Each of the tests are case-based, open book, and discussion/essay in nature.
In 1998, the Curriculum Committee began an initiative to evaluate several curriculum themes, including womenís health and pain. The MMD course had modules on pain and menopause. The current project was designed to assess medical student knowledge of these curriculum theme topics in students entering the fourth-year and the impact of MMD on their knowledge of these areas.
Students were given a pretest on the first class day of MMD. Two of the four test cases were on menopause and pain. Subsequently, on the midterm examination, the same 2 cases were included as part of 2 more extensive cases.
Each pretest and midterm examination on pain and menopause was graded on the standard Baylor grade scale. A checklist of key points to be included in the case discussion was created. Inclusion of a key point was scored as a correct answer. Each pretest and post-test was graded a second time using the checklist. Correct and incorrect answers for each key point were scored and tabulated.
The total scores of key points on each of the theme topics on the pretest and midterm exam were compared. On the Womenís health pretest, 29% of the key points were correctly identified; 53% of the key points were correctly identified on the midterm examination. On the pain pretest, 39% of the key points were correctly identified; whereas 61% of key points were correctly identified on the post-test. The scores of individual key points were also tabulated and compared. Significant differences in individual key points on each of the tests will be discussed.
Conclusion: MMD resulted in an improvement in students knowledge in
two evaluated curriculum theme areas: pain and women’s health. A
pretest at the beginning of the fourth-year is a reasonable instrument
to assess student’s knowledge of a given area. Subsequent examinations
can be used to determine changes in student knowledge bases, including
possible persistent deficiencies in the curriculum.
A34
SUPPLEMENTAL INSTRUCTION(SI): A LEARNING TOOL FOR AN INTEGRATED MEDICAL CURRICULUM WITH OUTCOMES FOR IMPROVED STUDENT PERFORMANCE
K.E. Borg, L.M. Olson and R.C. Vari. Office of Medical Education, University of North Dakota School of Medicine and Health Sciences, P.O. Box 9037, Grand Forks, North Dakota, 58202-9037.
Successful Supplemental Instruction (SI) programs typically target the traditionally difficult courses which experience the highest rates of attrition for a large number of students. SI therefore, targets problem courses not problem students. SI sessions usually consist of a small group of 8-10 students who gather outside of scheduled class time to meet and discuss material presented in lecture. These sessions are moderated by a student facilitator (SI leader) who has previously excelled in the course. The SI leader is there not as a tutor, but rather as a person who stimulates conversation amongst the group members to uncover where difficulty in the subject matter is encountered.
The University of North Dakota School of Medicine and Health Sciences has recently completed the first year of a new integrated medical curriculum that employs student-based learning techniques. It is best described as a PBL-hybrid model with lectures and laboratories built around patient cases. The program is entitled `Patient-Centered Learning’ (PCL). In this program, the student is actively involved in determining what he or she must learn to develop and understand basic science and clinical concepts. Multidisciplinary faculty serve as facilitators, guiding the learning process, and delivering lectures for the integrated basic science core content. Since this educational environment is devoid of the structure of traditionally distinct disciplines (Physiology, Pharmacology, Biochemistry, Anatomy, Microbiology) targeting difficult content areas is much more problematic when using an SI approach. We have integrated into our new curriculum an SI program which reinforces the techniques used in the PCL curriculum and fosters life-long learning skills, team work, acquisition of knowledge and professionalism.
Sessions are designed to address students needs. Participation
is completely voluntary. Students that have experienced difficulties
with the PCL curriculum in prior blocks are encouraged to participate.
The key to the success of the program, however, has been in the ability
to attract students in the upper third of the class who not only want to
gain a better understanding of the curricular material, but who also have
a genuine concern for the acquisition of knowledge and success of their
classmates. Students that attend SI gain a better understanding of
content, develop transferable learning and study strategies, and generally
improve their performance compared to performance before attending SI.
Students in academic difficulty who might avoid seeking assistance will
participate in SI, since they perceive no remedial aspect and no stigma
attaches to participation. SI is a student academic assistance program
that increases academic performance and retention through its structured
use of collaborative learning strategies.
A35
MED PREP: A PRE-MEDICAL PATIENT-CENTERED LEARNING EXPERIENCE FOR MINORITY STUDENTS
K.E. Borg1, L.M. Olson1, R.C. Vari1, K.G. Ruit1, J.T. McCormack2, W.S. Mann3 and R.W. Schauer3. Office of Medical Education1, Department of Anatomy and Cell Biology2, and Department of Family Medicine3, University of North Dakota School of Medicine and Health Sciences, P.O. Box 9037, Grand Forks, North Dakota, 58202-9037.
Med Prep is a six-week summer preparatory course for Native American students. Participants have either been accepted into medical school, or are on the alternate list. Enrollment in Med Prep has been limited to Native American students since partial funding support originated from the INMED (Indians into Medicine) program here at the University of North Dakota. Up to eight INMED students are accepted into each medical school class. It is strongly recommend that all INMED students participate in the course.
Med Prep is modeled directly from our new patient-centered learning (PCL) curriculum. This integrated curriculum will begin its second year in the Fall of ‘99. This curriculum is centered around the patient. On day one, students beginning the process as they are presented a `paper’ patient. This patient’s case unfolds before them as if the patient were being seen in their office for the first time. The students immediately are thrust into an environment where the patient is first. This exercise takes place in three two-hour PCL sessions each week. These sessions are moderated by a faculty facilitator who stimulates discussion within the group but does not direct the areas of discussion. The case unfolds gradually as they begin to process the chief complaint, history, physical, laboratory data and finally through diagnosis, treatment and prognosis. Students identify for themselves the basic science content areas with which they are unfamiliar, areas they need to strengthen and develop, and the mechanisms for obtaining information that they need to know in order to understand a particular patient’s condition. In essence, the facilitator is present partially to assist the student connect `what-to-learn’ with `how-to-learn’. In addition to the structured PCL time, students also are presented specific didactic lectures on basic science concepts which dovetail with the patient case. Gross anatomy and histology laboratories and Hospice/Home Health visits round out the experience to provide students a thorough understand of what to expect once they enter medical school.
