July 9-13, 2004 
Tulane University School of Medicine 
New Orleans, Louisiana U.S.A.
 

Abstracts on Instructional Methods

The following abstracts have been accepted for presentation at 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.
 
 

IM1	PREDICTION, PSYCHOCOMMUNITY AND EVALUATION Jesus Alveano M.D. Ph.D.*, and Felix Guzman PhD., Medical Education Department, School of Medicine, UMSNH Didactics Center, UMSNH , Morelia, Michoacan, C.P. 58280 MEXICO The work tried to merge predictors, integral education with the model of Psychocommunity and personal attention to improve the grades. The question was: Which factors can predict the academic proficiency? Methods: Two groups (N=72), of Medical Psychology; a Psychocommunity program, with a tutor (experimental group) and Psychocommunity with a workshop of study skills (control). Experimental design: randomized control group pretest-posttest. Variables: Biography, familial antecedents, personal motivations, multiple choice examinations, Pathfinder, self-evaluation and an Objective Structured Clinical Examination. Analysis: descriptive and inferential statistics of the student’s grades. Results confirm the experimental hypothesis (p=.01). Conclusions: biographic antecedents can predict the academic proficiency.
IM2	Team Learning in a Histology and Cell Biology course: student feedback on the learning experience Helen M. Amerongen, Ph.D.*, Susannah Reiser, B.A., College of Medicine, University of Arizona, Tucson, AZ 85724, and Michael A. Kallen, Ph.D., MPH, Houston Center for Quality of Care and Utilization Studies, Houston, TX 77030 U.S.A. Four team learning exercises were implemented in a Histology and Cell Biology (HCB) course to provide students with opportunities to apply course material in small group discussions using a minimum of faculty. For each team learning exercise the class of 110 students was divided into teams of 7-10 which met in the lecture hall. Students first answered multiple choice questions (MCQs) on a pre-assigned topic. This Individual Readiness Assurance Test (I-RAT) was then repeated but working in teams (Group-RAT). After discussion of test answers and relevant concepts, students worked on clinical applications (MCQs based on a vignette), first within teams then with the class as a whole. To stimulate discussion, in the first two exercises, I-RAT/G-RAT MCQs were intentionally ambiguous, often having more than one correct answer, and students were allowed to help determine the answer key. In the last two exercises, in response to student feedback, ambiguity was eliminated from RAT MCQs and very limited in the clinical applications; the key was set by the instructor. Each student was assigned a grade based on responses to I-RAT, G-RAT, and clinical applications. Feedback from students indicated the following: Students felt that having points assigned for the exercises fostered combativeness, but acknowledged that without points assigned they would not necessarily prepare for the exercises, and that preparing did help them keep up between major course exams. While students reacted very negatively to ambiguity in I-RAT/G-RAT questions, which were based on basic science, they were more tolerant of ambiguity in clinical application questions. Students found discussion within teams helpful in improving understanding, though frustrating because of the noise level in the lecture hall. Overall, in advising about changes that would improve the exercises, students most frequently suggested that the class be broken into 2 or 4 groups of teams rather than having all teams together in one room. We are currently analyzing data on student performance on midterm and final exams to determine if the team learning exercises improved students’ understanding of the topics addressed in the exercises.
IM4	MATRIX CONSTRUCTION AS A LEARNING TOOL FOR MEDICAL STUDENTS S. James Booth, Ph.D., Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-6495 U.S.A. Frequently, course or year directors must meet with, and advise, students who are in academic difficulty. There is commonly a discussion of the student’s study habits and an attempt is made to have a positive impact on their academic success. Since most faculty members have virtually no formal training in this area, it can be difficult to give meaningful feedback to students. In addition, students are commonly referred to the institution’s student counseling service, where they receive assistance on test taking skills, address the possibility of "test anxiety", and discuss other internal and external factors that might be affecting their performance on examinations. Frustrated with my inability to provide meaningful feedback, a method was developed that allowed students to more easily learn the important facts and concepts in the major basic science sections, especially microbiology, pharmacology and pathology, of the second year curriculum. This method is self-directed active matrix construction. The construction of matrices (tables) will be described, student examples displayed, and their use discussed. An emphasis will be placed upon the importance of the methodology of matrix construction that turns this task into an active learning endeavor.
