The following abstracts have been accepted for presentation at the this meeting in Poster format in the category of  Instructional Methods.  Those selected for Oral Poster Presentations are so designated in the far right column.
 
 

A40	Hold pending completion of meeting registration process
A41	VIDEOCONFERENCE SYSTEM BASED ON SATELLITE COMMUNICATION BY SINGLE CHANNEL PER CARRIER IN AN ARGENTINE SCHOOL OF MEDICINE  Barcelo HA, Feldstein, CA*, Instituto Universitario de Ciencias de la Salud (Fundacion HA Barcelo) School of Medicine, Buenos Aires, 1205  Argentina In a private Argentine School of Medicine founded on 1992, composed of two branches, one in Buenos Aires city and the other in La Rioja province, 740 miles apart from each other, we use a high mean time between failures satellite system to communicate them, operating all the day around. This system was designed in support of daily personal education activities of medical teachers that travel from the Buenos Aires branch to La Rioja branch. In the year 1999 the student population of the medicine career at Buenos Aires and La Rioja branches were 1,398 and 773, respectively, and the number of medical teachers were 308 (102 full-time and 206 part-time) and 128 ( 56 full-time and 72 part-time), respectively. The objectives of our videoconference system based on satellite communication have been to perform interactive medical education in seminars, case-problem discussions, and CD displaying for undergraduates, scientific meetings and special careers like computerizing sciences for postgraduates, and community education programs. The La Rioja bond has a data transmissions capacity of 192 Kbps that ensures against loss of imaging in bi-directional controlled emissions. The system uses equipment for Picture Tel videoconference. In La Rioja a satellite station of 3.8 meters of diameter working in C band. The central place in the Buenos Aires branch is connected to IMPSAT Co Teleport, where a master central station with a high reception sensitivity and great transmission power allows to get in the remote location an alignment of small stations integrated with communications satellite Nahuel II and a compact associated electronic device.
A42	Abstract withdrawn by author
A43	INTEGRATION OF CLINICAL TOPICS IN BASIC MEDICAL BIOCHEMISTRY USING STUDENT PRESENTATIONS Judith Binstock,.Ph.D.*, Department of  Metabolic Sciences, Division of Basic Sciences, New York College of Podiatric Medicine, New York, New York, 10035  U.S.A. The Biochemistry Student Presentations are clinical topics presented by the students that are intended to show the relevancy of biochemistry to clinical medicine.  Each presentation is assigned to a pair of students who work together to present their topic to a small recitation group of approximately 15 students.  The topics relate to a Biochemistry deficiency or disease that correlates to a subject being presented in the Biochemistry Lectures. The presenters are given general guidelines so as to incorporate the following points: 1. Discuss the biochemical basis of the assigned disease or disorder.  2. Search for a case describing this disorder with laboratory results and present it and compare to normal values. 3. Discuss what diagnostic tools are used to confirm a diagnosis in these patients 4. Discuss the treatment plan and long term follow up for these patients. 5. Discuss the latest research and advancements made in this area. 6. Discuss the epidemiology and /or genetic association for this disease. In addition, students must hand in literature searches of relevant material and articles related to their topic.  The incorporation of this type of recitations into the Biochemistry course has had many positive outcomes. First, it allows the students to learn biochemistry from an alternative approach and use it as a tool for solving and understanding a medical problem or disease. Second, it allows new information from the internet and other sources that would not normally be presented in a lecture. Third, it forces the student to organize a presentation using the latest available technologies such as power point, chime etc. Fourth, it integrates not only clinical information but other basic sciences as well. Fifth, this small group setting allows for student interactions and questions that might otherwise not occur. In conclusion, these types of small student presentations provide an additional mode of learning that originates with the student instead of the lecturer and that proves to be an excellent supplement to the traditional lecture format.
A44	AN INEXPENSIVE APPROACH TO WEB-BASED HISTOLOGY TEACHING Angela Y. Bond, B.A., M.S.(R)*, Bernard Pegis, B.A., Vernon W. Fischer, Ph.D., and Gregory S. Smith, Ph.D., Departments of Anatomy & Neurobiology and Surgery, Saint Louis University School of Medicine St. Louis, MO 63104 U.S.A. Introduction and Objectives:  As medical school curricula continue to evolve, it is incumbent that alternative teaching strategies be developed to offset time constraints and to maximize new learning technologies. One type of rapidly developing alternative teaching strategy is web-based computer instruction. The present study was undertaken to examine novel methods to produce web-based histology instruction, and to determine the relative impact of the resultant images by students after completing the Cell Biology module at our institution. Methods:  Pictures corresponding to a wide range of Cell Biology topics were taken using a Nikon Eclipse E400 microscope, utilizing a Nikon Cool Pix 990 digital camera. Once all the pictures were taken, they were viewed, edited, and labeled (Adobe Photoshop; version 3.0) according to specific tissue structure and characteristics. Optional captions were then added explaining the corresponding labels on the images, utilizing proprietary software developed by one of our students. The labeled and captioned images were put online for student access. At the completion of the Cell Biology module, surveys were administered to students to determine their relative level of satisfaction with this form of computer aided supplementary instruction. Results:  The students were asked to evaluate the images based on selection, image quality, labeling, and correlation to class work on a scale from 1 to 5, with 5 being excellent and 1 being poor. After analysis  of the data, it was found that the majority of the students felt the quality, selection, labeling, and explanations of the images were excellent. When the students were asked to evaluate how well the images correlated with their class work, 65% indicated an extremely high degree of correlation. When the students were asked to compare the online atlas to a traditional atlas, 65% of the students found that the online atlas was better than the traditional atlas. The final question the students were asked was to rate how much the images aided them in the class. The overwhelming majority of the students (97%) indicated that the images aided them in their overall performance in the class. Some of the students also made comments about the time it took to download the images. When providing high quality images, the resulting files are often large, which can lead to increased download time. Discussion:  The majority of the students indicated the online histology images helped them in their performance in class. Many students wrote comments stating they really appreciated the online atlas format, which included a self-quizzing element. They found this supplemental teaching approach to be accessible and convenient, particularly for self-study before exams. Although the students were receptive overall, some felt less enthusiastic concerning the length of time it took to download the images. Conclusions:  The present study demonstrates the ability to produce a cost-effective, easily accessible web-based histology atlas. With the ever advancing changes in accessibility, we expect download times to decrease significantly, allowing for easier access to such images. Due to the overwhelmingly positive response from students, we conclude that this form of web-based computer-aided instruction is a good supplemental approach to teaching Cell Biology and Histology.