Students who have previously enrolled in Med Prep have been appreciative
of the opportunity and are full of enthusiasm for the program and our new
curriculum. We are encouraged by this positive feedback and
we are confident we are providing the Native American medical students
a better start to the medical school career.
A36
THE BASIC SCIENCE FOUNDATIONS OF CLINICAL MEDICINE (BSF): A COURSE THAT FACILITATES INDEPENDENT LEARNING IN THE BASIC SCIENCES
Burt B. Hamrell, M.D., Ph.D., St. George’s University School of Medicine, Grenada, The West Indies.
The BSF is a pass/fail course in which medical students begin to learn to behave as responsible physicians. The BSF is integrated into an otherwise traditional basic science curriculum. The course consists of training in computerized searching of medical literature, panel presentations of the natural history of a disease and small group discussions. Clinicians and basic scientists make up the panels, which emphasize the application of basic science information to clinical problem solving. Each student must maintain a notebook that logs the student’s experiences and accomplishments in the BSF.
Methods: Shortly after entering medical school each student receives a notebook containing the course description and the first episode of a patient problem, such as diabetes. In the first semester the students attend computer workshops conducted by the library staff on how to search a medical database. Later in the first semester and throughout the following 18 months there are panel discussions of sequential episodes in the natural history of the disease under study. Simultaneously, the students participate in small group discussions of the results of their independent library work. Each small group is led by a clinician. Each notebook is periodically evaluated by the clinical faculty and should contain photocopied articles, notes from panel presentations and other evidence of independent study.
Results and Conclusions: The BSF emphasizes the physician’s responsibility
to self and patient. Each student is introduced to independent study of
a clinical problem. Student collaboration is encouraged, collegial communication
and sharing is fostered, the use of the library and other aspects of medical
informatics is promoted and the students are introduced to independent
clinical learning that reinforces their basic science experiences. The
BSF has been well received by participating faculty, who enjoy the collaboration
and collegiality. The students have responded well to the challenges of
the BSF. The BSF motto has become, “It is not that the white coat fits,
but whether you fit the white coat,” which refers to the first semester
white coat ceremony where students pledge to be lifelong learners. Evaluation
of the first set of notebooks indicates a significant amount of independent
study. It is anticipated that the BSF experience will prepare our students
for more active participation in clinical training later in medical school
and residency.
A37
A NEW APPROACH IN TEACHING BASIC MEDICAL SCIENCES FOR COMPREHENSION OF PATHOS
Murat D. Cekin, M.D. and Birol Cotuk, M.D., University of Marmara, Istanbul, Turkey.
Basic medical sciences form the `base’ from where doctors and paramedics see health and ill-health. But today’s pathophysiology education can’t satisfy students -prophysicians and proparamedics- and the people who will need them, because there are many `why?’s, `how?’s and `really?’s to be explained.
Paradigm shift in science (e.g. non-linear dynamic system theories, psychoneuroimmunology) seems to force educators for a new approach in basic medical sciences education. Emphasis in regard to five principles may be the core of this approach.
1. Emphasis on psychosomatic aspects of pathos.
How can we explain `essential’ hypertension?
Is hypertension a symptom, a sign, a syndrom or a disease?
How shall we understand somatization and neuromimesis?
2. Emphasis on individualism in differences and wholism in individuals.
How can we explain individual differences in allergic reactions?
Why is allergy less seen in epileptics?
How far can we understand these differences in terms of biochemical
differences?
What is the role of cultural differences and life conditions?
3. Emphasis on defensive aspects of symptoms and signs.
How does the `system’ strive to have minimum harm through relations
with pathogens?
What are the symptoms and signs outcome of and what do they define?
When is true to abolish a symptom and sign?
Must we `cure’ anemia in infectious conditions?
4. Emphasis on indeterminity of disease as a closed entity.
Is every disease an independent entity?
How far etiogenesis, pathogenesis and prognosis determine a disease?
Is disease classification -while enhancing the chance for `knowing’
and controlling the conditions-
also decreasing the chance for understanding interrelatedness of different
conditions?
5. Emphasis on health promotion.
Doesn’t patogenetic education feed alienation of both patient and doctor
today?
Can salutogenetic education help us for solving this problem?
A new curricular design in medical education in line with these principles
may be a more adequate base for comprehension of pathos
A38
STUDENT CENTERED TRANSDISCIPLINARY EXPLORATION (SCTE) AS A HOLISTIC EDUCATION METHOD FOR PARAMEDICS
Murat D. Cekin, M.D., Birol Cotuk, M.D., Ruhi S. Tabak, Ph.D., University of Marmara, Istanbul, Turkey
The ultimate aim of modern education strategies in medicine, avoidance of passivity and disciplinary segregation, is conceptualized straightforward as an active search by SCTE (student centered transdisciplinary exploration). The SCTE is way of dialectic inquiry by which paramedics can aquire relevant medical information.
We devoloped SCTE on grounds of the following assumptions:
* The student will be the center of activity shaping cognitive and
structural aspects of the so-called `teaching’ process;
* By only loosely formulating the contents of the curriculum for paramedics,
the `relevant’ medical knowledge is resynthesized rather than transferred;
* The classical disciplines of medicine are replaced by `transdisciplinary
modules’.
According to SCTE methodology the student explores a medical module by formulating `how-questions’. Two teachers, one physiologist and one clinician are helping this inquiry by providing direct information, audio-visual media and literature. Time and structure of one session (not lesson!) is kept open and variable. Also the extent of exploration of one module and session number is mainly regulated by the maintenance of creative interaction between the participants. Structure and content of modules are viable to each new SCTE trial and therefore continuously changing.
One example of SCTE for the module `heart attack’ is presented. Student
attitudes towards SCTE, gathered by a semi-structured interview, and the
effectivity of SCTE on enabling the student for independent learning is
examined. The application of SCTE for medical students is critically
discussed.