IM5	impact of a rotating dissection schedule on academic performance in the dental gross anatomy laboratory Jennifer K. Brueckner, Ph.D.* Department of Anatomy and Neurobiology, University of Kentucky College of Medicine, Lexington, KY 40536-0298 U.S.A. As curricular demands increase and qualified anatomists become scarce, professional schools are seeking more cost- and time-efficient ways to teach the laboratory component of gross anatomy. Many schools have replaced the traditional dissection method (where all students attend lab and participate in dissection) with alternative strategies, such as the "rotating dissection" approach. Rotating dissection mandates that only half of the students at each lab station dissect on any given day; at the end of the lab, these students demonstrate the day’s objectives to their non-dissecting peers, who learn by prosection. The present study examined the impact of a rotating dissection schedule on the performance of first year dental students in the anatomy laboratory. In the lab, each student was assigned a specific role in the dissection process by acting as head dissector, assistant dissector or reader; these roles rotated with each lab session. When surveyed regarding their perceptions of rotating schedule’s impact on their lab performance, 97.7% of students indicated that they learned more effectively when they participated in the dissection process. Forty-three percent perceived that they learned most effectively when assigned the role of reader, as compared to head dissector (39%) or assistant dissector (18%). Preliminary exam results confirmed the students’ perceptions that those who learned material via dissection earned a significantly higher average grade on the practical exam (85.97%), than those who learned via prosection (78.4%). We also investigated whether specific dissection roles (head/assistant dissectors, reader) conferred any academic advantage to students on the lab practical examination. Small differences in academic performance were observed amongst the three roles, with the readers demonstrating a slight academic advantage over both head and assistant dissectors, consistent with the results of the student survey. A thorough understanding of the role of cadaveric dissection in student mastery of anatomical relationships is essential, in an era where many professional programs are reducing or eliminating this important component of the basic science curriculum.
IM6	PROVIDING A CLINICAL SKILLS EXPERIENCE PRIOR TO CLERKSHIP ROTATIONS. Kurtis G. Cornish, Ph.D., Paul.M.Paulman, M.D., and Gerald. Moore, M.D., University of Nebraska College of Medicine, Omaha, NE 68198-5850 U.S.A. A concentrated Clinical Skills Experience (CSE) presented in a three day block the week prior to the clinical clerkships is an effective method of teaching technical skills. Objectives of the CSE are to review and to teach the clinical skills necessary to perform effectively in the clinical setting, to help the students become confident in their abilities to perform clinical skills and to provide training at a time that ensures the skills are current. Methods: The CSE has been taught for 5 years. Lectures cover infection control, reading ECGs, basic laboratory values interpretation, confidentiality, and literature search skills. Over the next 2 2 days the topics are covered in groups of 10 students with two or more instructors/group (50 min. blocks). Reading ECGs and the suturing/blood gas/lumbar puncture classes require 2 hours. Suturing is done on pigs’ feet. Blood gas draws, spinal taps, endotrachial suctioning and urinary catheters are done on models. The students do the injections, start IVs, vacutainer blood draws and nasogastric tube insertions on each other. They also practice gowning, gloving and isolation procedures. There is always apprehension about doing these procedures on each other. However, all of the students have participated and felt that it was a worthwhile experience. Conclusions: The CSE has been well accepted by the students. The faculty and students feel it is a valuable experience that increases students= confidence in their abilities to perform these procedures in the clinical setting.