A45	DEVELOPING AND IMPLEMENTING COMPUTERIZED IMMUNOLOGY CASE STUDIES John A. Caldwell, Ph.D.* and Louis B. Justement, Ph.D., University of Alabama School of Medicine Birmingham, AL 35294-0019  U.S.A. The University of Alabama School of Medicine (UASOM) Medical Education Committee conducts periodic reviews of all required courses and clerkships.  These reviews encourage course and clerkship directors to increase the use, and variety, of instructional techniques that require students to become actively engaged in the learning process.  Computerized case studies offer one strategy to accomplish this. This poster session will describe our resolution of development and implementation issues encountered by selecting the computerized case study strategy.  These issues include, but are not limited to: why and how; setting up a program without a programmer; structuring of the case without giving the “answer”; motivating students to do and value the cases; program evaluation and improvement.
A46	RUBRICS FOR EVALUATING PROBLEM-BASED LEARNING IN THE PRE-CLINICAL YEARS Louise M. Canfield, PhD* (Biochemistry), Susan Ellis, MA, EdS (Division of Academic Resources), Danielle A. DuBois (Curricular Affairs), Christopher M. Cunniff, MD (Medical & Molecular Genetics/Pediatrics), University of Arizona College of Medicine, Tucson, AZ, 85724, U.S.A. Since 1997 Integrated Problem-based Learning (iPBL) at the University of Arizona College of Medicine has been taught concurrently with traditional didactic lectures and integrates three of the first-year basic sciences; Medical Biochemistry, Medical & Molecular Genetics, and Human Physiology.  Grades are pass/fail and based on facilitator evaluation of individual student’s group participation and written summaries of the cases (case reports).  In course evaluations students consistently gave high ratings to introduction of clinical topics and the integration of the basic sciences; however, students were dissatisfied with the variability in facilitators (level of feedback, consistency in small group experience, consistent grading of case reports).  In addition, iPBL faculty expressed frustration in the logistics (student preparedness, attendance, tardiness, etc.) and quality of student participation in small groups. To address these problems, iPBL teaching faculty (LMC, CMC) collaborated with an educational specialist (SE) and an Academic Coordinator (DAD) to develop rubrics for classroom participation and case reports.  Rubrics were modified over the semester in response to student and faculty needs.  In general, the student participation rubric measured small group participation in four categories: 1-Logistics (on time arrival, preparedness, etc.);  2-Compre-hension (integration of ideas, ability to provide rationales for contributions, etc.); 3 -Group learning/ participation (sought clarification for unclear concepts, receptivity to ideas and contributions of others, etc.);  4-Leadership (synthesized or summarized information for group, encouraged participation of others, etc.).  The case report rubric focused on three areas: 1-Comprehension of relevant basic science principles; 2- Hypothesis framing and testing; and 3-Development of diagnostic skills. Students received copies of the participation rubric before the start of each case.  The students were also provided a case report template at the end of each case that included the rubric items on which they were to be graded.  Likewise, faculty received a "Key" to the case report.  This facilitated grading and decreased variability among groups.  Case report  "keys" were returned to the students with their reports so that they could compare the standard answers with their own In summary, grading rubrics provided students with clear guidelines for performance, decreased variability in grading among groups and improved faculty feedback to students.  Faculty reported greatly improved small group environ-ments:  students attended on time, were prepared and enthusiastic, presented well-researched learning issues, and submitted clear and concise case reports.  Overall, their use appears to have greatly enriched the quality of the course.
A47	DEVELOPMENT OF A WORKSHOP TO ENHANCE THE ABILITY OF SCHOOL PERSONNEL TO DISCUSS BRAIN INJURY AND ALCOHOL ABUSE David L. Davies*,  Mildred Savidge, and E. Robert Burns. University of Arkansas for Medical Sciences, Little Rock, AR 72205 U.S.A. The National Institutes of Health funds a program at the University of Arkansas for Medical Sciences that annually provides K-12 school personnel with access to a series of one-day workshops held on the medical center campus and conducted by its faculty. This study evaluated one of these workshops which was based on the observation that although numerous schools disseminate information about the risks associated with traumatic brain injury and alcohol abuse, little is known about the effectiveness of programs designed to train and equip school personnel to discuss either of these issues. To address this need, a workshop was offered in the summer of 1999 that focused on the brain, head injury and alcohol abuse. The specific aims of this workshop were to provide the participants with: 1) current information about the neurobiological consequences of traumatic brain injury and alcohol abuse, and 2) instructional resources to enhance their ability to educate others. An eight-month follow up survey was used to assess whether and how instructional resources were used by a trained group (n=22) of volunteer participants. This group was compared with a control group (n=16) of school personnel that attended workshops concerning other health related topics, but not the head injury and alcohol abuse workshop. The response rate to the eight-month follow up survey was 97%. Comparison of the study and control groups for nine demographic items revealed no statistical differences between the groups. Consequently, the study participants appeared to be representative of the population of school personnel that enroll in the medical center's educational outreach effort.  Seventy percent of the study group was classroom teachers, and the majority of them indicated in the follow up survey that they had discussed the content of the workshop with fellow teachers (81%) and students (100%). However, they were less likely to discuss the information with either an administrator (38%) or school nurse (25%). Since each participant received a package of instructional aids, the 8-month survey also assessed how specific instructional resources distributed at the workshop were utilized. The responses indicated that visual instructional materials such as laminated illustrations (55%) and anatomical specimens (45%) were more likely to be used than written materials. This pilot study demonstrated that a one-day workshop could enhance the discussion of a specific health related issue among school personnel, and between them and their students. Further, it showed that teachers have a strong, and almost exclusive, preference for visual instructional materials. These findings, coupled with qualitative responses from the participants, have been useful for developing additional instructional resources that are cost effective and potentially more likely to meet the needs of school personnel. Supported in part by NIH-NCRR grant # 1R25-RR12346 to E.R.B.