A39
A COMPUTERIZED TESTING PROGRAM AND THE ASSESSMENT OF BIOCHEMISTRY INSTRUCTION AND STUDENT LEARNING
John A. Caldwell, Ph.D., & Kenneth B. Taylor, MD, Ph.D., University of Alabama School of Medicine
The University of Alabama School of Medicine (UASOM) continues to expand its efforts for incorporating computers into the medical education program. A faculty curriculum committee has established criteria for selection of instructional software as part their Recommendations for Integrating Medical Informatics into the Undergraduate Medical School Curriculum*. The Biochemistry Tutorials are locally developed programs that exemplify these criteria. They provide students an opportunity to organize Biochemistry content presented in the text and course handouts. They provide faculty an opportunity to assess student understanding and evaluate instructional effectiveness. The assessment and evaluation procedures employ techniques derived from cognitive science.
The tutorials are a series of questions probing the students understanding of presented course content. A commercial computerized software program presents the tutorial to the students. The software is representative of those that allow item banking of assessment items. It allows the developer to incorporate graphics, sound, WWW links, or additional instructional software. The student can also receive performance feedback that is as explicit as the developer desires. The developer can also label each question with a description that captures the conceptual relationships (propositions) presented or addressed. This label will provide an indication of the student's conception of the subject matter, with correct responses leading to a more challenging question or situation and incorrect responses leading the student to information to correct the identified misconception.
As the student progresses through the tutorial, the program constructs
a record that includes basic item statistics, time spent, sequence of items,
and the propositions the student believes are true. This allows an
instructor to give effective comments during student evaluation.
Cumulatively these data allow the instructor to identify areas of instruction
that require modification because they are either too difficult or too
simplistic for the particular group of students. (http://WWW.UAB.EDU/uasomume/miscurec.htm).
A40
REVIEWING AND CORRECTING SOME BASIC PHYSIO-CHEMICAL CONCEPTS OF FRESHMAN MEDICAL STUDENTS
Eugene Hamori, Ph.D., Tulane Medical School, Department of Biochemistry, New Orleans, LA 70112
The ever growing information overload on students makes it increasingly difficult for a first-year lecturer to review and practice with the students physico-chemical concepts that form the foundation of Basic Science curriculum. Many in a typical freshman class have deficiencies in this area either because their undergraduate preparation was superficial or it was too rigorous at the expense of biological/medical applications. Students are accepted to medical schools without much pragmatic understanding of concepts such as Chemical Equilibria, Reaction Rates, Biochemical Catalysis, Steady State, Heat, Entropy, Free-energy changes (?G), Eagerness (“spontaneity”), Reversibility/irreversibility, etc. Unlike chemical formulas, biological names and antomical details, these concepts can not be mastered by memorization. Understandably, in competition for grades, premeds often forgo the time-consuming and arduous problem-solving -requiring work on these subjects and concentrate rather on cramming for more lexical knowledge. This tendency in medical school becomes even more pronounced making the task of a professor trying to remedy the situation almost hopeless.
It is proposed here that a serious effort be undertaken to re-teach
these concepts to all freshman medical students in a pragmatic and medical-application-oriented
manner. It should not be acceptable that some future physicians,
otherwise well versed in areas such as gene-therapy manipulations or complicated
neurosurgery, etc., be left ignorant about some fundamental science concepts,
not because of their lacking intellect, but rather due to teaching
obfuscations and textbook shortcomings. On the poster presented at
this meeting, several examples are elaborated as Teach-it and Don’t -Teach-it
recommendations.
A41
CREATION OF A SYMPTOM-BASED MEDICAL CURRICULUM BY EVOLUTION, NOT REVOLUTION
Steering Committee of the Interdisciplinary Foundations of Medicine
Curriculum, MCP Hahnemann School of Medicine
In 1995, our dean charged the curriculum committee to develop an educational
program that would integrate the basic, behavioral, and clinical sciences
over the 4-year training period for the MD-degree. The appointed
task force concluded that the curriculum for Years 1 & 2 should be
built of thematic blocks with a patient focus achieved through the use
of clini-cal cases. Each case would contain material on ethics, population-based
medicine, prevention, professionalism, the societal/environmental aspects
of illness, and the role of gen-der, age, and ethnicity in disease. The
expectation was that contextual learning would enhance knowledge acquisition
and retention. With this outline established, a steering committee
was formed in 1996 to translate the vision into reality.
It soon became apparent that use of clinical symptoms rather than fully
developed cases as the organizing foci would provide course directors a
greater degree of freedom in arranging and integrating their material.
Twelve common symptoms were chosen and course directors mapped lectures
to each using a system of color-coded cards pinned to module boards, noting
critical dependencies for sequencing course objectives. Faculty serving
as module coordinators organized the cards to maximize interrelationships
among courses while maintaining critical sequences. Module boards
then were displayed publicly and comments requested. Armed with the
boards and comment cards, the steering committee, course directors, module
coordinators, and student volunteers met in a series of retreats to identify
redundancies as well as topics to enrich the modules, and to reach consensus
that material mapped to a module represented a coherent and cohesive body
of knowledge. Meetings for the individual modules commenced in summer
1997.
Choosing a symptom-based focus afforded opportunities to under-score
the clinical relevance of basic and behavioral science concepts to
clinical medicine, and to expose students to the clinical reasoning proc-ess
earlier in their training. To actualize these, a 3-hour clinical framework
focusing on pertinent clinical entities, on medical decision-making and
problem-solving, and on the pa-tient as a person was developed for each
symptom by generalist physicians who participated in module meetings.
Prior to full implementation of this symptom-based curriculum in 1998,
a clinical framework for the abdominal section of Gross Anatomy was piloted
in the fall of 1997, and a shortened version of the Chest Pain Module was
presented that winter. Student reactions to each were
solicited through evaluation forms and focus groups, faculty
reactions through postmodule meetings (thus establishing a mechanism for
ongoing curricular review and evolutionary integration). The
response to these previews of the Interdisciplinary Founda-tions
of Medicine Curriculum was overwhelmingly positive, and
full implementation began August 1998.
A42
THINKING STYLES IN MEDICAL EDUCATION
Robert A. Lavine, Ph.D., The George Washington University School of Medicine and Health Sciences, Washington, DC
Introduction. Thinking styles refer to a person’s characteristic method
of processing information;for example, emphasizing orderliness versus new
ideas, or the big picture versus specific details. These preferred
styles might change over time and according to situational demands. Different
medical education approaches may call on different thinking styles.