IM7	REVERSE CURRICULAR ENGINEERING OF CLINICAL ROTATIONS IN THE COMMUNITY MEDICAL SCHOOL Gilbert Edward Corrigan M.S. M.D. Ph.D., Corrigan Laboratory, 11801 Hidden Lake Drive, Spanish Lake, MO 63138 U.S.A. Whereas clinical rotations for junior and senior students are generally allocated on a service and institutional basis (i.e. pediatrics at the city hospital) without a specific allocation of various types of patients with some dependence on assignment to various services within the sponsoring institution (i.e. nursery, walk-in clinic, and surgery) while meeting the curricular subject spread by associated lectures and reading assignments, a reverse engineering of this method is presented and applied to clinical teaching in a blueprint of a community clinic serving the underprivileged and utilizing the community patients and physicians teaching in the school. The needs of the students in each discipline (i.e. surgery) for each major disease topic (i.e. respiratory cancer) are established, the calendar for the examination and management of each patient (and patient type) is established by assignment to a specific day and clinic, and a curricular assignment made. The system assures that each student in the two years of clinical rotation attends to each major patient and disease type and that no breaches in clinical coverage are made. The system is based upon clinic management by the school with identification of patients by disease type and their assignment to clinics on the basis of the academic need and attending physician. An assignment schedule is presented. Model patients may be used. In the absence of academic need or in the circumstance of excesses or other problems, the patient will receive treatment as needed but without academic registration. Community medical school blueprint (second edition) http://hometown.aol.com/commedschool/ccmsmedschooljul142.wps
IM8	Use of Team Learning Techniques in an Introductory Graduate Pharmacology Course George A. Dunaway, Ph.D., Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL 62794-9629 U.S.A. Team learning experiences within a large group setting have had a variety of educational applications. In this poster, aspects of the team learning process, which were introduced into an Endocrine Pharmacology Unit of an Introductory Graduate Pharmacology course, will be described. Considerations for curriculum design, small group assignments, instructional materials, small group activities, assessment, student opinions, and cost/benefit considerations will be presented. The effects of team learning strategies on student participation during class, preparation before class, and student perceptions were examined considering a student feedback instrument, instructor perceptions, comparison of student performances in the Unit and the Course, and personal interviews with students. Many aspects of the team learning activities were utilized. These included separation of a class body into independent small groups, required mastery of stated objectives, common instructional materials, group problem solving in a class room environment, opportunities for inter-group discussion of rationale for responses, provision of valid information from a content expert as part of the group discussion, and extra-classroom opportunities for group problem solving and knowledge acquisition. A primary divergence from the classical team learning approach was the ways in which pre-class preparedness and individual responsibility for knowledge acquisition were encouraged and assessed. Specifically, the Individual Readiness Assurance Test was not utilized; and individual assessment of student performance was obtained at the end of the educational unit. For this application, employing group problem solving by extrapolation from earlier information to provide a response to a probe or addressing important pharmacological issues within a case vignette, proved to be an effective substitute for the Group Readiness Assurance Test. The onus for preparedness was placed on each student by requiring effective group participation to avoid negatively impacting group effort. Although slight differences of opinion existed among the graduate students, the incorporation of team learning into the classroom was broadly appreciated. All of the students felt that the time spent participating in team learning was as valuable a learning experience as the lecture. Also, there was general agreement that their class preparation and participation was increased over their usual efforts and that this enhanced knowledge acquisition.
IM9	INTEGRATION OF PRE-CLINICAL BASIC SCIENCE AND CLINICAL SCIENCE AND PBL IN THE MEDICAL CURRICULUM - INTEREST AND PRACTICE IN MEDICAL SCHOOLS IN SOUTH EAST ASIA Khoo Hoon Eng*, Matthew Gwee, Zubair Amin and Koh Dow Rhoon, Medical Education Unit, Faculty of Medicine, National University of Singapore, Singapore, Kent Ridge, SINGAPORE Medical education in Asia is currently undergoing rapid change that involve adopting new innovations, experimenting with new models of curriculum and realigning their mission and vision to serve their country’s healthcare needs better. The National University of Singapore has initiated a project to document the characteristic ‘Profile’ of individual Asian medical schools consisting of several key themes, including: history and structure; teaching and learning; student assessment; curriculum management structure and its governance; curriculum renewal process; funding of educational program; valuing teaching; future directions. In the first phase, the project was initiated with medical schools in the ASEAN (Association of South East Asian Nations) countries. The responses were open-ended, unrestrictive and designed to encourage self-reflection and self-analysis. To date, we have compiled Profiles from 30 medical schools. In this paper, we focus on integration of pre-clinical basic science and clinical curriculum and the use of PBL. Many schools are in the process of integrating their curriculum or have already done so. Interest in the use of PBL is strong but not all schools feel ready to start yet. Those who have implemented the use of PBL have done so in a "hybrid" curriculum together with other modes of teaching such as lectures, small group tutorials, practicals and IT-assisted learning. Thus, the large differences in the pace of implementing curricula reforms in Asian medical schools reflect well major differences in the socio-economic status, culture, patterns of disease and priorities of the health care delivery systems in our region.