A48	RELATIONSHIP OF LEARNING APPROACH TO PERFORMANCE IN BASIC MEDICAL SCIENCE EXAMINATION IN A DEVELOPING COUNTRY MEDICAL SCHOOL WITH A TRADITIONAL CURRICULUM Asoka S. Dissanayake*, Charmarie Weeraratne, N.Padmalal Gurugama, Department of Physiology, Faculty of Medicine, University of Kelaniya,  Ragama  11010, Sri Lanka Student’s approach to their  learning  has  a  major  impact  on  the  quality  and  quantity  of  their  learning,  acquisition  of  knowledge  and  academic  performance. Students  who  consistently  adopted  a deep approach  were  reported to be more  successful  in  passing  examinations  than  those  who consistently  adopted  a  surface  approach. No information is available on the relationship between learning approach and basic science examination performance in a developing country medical school. The medical school at Ragama follows the traditional subject based curriculum and admits students directly from high school after  13 years of  school education where the educational culture is still one of rote learning. We hypothesized that students using  mainly the surface approach perform better in the final bar examination in basic medical sciences. Method:  A  prospective  study  was  carried  out  on  a  cohort  of  one  hundred  and eighty  two  students   enrolled  in  the  Second  Year  of  an  undergraduate medical  course  at  the  Faculty  of  Medicine,  University  of  Kelaniya.  The  Adelaide  Diagnostic  Learning  Inventory  for  Medical  Students (ADLIMS)  was  administered  to  this  cohort  of  students  during  the  last week  of  the  final  term  of  the  Pre-clinical course.  The  marks obtained  at.  the  final bar examination , which was conducted a few weeks later,  were  then   used  to  rank  the  students  and  divide  the group  into  poor  (bottom 25%),  average (middle  50%)  and  good  (top 25%) performers.  The responses  to  the  Inventory  questions,  the  total  marks  and  the  marks obtained  for  the  individual  subjects – Anatomy, Biochemistry and Physiology, along with  marks for separate sections of the Physiology examination at  the  final bar examination were  entered  into  a  database. Data were analysed using Epi6. Results:  Data were available from 155 students(86% responses). As a whole the class did not show a preference for any particular approach. However, use of the Deep approach correlated significantly with examination scores in Biochemistry (r=0.2.0, p<0.05) and Physiology (r= 0.25, p<0.05) but not with Anatomy. Scores for surface approach correlated negatively with marks in all three subjects. Factorial analysis showed strong correlation between Factor 3 (which is an indicator of deep approach) and scores in all 3 subjects. The score for deep approach also correlated significantly with marks for MCQ, short-essay, OSPE and oral components of Physiology examination. There was also a strong positive correlation between the use of the surface approach and marks in the MCQ component. In those performing poorly, there was a negative correlation between the exam scores and indicators of disorganised study. Conclusion:  The strong correlation between the Deep Approach and examination scores suggest that even in a traditional curriculum, examinations could be constructed to encourage problem-based learning. The results suggest that MCQ component in Physiology should be modified to test problem-based learning more than pure recall.
A49	USE OF PROBLEM ORIENTED LECTURES IN UNDERGRADUATE CLINICAL TEACHING  Muhammad Tufail*, Ziauddin Medical University, Karachi, Pakistan  Objective:  To determine the role of problem oriented lecture as a student-centered, interactive teaching methodology in undergraduate medical education.  Methods:  Third year students of Ziauddin Medical College were given a scenario based on a case of Intestinal Tuberculosis, which was relevant to their course objectives. The scenario was given a week before with the lecture with instructions to come prepared to discuss various aspects in an interactive session.  The study comprised of two parts. First a three point Likert scale opinion questionnaire covering different aspects of the lecture was administered immediately after the lecture. The second part consisted of two surprise tests at an interval of one week and six weeks after the lecture. These tests were to evaluate the ability to recall the content and their ability to apply the concepts discussed in the lecture.  Results:  100% students agreed that the lecture had achieved all the objectives, the scenario was appropriate to their level of understanding and that the problem activated their knowledge of basic health sciences. 92% agreed that case stimulated self- learning. 65% student thought that case based lectures should be given from the beginning of the M.B.B.S program. 77% strongly disagreed with the statement that the objective could have been achieved by a traditional lecture.  In the second part of study two tests were given to test retention of factual knowledge and application of knowledge to solving a problem.  100% students were able to recall 50% or more of facts after one week and 96% could do so after six weeks. 87% of the students were able to recall 75% of facts after one week and 52% after six weeks.  As for application of their knowledge to solving the problem 71% could do so after one week while this improved to 92% after six weeks.