Assessment of student thinking styles, their correlation with performance,
and their application to development of ‘metacognition’ in students are
goals of this research. Method. The Thinking Styles Inventory (T.S.I.),
Short Form (Sternberg and Wagner, 1991) is a 65-item self-rating inventory
in which students rate their preferences in a number of activities.
We administered this inventory to second year medical students at the start
of the fall semester. Results. Ratings for 13 subscales were obtained
for each student. For example, 47% of respondents indicated that they preferred
planning and creative functions, 26% preferred executing tasks by following
rules, and 19% preferred analysis and evaluation. 55% preferred solving
problems by working with others and 39% preferred working independently.
Large positive correlations (p<.05, n=129) were found between planning
and future orientation, r=.57, and between planning and working independently,
r=.50. Executing tasks by following rules was correlated with a preference
for details, r=.58. Students were given their own scores and the
opportunity for small-group discussion of self-assessment results.
Discussion. Results suggest that the T.S.I. provides promising measures
of individual thinking styles that can be applied to students’ self-assessment
and the enhancement of medical education methods. Whether student performance
in lecture-based courses is correlated with different thinking styles than
performance in problem-solving courses will be explored by further analyses.
We will also attempt to identify learning strategies beneficial to students
with specific thinking styles.
A43
BASIC SCIENCES PERFORMANCE AS PREDICTORSOF CLINICAL SCIENCE PERFORMANCE
Robert A. Lavine, Ph.D. and Don W. Watkins, Ph.D., The George Washington University School of Medicine, Washington, DC
The standard medical school curriculum assumes that basic science courses
lay the groundwork for education in clinical medicine. This study explores
to what extent the numerical grades in selected basic science courses in
the first year at George Washington University School of Medicine can predict
the numerical grades in an Introduction to Clinical Medicine course (MED)
in the following academic year. Methods: Stepwise multiple regression analysis,
using maximum r-square improvement, was used to examine basic science grades
as predictors of MED performance as a criterion or dependent variable.
Only students in one class for whom all grades were available were retained
in the sample (n=112). Results: All first year courses were significantly
correlated with subsequent performance in the MED course (r = .44 - .70,
p< .0001). Step-wise multiple regression analysis indicated that most
of the variance in MED scores was accounted for by three first year courses:
microbiology, physiology, and microanatomy. Scores within the lowest quartile
of two or more of these courses allowed the correct categorization of 78%
of the students’ subsequent MED course performance as either being inside
or outside of the lowest quartile. In a prospective study of a subsequent
class of students (n = 130), the same criterion correctly categorized 80%
of the students’ MED course performance. Conclusion: The results of this
study suggest that there is a significant correlation between performance
in basic and medical sciences courses, and that the multiple regression
model can simplify the identification of students at risk based upon their
grades in selected first year courses.
A44
MULTIPLE MODALITIES FOR TEACHING CONCEPTS AND EVALUATING STUDENT LEARNING IN A SECOND YEAR NEUROSCIENCE SYSTEM COURSE
Kathryn L. Lovell, Ph.D., Office of Academic Programs, College of Human Medicine, Michigan State University
The Michigan State University College of Human Medicine has an integrated
problem-based learning curriculum in the second year, with systems or domains
(e.g. Infectious Disease, Cardiovascular, Neuromusculoskeletal) each taught
as an intensive block of 2-4 weeks. The Neuroscience domain, which
spans 4 weeks, includes clinical neuroanatomy review and neuropathology,
as well as other selected topics. In addition to the printed case materials
for PBL groups and required reading materials, resources have included
a Neuropathology Self-Instructional Units CD-ROM, which contains didactic
material on neuropathology and clinical neuroanatomy, integrative case
examples, and practice questions in multiple formats. The neurological
examination is taught concurrently in the Clinical Skills course, and computer-based
materials were developed to supplement the clinical skills sessions with
an emphasis on the neuroanatomical basis of neurological exam testing and
localization of lesions. The final exam for the Neuroscience domain included
100 multiple choice questions (MCQs), short essay questions (10 points),
and eight computer-based questions (CBQs) designed primarily to test integration
and problem-solving based on images and movies. The short essay questions
asked students to draw the location of lesions on a diagram or explain
pathophysiology based on a case history. The image-based CBQs challenged
students to integrate pathology images and movies showing patient findings
with clinical case histories in ways not evident with MCQs. The implementation
of these questions and the availability of practice questions appeared
to motivate students to spend more effort on practicing problem-solving
and clinico-pathological correlation. We think that the availability
of several modalities of resource material, the exam performance expectations
indicated by the multiple types of questions, and the correlation between
basic science content and the clinical skills neurological examination
requirements contributed to enhanced student learning.
A45
TEACHING A PHYSIOLOGY COURSE FOR PHYSICIAN ASSISTANT STUDENTS USING THE INTERNET
S.G. Iams and R.H. Ray, Department of Physiology, School of Medicine , East Carolina University, Greenville, NC 27858
The Department of Physiology developed a Human Physiology course for
Physician Assistant (PA) students for offering via the internet to distance
learners. The course is part of the Partnership for Training
(PFT) program developed by the Nursing and PA Programs at Duke University
and East Carolina University. The course was designed to be self-directed
and the students were required to use a textbook. The material placed
on the server included questions that required students to read the text
and use other sites on the web to get the information required to meet
the learning objectives and pass the course. The on-line syllabus provided
in-depth explanations, graphics and in some cases, animations. E-mail
was used for communication between students and between students and faculty.
The course was presented during the same semester as an on-campus team-taught
Human Physiology course for PA students, enabling comparison of student
performance, student satisfaction and faculty time. When possible,
both groups of students were given identical learning objectives and test
questions. No significant differences in student performance or satisfaction
were found. Faculty time for development and presentation was significantly
greater. The major advantage of the web-based course was that it
allowed students already working in health care in underserved areas to
work toward degree completion without relocation and without leaving employment.
The disadvantages include: 1) considerable "re-tooling" on the part
of faculty is required to develop technical expertise necessary to present
their discipline via the web, 2) technical support must be available to
maintain server and assure access by students at whatever time their schedules
permit, 3) time requirements of faculty during both course development
and presentation exceed that required for classroom teaching of similar
numbers of students, 4) maintaining an appropriate testing environment
is difficult. Teaching physiology via the web can be effective but development
is costly and technical support is critical for success. The PFT
Program was partially funded by a grant from the Robert Wood Johnson Foundation.