IM10	BASIC SCIENCE POSTDOCTORAL FELLOWS ARE EFFECTIVE SMALL GROUP LEADERS Tracy B. Fulton, Ph.D.*1, Katherine Hyland, Ph.D.1, and Marieke Kruidering-Hall, Ph.D.2 (1) Departments of Biochemistry and Biophysics and (2) Cellular and Molecular Pharmacology, School of Medicine, University of California, San Francisco, CA 94143 U.S.A. The first two years of the medical school curriculum at the University of California San Francisco (UCSF) include extensive learning in small group discussions. The pool of teaching faculty suited to small group teaching is limited in many basic science departments. For the past three years, our departments have recruited and trained postdocs to be small group leaders in two first-year courses: Prologue, and Cancer. The goals of this Postdoctoral Teaching Fellowship program were to expand the pool of effective small group leaders, and to provide structured teaching opportunities to postdocs. At the start of the program, Postdoctoral Teaching Fellows attend a workshop sponsored by the Office of Education and Technology which introduces the content to be taught and models effective small group teaching skills. During the program, small group leaders (both Postdoctoral Teaching Fellows and faculty) teach three or four 2-hour sessions with groups of fifteen students. Prior to each teaching session small group leaders receive a 2-hour training that connects the pedagogy learned in the development workshop with the specific content to be taught. Immediately after the teaching session a debriefing meeting for small group leaders and coordinators is used to discuss problems, dynamics and common student misconceptions. At the end of the course, students evaluate their leaders in three areas: level of preparation, ability to lead the discussion without dominating, and overall effectiveness. In this study, we have examined the overall effectiveness of the postdocs compared to the effectiveness of the faculty, based on evaluations by both students and the small group coordinators. We observe two trends. First, the difference in average scores for "overall effectiveness" between the postdocs and faculty in any given year is not significant. Scores for faculty are for the most part marginally higher, which presumably reflects a gain of knowledge, teaching skills, and understanding of the needs of the students over consecutive years (see below). Second, the average rating for "overall effectiveness" increases among the faculty (on a 5-pt scale with 5=best: 3.78 for Prologue 2001, 3.93 for Prologue 2002, 4.13 for Prologue 2003; 3.74 for Cancer 2002 and 4.23 for Cancer 2003). Several faculty have taught in the small group setting for consecutive years, and the increased average likely reflects increased ability to tailor their content to the needs of students at this level. Based on evaluation data, we conclude that postdocs can be used as effective small group leaders in medical curricula, provided that they receive adequate training in both content and group dynamics.
IM11	ACTIVE LEARNING STRATEGIES IN UNDERGRADUATE MEDICAL EDUCATION OF PATHOLOGY: A SASKATOON EXPERIENCE Rani Kanthan MBBS, MS, FRCS, FRCPC*, & Sheryl Mills B.Ed, M.Ed. Depts. of Pathology & Educational Administration, Colleges of Medicine & Education, University of Saskatchewan, Saskatoon, SK S7N 0W8 CANADA There is a shift in medical education towards educating physicians who can work as part of health care team for an evolving practice of "patient centered medicine." Teaching styles in medicine have, however, remained fairly pedantic with traditionalist modernist classrooms structured around faculty authority and visual learning promoting individualistic competitive environments rather than fostering the skills of co-operation that are required to function effectively as part of a team. Active learning strategies promote learning through active participation by the student with focus not only on knowledge content but also in the construction, analysis, synthesis, and evaluation of this knowledge by working in-groups. The aim of this study was to evaluate the inclusion of active learning strategies in the general pathology course of the undergraduate medical curriculum. The specific teaching strategies addressed both process and content objectives of developing and practicing interpersonal and communication skills, and promoting a more cooperative atmosphere among individuals and providing opportunities for group problem solving. A wide variety of active learning strategies were incorporated into the General Pathology course that was attended by 60 2nd year medical, 26 dental and 2 masters students. They frequently worked in small groups of 3-4 students. The students discussed key points, formulated questions, developed visual and verbal metaphors, summarized using a "fish-bone" technique, and wrote short quizzes. The students received feedback on their submitted work and participation earned them 10% for their final grade. The inclusion of these strategies was evaluated anonymously by all students at the time of the midterm and by a focus group of 8 medical students at the conclusion of the course. The overall feedback from the students to the midterm questionnaire was generally favorable. The students enjoyed the interaction with their peers but did not feel the active learning strategies helped them learn more easily. Of 223 comments, 141 were coded as positive. The negative comments clustered mostly around ineffective use of class time. Students felt that active learning strategies detracted from the traditional and expected lecture time, that they learnt better on their own than in-group work, and that analogies and metaphors were ‘too abstract." In conclusion, active learning strategies can be incorporated in the delivery of pathology education as part of the undergraduate medical curriculum. The long-term effectiveness of incorporating metaphor, analogy, and interpersonal skills, however, may only become apparent when these students are doctors in team-oriented, patient-centered clinical practices.