A50	ESSAY QUESTIONS ON CASE-BASED LEARNING PATIENTS: A MECHANISM FOR  ASSESSING STUDENTS' ABILITY TO INTEGRATE BASIC SCIENCE AND CLINICAL CONCEPTS  Kristi J. Ferguson, Ph.D.*, University of Iowa College of Medicine, Iowa City, IA  52242  U.S.A. Foundations of Clinical Practice I is the first semester of a four-semester course. Case-based learning, an integrative learning experience, is a key component of the course.  At the conclusion of each of three cases, students are asked to write an essay about the patient. They are asked to explain what the diagnosis means in terms the patient can understand, to describe what the laboratory results and physical findings signify in relation to the underlying disease process, and to tell the patient what to expect in the future. This approach allows students to apply both basic science principles and counseling skills in a context that is very familiar to them, i.e., a patient case they have spent 3-4 weeks working through in their small groups. Students have responded positively to the experience.
A51	TEACHING EMBRYOLOGY IN A TRADITIONAL SCHOOL OF MEDICINE, RESULTS OF LARGE VERSUS SMALL GROUPS Carlos E. de la Garza-González *, Norberto López Serna, Ma. Esthela Morales Pérez,  Departamento de Embriología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Administración de Correos # 3, apartado postal #712, 64461 Monterrey, N.L. México In our country a great number of students have access to public medical schools every year, that oblige us to create groups with a high number of students, where a very poor professor-student relationship is developed.  In our faculty, embryology as part of the basic sciences is given in the first year, therefore we belong to the group of professors who are the first to be confronted with the situation of the great number of students who fail to pass the course (about 50%).  We have the possibility of analyze the results of two promotions of medicine students.  In order to elucidate how the number of students for group influence the results of the examination, since September 1999 we divide the students in four large (mean 116 and 64 for the first and second promotion respectively) and two small groups (mean 38 and 30), and analyzed the results of the examinations. Using the z test at a level of confidence of 95%, in the groups analyzed, we didn&#8217;t find a significant difference of the results between large and small groups.
A52	MIXING AND MATCHING DIAGNOSTIC MODALITIES IN MEDICAL STUDENT PATHOLOGY LABORATORIES Roger W. Geiss, M.D.* and Steven A. Bigler, M.D. University of Mississippi School of Medicine, Jackson, MS 39216-4505  U.S.A. In recent years, traditional laboratory exercises in the basic sciences have come under increasing criticism by educators as having little or no direct application to clinical practice.  In addition, students have expressed their dislike for such exercises, not only for the aforementioned reason, but also because they consider them to be uninteresting as compared either to direct clinical experience or to computer-based learning.  In response to these factors, we at the University of Mississippi School of Medicine have devised a low-technology, case-based form of pathology laboratory exercise in which the manifestations of several diseases within a single organ system are presented to the students using a number of different diagnostic modalities, including clinical history, radiologic studies, gross examination, and/or microscopic study (light, immunofluorescent, and/or electron microscopic).  The students are also provided with a list of diagnoses, and are given the task of determining the identity of the clinical history, radiogram, gross specimen, and microscopic specimen that corresponds to each of the diagnoses listed.  Following each laboratory session, the cases are reviewed with the students by the faculty, and the students are provided with the correct clinical history and diagnostic studies for each disease listed.  To date, we have successfully utilized this approach in laboratory exercises related to both renal and bone pathology, as illustrated. In this way, the laboratory is used as a platform for active learning and participation.  These exercises emphasize the correlation of clinical, morphologic, and laboratory information in order to aid in bridging the preclinical with the clinical years.  This is done in a format which the students consider to be an enjoyable learning experience.  We are currently exploring the use of this type of exercise in the teaching of the pathology of systems other than those we have described.
A53	TEACHING AND ASSESSMENT OF SURGICAL SKILLS THROUGH SIMULATION IN SURGICAL TRAINING A. Goyal, (Senior Resident) MS*, A. Srivastava, (Professor) MS,FRCS,PhD,MPH, V.M. Seenu,R.  Parshad, MS,DNB, and S. Guleria, MS,DNB,FRCS, All India Institute of Medical Sciences, New Delhi-110029, India Settings:  Department of Surgery, All India Institute of Medical Sciences(AIIMS), New Delhi, India. Background:  Teaching and assessment of technical skills to the medical students is one of the most crucial tasks. The proper teaching in operation theatres is difficult due to pressure on theatre time, ethical issues, medicolegal concerns and complex procedures. Simulation provides an useful alternative. However the introduction of simulation in surgical training has been a slow process in developing countries like India. Still, the operation theatres form the only training grounds and patients the only models in this part of the world. Objective:  Teaching and Assessment of basic surgical skills to the trainees in a simulated environment outside the operating room. Material and Methods:  A one day suturing and knot tying workshop was held, where the students were invited to learn the necessary knowledge and skills for suturing tissues. Four general surgery consultants and 3 senior registrars served as supervisors and examiners. The students were given information on suture materials, needles and various skin suturing techniques. Students followed this by a hands-on practice session on skin simulator (foam piece with codrye cloth on top) under supervision by faculty. The suturing skills of the trainees were assessed before and after the training by OSCE using the checklist. The checklist consisted of 19 task steps to be assessed. A pre-training and post training questionnaire was used to assess their knowledge about sutures and their perceptions about the workshop.  Results:  32 students participated in the suture and knot-tying workshop. 14 were MBBS students studying in the 7th semester, and 18 were junior residents in the general surgery training program of the institute. All trainees believed that such workshops were useful and should be held periodically. Most felt (55.6%) the frequency should be once every six months, 38.9% felt it should once per year, 5% felt it should be less than once per year. 61.1% felt that the workshop should be held during the beginning of junior residency, 16.6% felt it should be held during the MBBS course(3rd year), while 16.6% felt it could be held anytime. 88.9% felt the training improved their practical skill and theoretical knowledge and would improve their confidence to do real life surgery. Significant improvement was revealed in the post training checklist scores (mean 15.3, SD 1.97, median 15, range 12-19) of trainees compared to the pre-training scores(mean 9.9, SD 4.5, median 10, range 1-16) on wilcoxan signed rank test. The improvement was more marked for MBBS students. The improvement seen in the post training questionnaire scores (mean 4.48, SD 2.88, median 5) over the pre-training scores(mean 4.44, SD2.22, median 4) was not marked on the wilcoxan signed rank test. Conclusions:  Teaching basic surgical skills in the workshop setting is both feasible and advantageous using simulation. Basic surgical skills should be taught to all medical students regardless of their career aims.