A46
COPYRIGHT ISSUES IN DISTANCE EDUCATION: FAIR USE INTERPRETATION FOR TIMELY DEVELOPMENT OF WEB-BASED TEACHING OF BASIC SCIENCES.
R.H. Ray and S.G. Iams, Department of Physiology, School of Medicine, East Carolina University, Greenville, NC 27858
Medical school faculty are increasingly being called upon to develop
and implement web-based courses in the basic sciences. Members of
the Department of Physiology were asked, as part of the Duke-ECU Partnership
in Training Program, to create and deliver 2 courses: Human Physiology
(5 sem. hr.) and Pathophysiology (3 sem. hr.) for physician assistant and
nurse practitioner students, respectively. The agreement allowed
5 months for course development. Concepts in physiology and pathophysiology
are usually taught in the classroom using slides, images and increasingly,
multimedia; web-based teaching requires such presentations. Development
of these materials for the web requires significant expertise, time and
resources. The Copyright Act of 1976, and fair use interpretation
of same affords teachers in face-to-face classroom teaching the ability
to present copyrighted work in slide presentations, etc. Universities
have variously interpreted copyright law as it applies to distance learning
situations, some banning presentation of any material potentially subject
to copyright protection, some allowing faculty to digitize all materials
used in their classrooms. Statutory regulations have not yet addressed
many of the issues created by the use of technology for education.
To meet the time constraints of the program and to avoid copyright infringement,
we provided many of the illustrations and animations needed for our initial
course year by linking directly to graphs, photos and animations currently
available on the web. This process was well-received by the students
and provided them with a rich learning environment while the courses remained
under development. Advantages include: 1) diverse materials
are available and are often professionally created and presented, 2) students
with time and interest can spend additional time at the linked sites, 3)
course development time is reduced, 4) costs associated with course development
are reduced. Disadvantages include: 1) linked sites must be
thoroughly reviewed by faculty for content, etc., 2) links change frequently
and must be monitored for the duration of the course, 3) students must
have access to computers with advanced technology and browser capabilities,
4) some linked images may have been posted without regard to copyright
protection. The Program is partially funded by a grant from the Robert
Wood Johnson Foundation.
A47
THE ULTIMATE INTEGRATION OF BASIC AND CLINICAL SCIENCE: THE CRITICAL CARE MODULE OF THE INTERDISCIPLINARY FOUNDATIONS OF MEDICINE CURRICULUM
Lewis J. Kaplan, MD, Heatherlee Bailey, MD*, Robert Alteveer, PhD**, Barry Mann, MD, Medical College of PA – Hahnemann University, Departments of Surgery, Emergency Medicine*, and Physiology**, 3300 Henry Avenue, Philadelphia, Pennsylvania 19129
Introduction: In an effort to bridge the gap between the preclinical
and clinical years, our modular curriculum designed a Critical Care Module
(CCM) to underscore the dependence of clinical reasoning and decision making
on basic science knowledge.
Materials and Methods: A one-week module was designed to cover the
majority of topics that are introduced during the first two preclinical
years of medical education. These broad areas would be explored using
a case based format that allowed the clinical information to be linked
to appropriate basic science topics. The following areas were developed:
sepsis, infectious disease, neurology/neurosurgery, endocrine, renal, pulmonary,
immunology, and cardiac. The clinical cases served to highlight how
critical elements of the patient history, physical examination, laboratory
and imaging data allowed the construction of a decision tree. Moreover,
the junctures of each of those decision tree points were evaluated with
regard to the basic science structural elements upon which they depended.
Following the case presentations, basic scientists reviewed the basic science
elements in detail. A summary of the critical elements of decision-making
for each case followed the basic science review to serve as a paradigm
for subsequent patient evaluation during the clinical years. Students
will be anonymously surveyed at the beginning and completion of the CCM,
as well as after the first part of the USMLE to determine the utility of
the CCM as part of a review strategy. Students will be resurveyed
after two months of clinical rotations to evaluate the utility of the CCM
as a preparatory course for entry into clinical rotations.
Conclusions: The concept of an integrative CCM was well accepted by
both the students and faculty (clinical and basic science). The development
of a bridging module strengthens the ties between the basic science
and clinical faculty. Furthermore, the CCM is a useful paradigm for
linking basic science elements with clinical practice through the illustration
of clinical reasoning.
A48
NEW WAYS OF MEDICAL EDUCATION IN THE UKRAINE
A.P. Volchenko, V.A. Volchenko, I.G. Mnuskina, Crimean Medical State University Simferopol, Ukraine
Medical education is part of a long term reform of the health care system.
The main aim of the state programme for development of this education in
the Ukraine is the creation of an effective world class system. To
realize this purpose we have to solve two groups of problems. In
the first (internal) group we include the tasks, which can be solved by
the state authorities and the schools of medicine: to improve the qualification
of our students and doctors to get the international level; to use the
modern teaching and medical technologies; to unify the programmes and evaluation
of competence. The second group of problems (external) consist of
the recognition of our diplomas, free migration of medical specialist to
work in different countries, student, graduate and teacher exchange and
participation in the international projects of medical education.
A49
THE HARVEY PROJECT: COLLABORATION + OPENNESS + STANDARDS = DEVELOPING AN INTERACTIVE ONLINE PHYSIOLOGY COURSE
Dennis P.Valenzeno, Dept. of Molecular & Integrative Physiology, Univ. of Kansas Medical Center, Kansas City, KS, Robert S. Stephenson, Dept. of Biol. Sciences, Wayne State University, Detroit, MI
Interactive digital materials such as animations, simulations, 3-D models, video clips and online problem solving can be significantly more effective in teaching basic science concepts and how to apply them than conventional lecture slides. The problem has been how to find the time, expertise and money required to develop such materials.