IM12	Active Learning in a Second-Year Pathology Curriculum: A Prospective Comparison of Case-Based Group Discussion versus Team-Based Learning Paul Koles M.D.*, Stuart Nelson, Ph.D., Adrienne Stolfi, M.S.P.H., Dean Parmelee M.D., Dan DeStephen, Ph.D., Department of Pathology, Wright State University School of Medicine, Dayton, OH 45435 U.S.A. A prospective crossover design assigned 80 second-year medical students to either case-based group discussion (CBGD) or team-based learning (TBL) for eight separate modules in the pathology curriculum. Effectiveness of these two active learning strategies was assessed by performance on pathology-related examination questions administered in end-of-course exams. There were no differences in whole group performance on pathology-related exam questions as a consequence of experiencing CBGD or TBL. However, lowest academic quartile students showed better exam performance when experiencing TBL than CBGD (p=0.035, 2-way ANOVA). Students perceived that contributions of peers to the learning process were more helpful in TBL than in CBGD (p=0.003, paired t-test). We conclude that both CBGD and TBL are acceptably effective strategies for active learning in a second-year pathology curriculum, but students with lower academic performance may benefit more from TBL than from CBGD.
IM13	GUIDED DISCOVERY LEARNING WITH VIDEOTAPED CASE PRESENTATION IN NEUROBIOLOGY Robert A. Lavine, Ph.D.*, Department of Pharmacology & Physiology,  George Washington University School of Medicine and Health Sciences, Washington, D.C. 20037 U.S.A. Guided discovery learning combines didactic instruction with more student-centered and task-based approaches (Spencer and Jordan, 1999). Key features are (1) a framework for student learning, (2) student responsibility for exploring content needed for understanding, (3) study guides provided, and (4) application to clinical or experimental problems. Guided discovery learning is superior to the less-structured approach of pure discovery learning in promoting learning and knowledge transfer (Mayer, 2004). In the interdisciplinary Neurobiology course for first-year medical students directed by the author, videotaped presentation of patient history, radiological findings, and neurological examination, with faculty guidance in diagnosis, provides an example. Following didactic presentations of CNS structure and function, we presented (1) goals and procedures of the clinical case presentation, and outline of the neurological examination, (2) presentation of a videotape case presentation of a patient admitted with a stroke, with a neurologist taking the history and reviewing the examination at admission. Each segment was followed by questioning students and discussion on differential diagnosis based upon their knowledge of neuroanatomy and neurophysiology. Brain scans and a follow-up examination were then shown. (4) Each student wrote a review of this case, describing the neurobiological correlates for the patient’s symptoms and signs. Basic scientists and clinicians have guided these sessions. Students evaluated this component of the course on a 1-5 Likert rating scale (1=strongly agree to 6=strongly disagree). 85% strongly agreed or agreed that it "increased my knowledge of neurobiology" (mean= 2.18), 79% that it "increased my motivation to learn neurobiology" (mean=2.24), 88% that it "increased my ability to apply neurobiology to clinical problems" (mean=1.82), and 88% that it "improved my understanding, motivation to learn, and/or ability to apply neurobiology more than a typical lecture" (mean=2.06). The results suggest that guided discovery learning featuring a clinical case serves to focus on real problems and adds relevance and motivation to mastery of related basic science information.	ORAL
IM14	ENHANCING MEDICAL STUDENT TEACHING SKILLS Carol A. Nichols, Ph.D.* and Ruth Marie E. Fincher, M.D. Department of Cellular Biology and Anatomy and Academic Affairs, Medical College of Georgia, Augusta, GA 30912 U.S.A. Medical school faculty and students often are asked to teach because of their content expertise. However, this expertise does not always translate into effective teaching. Selected rising sophomore medical students at the Medical College of Georgia have an opportunity to work as instructors or teaching assistants during the summer. To enhance their teaching skills, School of Medicine faculty developed an innovative teaching skills elective for first year medical students. Using a workshop format, the elective offered an overview of educational strategies and practical tips for presenting basic science material in a variety of settings. Students completed a learning-styles inventory to promote awareness of different learning and teaching styles. Videos, group discussions, and short presentations were used to stress effective lecturing techniques and alternative instructional methods. Students learned to search for web-based educational tools, write quality test questions, create effective handouts, and give each other constructive feedback. At the end of the elective, students demonstrated their newly acquired skills with a short presentation supplemented with an original handout and test questions. Faculty facilitators and peers gave oral and written feedback. Pre and post course self-assessment surveys indicate a rise in the students’ perceived educational skills and confidence. Course evaluations will serve as a measure of the students’ educational skills in practice. We expect both teaching confidence and performance to be enhanced by participation in this teaching skills elective.