A54	A STUDY ON OPINION OF MEDICAL COLLEGE TEACHERS ABOUT TEACHING METHODOLOGY TRAINING Dr. Md. Zakir Hossain MBBS, MPH*, Senior Lecturer, Community Medicine Department, Bangladesh Medical College, Dhaka, Bangladesh This study was carried out among 108 mid level medical college teachers who had participated in the Teachers’ Training workshop on teaching methodology conducted by the centre for medical Education. More than 90 percent of the participants had given opinion in favor of the workshop in terms of having a good environment, adequate number of participants, taking pre-test and post-test, use of audio-visual aids and co-operation of the facilitators. A lesser percentage had agreed with adequacy of duration (50%), course content (74%) and supplied hand outs (70.3%). They mentioned that these work shops helped to improve the quality of teaching (63%), helped in self evaluation and self improvement (59.3%), Helped to realize that quality teaching is an art and science to be acquired by earnest practice (46.3%). There was chance to exchange views and ideas among teachers of different medical colleges in the workshop (26%) and it helped the teachers to be in pace with the changes taking place in education (20.4%). Almost all of the participants wanted to attend this workshop again because they wanted to increase their knowledge about education and be up-dated with new in formation (94.3%). For improvement of the activities of this workshop, the participants had recommended that duration of the workshop should be increased; a training manual should be prepared.  Such workshops should also be held in all medical colleges, teachers of private medical colleges should also be included in these workshops as participants and residing accommodations should be made for participants coming to attend the workshop from out side Dhaka city.
A55	A COMPETENCY-BASED INTERNSHIP PROGRAM IN BANGLADESH. Dr. Md. Zakir Hossain MBBS, MPH*, Senior Lecturer, Community Medicine Department, Bangladesh Medical College, Dhaka; Prof. M. Muzaherul Huq, Director and Dr. Md. Anwarul Azim Majumder, Assistant Professor, Centre for Medical education, Dhaka, Bangladesh. Internship or pre-registration training program is an integral and essential part for a medical graduate during which he/she develop a range of general professional skills and attitudes for the practice of medicine. This paper will be concerned with the redesigning of existing internship program in Bangladesh to make it more competency based in order to prepare a practicing doctor with necessary competencies to manage common health problems prevailing in the community. To develop the programme series of meetings with interns, their immediate and senior supervisors were held and three surveys were conducted to obtain the views of interns and their supervisors including professors of the medical colleges. These results were then taken in consideration in the formulation of a competency-based internship programme, which was again validated with the supervisors. The important aspect of the programme are: training arrangements to include ‘core’ subject, community placements, assessment and certification, identification of generic competencies, induction session and log book with task/activities.
A56	USING A DISTANCE EDUCATION METHOD TO TEACH BEHAVIOURAL SCIENCES IN A TRADITIONAL MEDICAL SCHOOL  A.P. Kurukulasuriya*, Zoysa de P., Faculty of Medicine, University of Colombo, Sri Lanka Introduction:  The Faculty of Medicine, University of Colombo Sri Lanka changed it's subject based teacher centered curriculum to an organ system based, more student centered curriculum in 1995. The teachers were thus motivated to explore new learning/teaching strategies. The video on communication skills for doctor patient relationships with an accompanying handbook was made as a completely student centered lesson based on principles of distance education. Objectives: To create a novel student centered lesson involving students and experts in the open and traditional universities. Method:  The objectives, script and handbook for the video were written by the authors. Medical students were selected from volunteers and were trained to act in the different scenarios for two months. After which shooting of the video and editing were done by the staff of the open university. Discussion:  This video has been used to teach a batch of 200 students. We intend to use it for groups of twenty students in a small group format in the future and compare it's effectivity with a lecture.