This presentation describes a novel project to build such materials for a complete, Web-based, introductory human physiology course. The Harvey Project is a collaboration of educators, students, physiologists, medical professionals, illustrators, Java and JavaScript programmers, instructional designers and web designers working together. The materials produced by the Harvey Project will be open and freely available to any educational institution. By basing such materials on widely accepted standards, they will be consistent, cross-platform, interoperable and as widely useful as possible. Because they are customizable, the Harvey Project lessons will be suitable for a wide range of students, and can be used as part of a lecture or for self-study.
We will describe this novel, Open Course model of curricular development,
discuss what fuels such a project, and provide examples of the sort
of teaching materials and standards being developed. The Open Course model
is applicable to other basic science disciplines, and may impact the teaching
of fields far from physiology. The Harvey Project website at http://HarveyProject.org
includes an interactive database of hundreds of physiology sites around
the Web, as well materials developed by the project.
A50
DISTANCE LEARNING IN MEDICAL EDUCATION: DEVELOPMENT OF A PATHOLOGY EDUCATION INSTRUCTIONAL RESOURCE (PEIR)
Peter G. Anderson, DVM, PhD, and Kristopher N. Jones. University
of Alabama at Birmingham, Birmingham, AL 35294
The need for “just-in-time” information access and the desire
to develop ìinformation seeking behaviorî in our medical students
necessitates creative modifications in medical curricula. Distance
learning strategies with information access via local intranets and the
Internet can help to fulfil these goals. The purpose of this presentation
is to demonstrate distance learning strategies and resources that we have
developed for pathology education. Using faculty developed computer
assisted instruction modules with interconnections via an Internet based
discussion board program; we provide students with case-based self-study
that has ready access to faculty, other students, and links to other Internet
resource sites. Second year medical students utilizing this PEIR
program for their Pathology course in 1998-99 enthusiastically embraced
the ìself-studyî option of these programs and they utilized
the discussion board program to facilitate communication with faculty members
and among the students themselves. Additional features include computer-based
testing, image databases, and links to other pathology education sites.
Student performance data, students survey data, and Web site use logs demonstrate
that the students liked the online resources, they utilized them heavily,
and their comprehension of the material was as good or better than traditional
faculty time-intensive pathology laboratory sessions. The PEIR provides
resources for students and faculty that have facilitated development of
and use of innovative distance learning strategies that has enhanced the
learning/teaching environment.
A51
HemoSurf – AN INTERACTIVE ATLAS OF HEMATOLOGY ON THE WEB
Woermann U., MD, Tobler A., MD, Montandon M.
While medical knowledge was and is created
empirically i.e., by induction, the transfer of this knowledge to medical
students occurs in the opposite direction i.e., by deduction. Today’s medical
students are confronted with huge amounts of knowledge normally organized
in hierarchies, which they often don’t understand because they could not
follow the process on how this knowledge was established and ordered.
Feeling very unsatisfied with this situation,
we thought of a way to imitate the original sequence of knowledge generation
and acquisition. It is obvious that medical students cannot go through
the whole process again, but it is feasible to let them experience an abbreviated
version of it. To obtain our goal, we developed for our learning program
a set of four features: 1. Present phenomena first 2. Provide theoretical
knowledge on demand 3. Give exercises with immediate and meaningful feedback
4. Create a “close to real” situation. These four features can be translated
into the process of knowledge generation as 1. Observe, 2. Explain, 3.
Test, and 4. Apply.
Let’s look at the chapter on white blood cells
to see how this concept was implemented. In the first module, students
are exposed to series of 10 to 25 images of each cell type that are shown
in two adjacent frames. The student can browse through these series and
choose which cell is to be displayed in which frame. Thus, he has the possibility
to see the range of variability and can compare the different cell types.
To learn more about these cells, he can open additional windows with information
such as appearance, normal values and function of these cells. Links to
other information units such as diseases or lab techniques allow the learner
to build, based on interest and curiosity, their own knowledge. If
the student believes, he knows how to recognize the different leukocytes
he proceeds to the next module. There are about 150 images of white blood
cells. He now must decide what cell is shown by choosing the name from
a popup menu. He receives immediate feedback telling him if he’s right
or wrong. Again additional information windows can be opened as well as
windows to compare the cell types in case of disagreement. The last module
consists of six blood films on which the student has to perform a complete
differential count. Having identified 100 leukocytes, he can review the
cells he misinterpreted and will be told the right name. He also can try
to establish a diagnosis based on the numbers he produced in the differential
count.
The positive response from our students as
well as enthusiastic emails from online users support our approach to learning
the interpretation of peripheral blood films. A complete German and a partial
English version are accessible under http://www.aum.iawf.unibe.ch/VLZ/BWL/HemoSurf/Index.htm.
The definitive English version will be ready in June 1999.
A52
MEDICAL AND VETERINARY STUDENT STRUCURAL KNOWLEDGE OF PULMONARY PHYSIOLOGY CONCEPTS
William C. McGaghie, Donald R. McCrimmon, Jason A. Thompson, Michael M. Ravitch, Northwestern University Medical School; Gordon Mitchell, School of Veterinary Medicine, University of Wisconsin
Research in a variety of fields including physiology, medicine,
physics, psychology, and biology has tried to capture or represent the
cognitive structure of concepts acquired by learners at different educational
levels. This study addresses a knowledge organization problem involving
12 concepts in pulmonary physiology: chemoreceptors, lung gas exchange,
ventilation, spinal cord, perfusion, intrapleural pressure, respiratory
mechanics, surface tension, resistance, control of breathing, diffusion,
partial pressure. Northwestern University medical students (n = 131)
and Universith of Wisconsin veterinary medical students (n = 73) judges
the similarity of all possible pairs of the concepts before and after completing
a focused instructional unit. Students also completed an examination
of acquired knowledge. The similarity data were analyzed for strucctural
knowledge using individual differences multidimensional scaling (INDSCAL)
and Pathfinder scaling. The INDSCAAL analysis shows that a four dimensional
solution provides the best fit to the similarity data with minimum stress.
Pathfinder analyses yield solutions in two dimensions. Both the INDSCAL
and Pathfinder solutions are interanlly consistent. However, unlike
past research student scores on each index of stuctural knwoledge do not
correlate with scores on the examination of acquired knowledge. We
conclude that in this study structural knowledge and acquired knowledge
are different.