A57	DESIGN OF AN INTEGRATED EVALUATIVE STRATEGY FOR BASIC SCIENCES COURSES  Roberto López, Alvaro Pérez, and Martha García*,  San Juan Bautista School of Medicine, Caguas, Puerto Rico Basic Biomedical Sciences have shown an explosive growth during the past ten years. The scientific community has a vast quantity of new information each day. However, a great number of new data and publications had fragmentized the knowledge and generated difficulties to understand the physiological and pathological process of life. Today, scientific groups are working in the search of common pathways in the biomedical sciences. New disciplines had emerged, such as neuroimmunogenetics, immunoendocrinology, neuropharmacology, pharmacogenetics, etc., Medical education needs continuous updates according to this scientific transformation. With the aim to find new teaching-learning methodologies for a new generation of medical students, within the context of a traditional medical curriculum, we designed a new strategy integrating three basic sciences courses (Human Genetics, Neurosciences and Immunology). Also, this methodology reinforces the importance of basic research in the formation and future performance of physicians.  The methodology includes a workgroup, developed through an academic semester, in which the students present a research proposal according to the scientific method and including the three disciplines. The instructors, will evaluate progress aims during meetings and interactive communication, and will supervise the process. The work has several progressive steps according to the development of each course objectives, as follows:          1. Theme selection          2. Methods selection          3. Poster Design          4. Final Presentation in a symposium to medical students, professors, and guests.  The benefits of this strategy include critical revision of the literature, learning of basic research methodologies, use of informatics in medicine, scientific presentation methods (oral and written), critical evaluation of medical information trough a peer review process, that includes evaluation of his colleague's posters using a form designed to this activity, knowledge of scientific methodology, approach to complex problems solving, and accomplishment of new curricular strategies. We will illustrate the background, general design and results of this methodology.	ORAL
A58	Hold pending completion of meeting registration process
A59	DISTANCE LEARNING IN MEDICAL EDUCATION – IS A  FACE-TO-FACE COMPONENT ESSENTIAL? Win May, MD, PhD, MHPEd, MMedSc*, Dixie Fisher, PhD, Maurice Hitchcock, EdD. University of Southern California Keck School of Medicine, Los Angeles, California  90033  U.S.A. The Faculty Development Program for health professions educators at the Division of Medical Education, University of Southern California Keck School of Medicine is a well-established program that has been in existence for over thirty years. For most of that time, the Division offered a conventional on-site Master’s program, a supplemental part of the Ph.D./Ed.D programs, and short-term individual training for national and international participants. In 1998, as a result of numerous requests from health professionals outside the local area, the Division implemented a program that was a hybrid of distance and face-to-face learning. To increase flexibility, a number of options were offered: a Master’s degree, a fellowship in Teaching and Learning, a fellowship in Educational Leadership, as well as attendance at individual workshops. Since acquisition of skills is required to become an excellent teacher, face-to face sessions on key topic areas were an integral part of the program. The distance learning portion utilized the web, e-mail, postal services and the telephone as the modes of delivery for both instruction and communication between faculty and students and between the students themselves. The Master’s program is a two year program for participants from the United States, whereas, international students can complete the program in a year, doing it full-time. The latter group participated in additional weekly face-to-face discussions with a faculty member. Focus group discussions were conducted at the end of each year to determine the value of both the face-to-face instruction and the distance learning aspects.	ORAL
A60	UNDERSTANDING FUNDAMENTALS OF EXTREMITY ANATOMY- AN EVALUATION Dr. Narga Nair* and  Mrs. Shreemathi Y. *Associate Professor, Department of Anatomy, & Senior Lecturer, Department of Medical Education, Kasturba Medical College, Manipal, India It is important for a medical student to gain competence in skills like carrying out a venepuncture, an arterial puncture, palpate an enlarged lymph node, a peripheral nerve, or arterial pulsation, recognize the presence of varicose veins, exaggerated tendon reflexes, a foot drop or a shoulder dislocation.  For the above to take place the student needs to have a firm foundation of knowledge in the anatomy of the upper and lower limbs.  It is on this corner stone that the superstructure of clinical medicine may well rest secure.  It is in this context that we proceeded with the present investigation. Aim:  To strengthen the fundamental knowledge of anatomy of the upper and lower limbs, so as to provide a more effective clinician to the world. Objectives: To assess recall of basic factual data with regard to the anatomy of the upper limb. To test understanding of basic clinical principles as applied to the upper limb. To assess recall of basic facts with regard to the anatomy of the lower limb. To test understanding of basic clinical principles as applied to the lower limb. Method:  200 freshman medical students having completed their anatomy modules of the upper and lower limbs, were given a questionnaire of 10 questions (of fill in the blank type), for formative evaluation, which they were able to complete in 5 minutes.  The difficulty index and the discrimination index of each of the ten questions were assessed. The results of the study and their implications thereof will be presented at the conference.
A61	INTRODUCTION OF CLINICAL PROBLEM SOLVING IN AN INTEGRATED NEUROSCIENCES CURRICULUM, THE MOUNT SINAI EXPERIENCE  Daniel P. Perl*,  Merril Schindler, Mount Sinai School of Medicine, New York, NY 10029   U.S.A. Brain and Behavior, an integrated neurosciences course in the second year of medical school, is charged with teaching the basic tenets of neuroanatomy, neurophysiology, neurohistology, neuropathology, and pathophysiologic methansims underlying clinical neurology and psychiatry.  In the past, the course has been taught using a strong combination of didactic lectures and laboratory exercises.  We have now added a series of small group clinical neuroanatomy problem solving sessions in an attempt to supplement the material being taught in the course.  We use these sessions to introduce clinically relevant patient vignettes and develop clinical problem solving skills in the students.  A total of 14 sessions have been written, each typically encompassing 2 illustrative patients.  The theme of each session closely parallels the topics being considered, at that time, in the course.  For each patient, a brief history and summary of the physical findings are provided, often followed by relevant imaging studies (typically in direct parallel with specimens just examined by the students in the laboratory).  When available, a short video of the patient under discussion is also included.  The students are then directed to consider a series of problems, frequently requiring them to investigate aspects that are beyond what has been specifically covered in the course.  Protocols for these exercises are provided to the students by way of a course web site.  Each session culminates with a two hour interaction with a clinician preceptor, in a small group setting.   The sessions emphasize defining each patient in the context of structural/functional relationships, rather than considering clinical diagnostic and therapeutic algorithms.  We urge our preceptors to encourage discussion among the students and guide them in reaching solutions to the problems raised. Acceptance of these sessions, as an addition to the course, has been excellent with many students indicating that they provide an opportunity to see the clinical relevance of the basic science material they are trying to learn.  Small group preceptors relate their feeling that participation in these sessions has promoted a progressive improvement in problem solving skills among the students and an enhanced ability to discuss clinical situations using the facts and principles they have learned.  Students also indicate an increasing interest in considering the clinical neurosciences as a career choice.  Based on this success, we plan to expand the use of this approach to the learning environment of this course.
A62	CASE-BASED LEARNING IN BIOCHEMISTRY Peter Ronner*, Diane Merry, and Annemarie Weber**; Thomas Jefferson University, College of Medicine, and ** University of Pennsylvania, School of Medicine, Philadelphia, PA  U.S.A.  On exams, students can easily recall biochemical facts, but usually have difficulty using these same biochemical facts to solve medically relevant problems. To improve students&#8217; problem solving abilities and aid in long-term retention of medical biochemistry, we designed a series of case-based problem sets (some of these originated at the University of Pennsylvania, others at Thomas Jefferson University). We hand out the problem sets in advance and ask the students to answer as many questions as possible. Only the best students are able to answer all questions, but the questions are designed so that every student is able to answer at least 20-30% of the questions. The problem set is then discussed in class. The faculty welcome all answers, even if incorrect, recognizing the value of discussing why an answer is incorrect. Whenever feasible, students are encouraged to comment on other students&#8217; opinions. At the conclusion of the discussion of a question, it is important for the lecturer to state clearly which answers are considered correct and which ones not. We currently discuss the problem sets in a large class of ~230 students; however, the problem sets are ideally suited for small groups. In creating problem sets, in our experience, it is best to use only one or two cases for a 1-hour discussion. We use published case histories and in-house hospital charts as a basis for our problem sets. Published cases most often involve newly discovered clinical entities and uncommon diseases, while hospital charts are more valuable for up to date histories of common diseases. Students respond better to problems dealing with common diseases than to problems involving rare diseases, even if these rare diseases illustrate important principles of biochemistry. We prefer case histories that contain graphic material, such as a picture of a patient, a pathological specimen, or a radiologic procedure; these are generally more common in the older literature. At the end of a problem set, the students are asked to sum up the case and explain the relevant information. The students are also asked to familiarize themselves with the approximate normal ranges of the most common laboratory tests. To date, at Thomas Jefferson University, we have problem sets on trinucleotide repeat diseases, hypophosphatemia/glycolysis, glucose 6-phosphate dehydrogenase deficiency (with a review of enzyme kinetics), glycogen debranching enzyme deficiency, insulinoma (review of glucose homeostasis), ketotic hypoalaninemic hypoglycemia of children (review of gluconeogenesis), abetalipoproteinemia (review of lipid metabolism), diabetic ketoacidosis, preeclampsia (review of purine metabolism), propionyl-CoA carboxylase deficiency, and glucagonoma (the last two for overall reviews of metabolism).	ORAL
A63	PATIENT-CENTERED PHYSIOLOGY SMALL GROUPS - CLINICAL ASPECTS OF PHYSIOLOGY Nancy R. Stevenson*, David J. Riley and Mark J. Greco.  University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ  08854   U.S.A. To achieve better integration of basic and clinical aspects of medical physiology, we have added videotaped interviews of patients to supplement small group case studies.  The purpose of the videos is to illustrate the symptoms of the disorder in the patient's functioning and other clinical aspects of the disease.  In general, the cases are of commonly seen disorders and/or demonstrate the involvement of more than one organ system.  Some cases are chosen with specific biochemical defects (eg. alpha-1-antitrypsin deficiency and pheochromocytoma) that directly cause physiologic consequences (emphysema, hypertension).  Other cases illustrate the clinical consequence of physiologic processes (right heart failure caused by hypoxia-induced lung disease). The videotapes (15 - 25 minutes) include an interview, illustrating the pertinent physiological findings, radiographic and relevant laboratory test results.  Normal subjects are included for the purpose of comparing physical findings and test results.  A clinician involved with the case, or one familiar with the case moderates the video with the students and answers student questions not directly related to the activities of the subsequent small group discussions.  The videos are available for the students to review until the case is finished. In the small groups, students have a copy of the case and any X-rays or films used for the diagnosis.  At the first meeting, a facilitator and a group of 8 to 10 students discuss the case and the each student chooses a question he/she would like to pursue.  At the second meeting, each student presents a 5 minute oral answer to the question and prepares a 1 page answer to be handed out to the rest of the group.  The two meeting are separated by about one week. This format was designed to address several curricular and pedagogical needs.  1)  How to provide a link between altered physiology and its clinical impact on patients.  2)  How to integrate clinical role models in the first year of the curriculum.  3)  How to insure uniformity of material for small group sessions when the facilitator is a non-clinician.  4)  How to integrate physical findings as part of the evaluation the of clinical problems. We have found video-supplemented small groups case conferences to be an effective teaching method for medical physiology.  These exercises are enriched by showing vivid tapes of patients affected by physiological alterations of organ function.  The student's response to these Patient-Centered Physiology Small Groups is more positive and enthusiastic than to "paper case studies".  Several students speak of these as "real cases".	ORAL
A64	DEVELOPMENT OF TEACHING TOOLS FOR MEDICAL EDUCATION  Katherine H. Taber, Ph.D.*, Robin A. Hurley, M.D., L. Anne Hayman, M.D., Baylor College of Medicine, Houston, TX 77030  U.S.A. The volume of medical knowledge increases massively every year, creating a real problem with information overload for learners at all levels from medical students to practicing physicians. One approach to this problem is to improve didactic teaching and support materials so that information is presented in a more concise and organized manner, facilitating development of a properly structured knowledge base and obviating the need to relearn material when the student enters the clinical setting.  Most teaching and reference materials are still based upon the oldest of the print technologies - block print on a white page with at most occasional use of color to lighten up the often dry prose. Most are presented in a way that would be quite familiar to a physician from 50 or 100 years ago. Advances in printing and computer graphics technology have made it possible to create teaching and reference materials in a very large page format, like a wall chart, relatively easily. This approach allows a great deal of related information to coexist simultaneously in the learner's field of view. Extensive use of graphics promotes a highly condensed presentation of information. By careful application of the principles of information design it is possible to arrange material so as to make the connections among the blocks of information obvious and easily grasped. Thus the design and presentation of the information helps to create the scaffold the learner needs in order to integrate the it into their own knowledge base in an organized manner. An additional advantage of this approach is that it makes it possible to use color to carry a significant portion of the information content. When color is used informatively in teaching and reference materials (rather than decoratively or for emphasis) it can greatly increase the speed of access as well as broaden the relevant information that will be easily found.  For the past seven years our group has been using the principles of information design in creating sets of teaching and reference materials that integrate related information across clinical subspecialties. These charts organize and synthesize anatomy with function in a way that bridges across disciplines in a "user friendly" format that enriches teaching. This approach facilitates the learning process by providing a memorable basis for organizing new information to form an elaborated knowledge base. In addition, all anatomy is presented as it is seen clinically, allowing the charts to be used for rapid clinical reference. Chart set on functional anatomy of the brain and spine, vascular anatomy of the brain and spine, and sectional anatomy of head and neck will be presented.