A53
A FLEXIBLE WEB-BASED HUMAN ANATOMY SYLLABUS THAT PROVIDES PREREQUISITES FOR SEVERAL HEALTH-RELATED DISCIPLINES USING A DISTANCE EDUCATION FORMAT
B.R. MacPherson, J.G. Tieman, D.J. Gould & H.H. Traurig. Anatomy & Neurobiology, The University of Kentucky, Lexington, KY , U.S.A.
Pressures of increasing class size, decreasing numbers of faculty trained
to teach functional human anatomical sciences and increasing numbers of
non-traditional students changing careers, have forced basic science educators
to investigate other methods by which these individuals can obtain their
human anatomy prerequisites. We are compiling a series of basic human
anatomy lectures that form the backbone of a typical undergraduate anatomy
syllabus. Each lecture in the series has an accompanying set of lecture
notes available as a downloadable PDF file, short animations where appropriate
and a complementary laboratory session to enhance/reinforce the lecture
material. The student can utilize the Learning Objectives following
each lecture to guide their study. Intermittent, automatic self-evaluation
sessions can be activated within each lecture to keep student attention
focused on relevant material. Structured self-assessment is available
through a quizzing format that allows the student to select the content
of any one or more lectures. All formal examinations in the course
will be offered on-line in a timed environment. More importantly,
this lecture series can be easily modified to stress anatomical regions
or systems of importance to any particular student group. This will
allow expansion of our anatomy curriculum to meet the increasing demands
of new programs and to better focus on the content requirements of
particular student groups. The accessibility of course materials
allows unlimited numbers of students to take these courses at any time,
in any semester, at any location in Kentucky. We predict these courses
will rapidly change the way in which we offer our undergraduate anatomy
courses and allow a diverse student population to complete their human
anatomy prerequisites at their own pace and in a time-frame compatible
with their other commitments.
A54
TEACHING AND KNOWLEDGE ASSESSMENT IN A MOLECULAR CELL BIOLOGY COURSE: A PROBLEM-ORIENTED APPROACH
Szeberenyi, Jozsef; Department of Biology, University Medical School of Pecs, Hungary
The Molecular Cell Biology course is taught as a two-semester
subject to first year medical students at the University Medical School
of Pecs, Hungary. It covers the topics of nucleic acid and protein
synthesis, regulation of gene expression, functional morphology of eukaryotic
cell organelles, regulation of the cell cycle, signal transduction, molecular
mechanisms of carcinogenesis and molecular medicine. Over the years,
a problem-oriented approach has been developed in both the teaching process
and assessment of knowledge. Great emphasis is given to the sophisticated,
rapidly advancing, clinically relevant methodology of the subject.
This solid methodical background established in the first quarter of the
academic year is then used to present the students with an experimental
approach to important discoveries and facts of cell biology. Problem-based
educational tools developed in our department are extensively used in both
the teaching and examination process. This sort of teaching approach
poses a real challenge to instructors and students as well, but the process
of education appears to be more interesting, effective and rewarding for
both parties involved.
A55
CURRICULUM CONCEPTS FOR ALTERNATIVE/COMPLEMENTARY MEDICINE
James Buggy, Ph.D. Department of Pharmacology and Physiology, University of South Carolina School of Medicine, Columbia, SC 29208, USA
Since consumer use and interest in alternative/complementary
medicine is substantial and increasing, many medical schools are incorporating
some information about this topic into the standard curriculum. Our
school has implemented a ‘Section on Alternative / Complementary Medicine’
in the Introduction to Clinical Practice course for second year medical
students. The purpose of this nine-hour section is not simply to
expose medical students to the variety of alternative/complementary medicine
and the demographics of use. Rather, also provided in this
sequence is a conceptual framework to understand distinctions with conventional
biomedicine, criteria to evaluate efficacy and safety, and opportunities
to develop personal attitudes promoting effective, open communication.
Sessions included:1) history of medicine as a profession and the rise of
accreditation and licensing standards presented by the chair of Medicine;
2) impact of alternative medicine in the practice of conventional medicine
presented by a recent graduate; 3) evidence-based medicine for assessment
of conventional and alternative practices presented by a clinical faculty
panel; 4) acupuncture demonstration; philosophy and practice of traditional
Chinese medicine by a Chinese physician, 5) alternative treatments for
chronic diseases such as arthritis by an internist; 6) overview of relaxation
and stress management by a psychologist; 7) experiential session on relaxation,
meditation, and imagery by a psychologist; 8) safety and efficacy considerations
with herbal products presented by a Pharm. D.; and 9) group discussion
of situations in which conventional physicians interact with users or providers
of alternative treatments presented by an experienced physician.
The ‘Section on Alternative / Complementary Medicine’ in the second year
of medical school informs students without prejudice or advocacy as alternative/complementary
practices are neither endorsed nor dismissed; this curricular content serves
as a foundation for more specific practice-based information on alternative/complementary
medicine to be presented in third and fourth year clinical clerkships.
A56
LONG WAVES, INNOVATION CYCLES, AND REFORMS OF MEDICAL CURRICULA: THE SILENT AND EX OFFICIO CURRICULUM COMMITTEE CONTRIBUTIONS OF NIKOLAI KONDRATIEFF, JOSEPH SCHUMPETER, CESARE MARCHETTI, AND CARLOS MALLMANN
James F. Amend, Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Texas A&M University, College Station TX 77843-4466
On the occasion of the American Bicentennial, Stevens (New England Journal of Medicine 295:1252, 1976) noted that “cycles repeat,” in medical education, and used as an example the progression from individually-mentored ‘apprenticeships’ of the 19th century to institutionally-mentored ‘apprenticeships’ of the present. Maulitz (Academic Medicine 71:898, 1996) observed “centennial cycles” of crisis and reform in medical education, describing upheavals in the 1790’s (influence of the French Revolution), the 1890’s (immediate pre-Flexner period), and the 1990’s (turning of the millennium). Most recently, Papa and Harasym (Academic Medicine 74:154, 1999) discussed “five major curricular reform movements” in North American medical education. They defined the apprenticeship model (1765-), the discipline-based model (1871-), the organ-system model (1951), the problem-based-learning model (1971), and the clinical-presentation-based model (1991).