A65	THE EFFECT OF INCREASED CLINICAL CORRELATION TEACHING ON STUDENTS’ PERFORMANCE IN THE DEPARTMENTAL AND NBME SUBJECT EXAMINATION N.S. Vasan, DVM, PhD*, Department of Anatomy, Cell Biology and Injury Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ  07103  U.S.A. Basic science curriculum in medical schools around the world is increasingly being taught with clinical correlation in order to provide a seamless transition from preclinical-to-clinical years. Furthermore, the standardized tests for basic sciences (USMLE Step I), which in part tests the critical thinking skills of the student, is also clinically  oriented. At New Jersey Medical School the Department of Anatomy took the lead in curriculum enhancement. This was done by decreasing the amount of didactic material, increasing the focus on laboratory teaching by way of small group interactive teaching, and increased clinical correlation both in teaching and in departmental course examinations. The purpose of this performance-based retrospective study is to evaluate the effectiveness of curriculum reform, and to identify additional directions for continuous improvement. Over the last five years the clinical vignettes in the multiple choice questions in the in-house examinations increased from 25% in 1997 to 90% in 2001. The data to be presented involves analysis of the class performance in both departmental and NBME subject examinations. The results indicate that increased incorporation of clinical correlation teaching both in lectures and laboratory, and testing substantially increased student performance in the in-house and NBME subject examinations. The results further indicate that initially some students had difficulty in adjusting to the application of factual material, however constant practice in problem solving helped them to overcome this difficulty. We believe that the anatomy program encourages and helps the students develop problem solving skills, and promote life long learning. Data from a study in progress also suggests that even in student-centered learning, knowledge gained in isolation does not allow long-term retention, unless it stimulates critical thinking linked by clinical correlation to the learning process.	ORAL
A66	ASSOCIATION OF REMEDIAL TUTORIAL TO STUDENTS AT RISK OF FAILING ANATOMY AND THEIR IMPROVED PERFORMANCE  N.S. Vasan, DVM, PhD*, Department of Anatomy, Cell Biology and Injury Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ  07103  U.S.A. The Association of American Medical Colleges (AAMC) in 1984 recommended curriculum changes at all traditional medical schools toward student-centered, problem-based learning with an integration of basic and clinical sciences. This is done by reducing didactic material, and increasing the emphasis on teaching concepts and principles, and helping students develop problem solving skills. The gross and developmental anatomy course at New Jersey Medical School is a very highly clinically correlated course. To perform well in the course, the students need to have basic cognitive skills in acquisition of knowledge, problem solving, hypothesis generation, interpretation and clinical reasoning. When students are confronted with such a demand during the early part of their medical schooling, acquisition of such a cognitive competency varies to a high degree among them. For some of the students, this resulted in an inability to cope with the new expectations which were very different from their undergraduate learning style. These students experienced failure in the early part of the program. In spite of a rigorous selection process to medical school admission, studies have shown that the existing prediction models on student performance have limitations. At New Jersey Medical School during 1997-2001between 10-15% of the first year students who have taken gross anatomy failed the first unit examination which is given five weeks into the program. These students who are at risk of failing the course were provided with highly structured, interactive remedial tutorials that specifically involved the application of factual knowledge to clinical problem solving. The purpose of this study is to evaluate the effectiveness of such an intervention. The results to be presented involves an analysis of the remediators performance in subsequent departmental examinations and the NBME subject examination. The results indicate that in the last five years 124 students failed the first anatomy examination. When entered into the remedial program 105 (85%) successfully completed the course. Of the remaining 19 students, three left the school, five successfully completed the summer makeup examination, and eight students repeated the first year due to multiple course failures. No decision has been made on the remaining three students who are still completing their first year. In conclusion, early identification of those students who were at risk for failing anatomy who then took part in the structured remedial tutorial program were successful in passing the course. The key to success of the remedial program in improving cognitive skills is delegating to students the responsibility of knowledge acquisition, and facilitating an interactive group process in which the knowledge is applied to clinical problem solving.