Nikolai Kondratieff is recognized as the originator of the ‘long wave’ concept in economics, wherein he proposed a cycle of prosperity and recession of some 50-60 years in length. Joseph Schumpeter added to this idea the proposal that such economic cycles were in fact derived from chronologies of invention and innovation. Cesare Marchetti has successfully correlated both economic cycles and patterns of invention and innovation with shifts in dominant energy resource. Carlos Mallman has offered evidence that these cyclic phenomena are correlated with particular behaviors within generations, and are therefore determined more sociologically than economically.
Kondratieff cycles or waves show peaks (prosperity) at approximately
1760, 1810, 1860, 1920, and 1970. The Marchetti invention and innovation
cycles begin in ‘valleys’ of the Kondratieff waves, and progress until
applications of the inventions (the innovations) effect the rising phase
of the subsequent Kondratieff wave. If one examines the relationship
between cited (Papa and Harasym) curricular reforms, Kondratieff waves,
and Marchettiís phases of invention and innovation, one finds that
initiation of the apprenticeship model, the discipline-based model, the
Flexner report, and the problem-based learning model all occur at Kondratieff
peaks. The organ-system model originates in a ‘valley’. The
most recent curriculum initiative, the ‘case-presentation’ model (Mandin
et. al., Academic Medicine, 70:186, 1995) began its journey as the Marchetti
invention-innovation phase reached its peak about 1990. Lest anyone
wonder why no curriculum initiative is associated with the 1820 Kondratieff
peak - probably everyone was too busy with new stethoscopes, just then
invented by Rene’ Laennec.
A57
ENRICHMENT OF THE "NERVOUS SYSTEM BLOCK" BY INCLUDING CLINICAL ORIENTATION COURSES AND PROMOTING COLLECTIVE PROBLEM SOLVING BY BIO-PSYCHO-SOCIAL APPROACH: A MODEL FOR EARLY VERTICAL INTEGRATION IN HUMANISTIC MEDICAL CURRICULUM
G.Ö. Peker1*, M. Baka2, A. Çertu3, Y. Erahin4, H. Hancý5, H. Cokunol6, M. Zileli4, Y. Kirazlý7, T. Tacý1, I. Durak8, and . Pöün1. Ege University School of Medicine, Departments of 1Physiology, 2Histology-Embryology, 3Anaesthesiology-Reanimation, 4Neurosurgery, 5Forensic Medicine, 6Psychiatry, and 7Physical Therapy-Rehabilitation, and 8Office of Medical Education, Bornova, 35100 Ýzmir, TURKEY.
Organ system-based, horizontally integrated,
and lecture-centred basic science curriculum has been in practice for the
last 10 years in a classroom environment to a student body of 150-450.
Students, graduates, basic and clinical science faculty have not been satisfied
despite the considerably high scores of the graduates in the central national
placement for residency and graduate training exams. Education is based
on passive rote learning instead of self-directed conceptual and problem
oriented methodology. There has been no real vertical integration. We aimed
to design a moderately innovative and least resistance liable curriculum
at no additional cost, to accommodate large classes and to promote collective
problem solving attitude in classroom environment. Nervous system block
was chosen as pilot and the following were done in order: 1) Macroanalysis
of the current curriculum for betterment of horizontal integration between
basic sciences, 2) training of faculty for promotion of concept mapping
in lectures, 3) inclusion of practicals, video viewing, case studies, demonstration
of diagnostic approaches and clinical interventions at all neuroscience
related clinics, and 4) presentation of a moderately morbid car accident
scenario where the patient and his family was followed in the acute, sub-acute
and chronic phases and also retrospectively in interest of Preventive-Community
Medicine and Psychiatry. Main focus was on conceptual acquisition and reinforcement
of all relevant basic science topics. Evoking awareness in critical reasoning,
communication skills, attitudes, ethics, public health issues, quality
concepts in health education, service and research and an early orientation
to clinical neurosciences was also prospected. Students responded positively
by improved classroom and lab course attendance and scholastic achievement
(40% higher scores than previous years’ on end-block exam and clinical
orientation quizzes) and by providing encouraging feedback on the questionnaires.
Feedback from students and faculty suggested a significant positive impact
of the new curriculum on culture and learning performance and also indicated
requirement for revision for better timing, reduced passive lecture hours
and vigorous encouragement of student participation in problem solving.
A58
A TRAINING MODEL BASED ON INTERACTIVE METHOD IN MEDICAL EDUCATION FOR INSTRUCTORS IN ANKARA UNIVERSITY SCHOOL OF MEDICINE: PRELIMINARY REPORT
Özyurda F, Dökmeci F, Palaoglu Ö, Arda B
A course program on training skills has been organized by Medical Education
and Informatics Department of Medicine Faculty of University of Ankara.
The training course for trainers is based on John Hopkins Program for International
Education in Reproductive Health (JHPIEGO) and a master trainer team
is assigned for each course. Three courses were organized and 50 academic
staff who attended these courses was certified till now. All of the attendants
believe that the course has reached the aims. 97.8% of the attendants think
that the course satisfied their expectations and 95 % of them agree
on that the course is related with their profession. All of the attendants
stated that organization of the course, material and tools used during
the training and interaction between trainees and trainers was either good
or perfect.
Attendants selected the the subjects covered during the training
period which will be most useful during their professional lives as; interactive
training techniques (69.2 %), information based qualification (30.7
% ) and use of audio visual equipment (25.6 ). This qualification
arise with some differences due to the attendant’s background. 82 % of
the attendants believe that enough time was used to cover each subject
during training. When observations of the attendants and feedback from
them taken into consideration, courses are qualified to be satisfactory.
A59
A COMPREHENSIVE FRESHMAN’S GUIDE TO MEDICAL EDUCATION AT EGE UNIVERSITY
SCHOOL OF MEDICINE
Gönül Ö. Peker*, Ýbrahim Durak*, Tulga Kalaycý*, Gürbüz Çelebi*, Berna Yýlmaz*, Seray Özensoy*, Aygegül Uysal*, Hilal Batý*, Tijen Tanyalçýn*, Tijen Özacar*, Canan Saylam*, Fehmi Akçi&cced