IM15	RESULTS OF A LIMITED SURVEY OF POWERPOINT (PPT) USAGE BY MEDICAL SCHOOL, GRADUATE, AND UNDERGRADUATE SCIENCE FACULTY. James M. Norton, Ph.D.*, Department of Physiology, University of New England College of Osteopathic Medicine, Biddeford, ME 04005 U.S.A. The following is a summary of 201 responses to an online survey of PPT usage sent to listserv members of the American Physiological Society Teaching Section (158 responses) and the Human Anatomy and Physiology Society (43 responses). Of those responding to the survey, 71.1% indicated that they used PPT in the classroom; 6.1% were considering its use; 15.2% had considered using PPT but decided against it; and 7.6% had tried PPT but had stopped using it. For those who used PPT, the reasons for their choices were: the ability of the software to incorporate images and animations (n=130); instructor convenience (n=118); the perceived value of PPT in transmitting content (n=77); the perception that PPT engages students (n=76); an expectation or demand by students that PPT be used (n=43); and an institutional encouragement of, or requirement for, PPT use (n=42). Remarkably, only 1% of survey respondents indicated that their choice to use or not use PPT was based on a review of published studies on the effectiveness of electronic presentation media. Of those who used PPT in the classroom, 44.9% provided a separate, detailed handout to supplement the PPT presentation; 9% provided a text outline generated by the PPT software itself; 23.6% provided handouts consisting of 1-6 PPT slides per page; and 22.5% provided no handouts at all to accompany their PPT presentations. Electronic and/or Internet access to the PPT file for students was provided by 61.2% of PPT users through email, web pages, or course platform software such as Blackboard or WebCT. For those who provided electronic access, only 26.7% acknowledged problems with students’ downloading and printing of the PPT files (e.g., increased institutional costs for paper, ink, and printer maintenance). Less than half of PPT users (47.3%) indicated that PPT use in the classroom made them better teachers. Respondents who had chosen not to use PPT, or had tried it and stopped using it, indicated in their written comments that reasons for their choice included perceived or real technical problems associated with electronic presentation media; the opinion that PPT was too confining, too scripted, too linear, or otherwise inconsistent with their teaching style; the perception that a PPT presentation was less interactive than other forms of teaching (e.g., blackboard and chalk); and the conclusion that there were better ways to present animations, images, graphs, and text to a class (e.g., document cameras, word processing software, HTML pages, direct web links, or overhead transparencies).	ORAL
IM16	PEER FACILITATION OF A CASE-BASED EXERCISE IN MEDICAL PHARMACOLOGY Julia M. Ousterhout, Ph.D.*, Department of Pharmacology, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501 U.S.A. The purpose of this study was to evaluate the use of second-year medical students to facilitate a case discussion and completion of an assignment by a small group of their peers. The goal of the exercise was to increase understanding of course content and to integrate basic science with clinical material. The case was selected to precede and complement a lecture on antihypertensive agents in the cardiovascular section of the Medical Pharmacology course. After attending a brief orientation session, volunteer facilitators guided groups of 7-8 students through the case. The web-based case was projected on a SMARTboard and included prerecorded patient responses, results of a history and physical exam, lab results, other diagnostic test results, and a case summary. The facilitator made sure that each individual had a learning issue to research, coordinated discussion of the learning issues, and organized a written report submitted by the group. Each group was required to address issues related to the patient’s treatment plan that incorporated recommendations for pharmacotherapy and behavioral changes. Upon completion of this experience, all students were asked to fill out an evaluation form containing six items. Facilitators completed a separate survey that included questions about facilitator training and experience, the group experience, and other items. Feedback about this learning experience has been generally positive, and the majority of students have felt that they worked together effectively in a group. Most of the students also felt that peer facilitators were effective. Facilitators have enjoyed the opportunity to lead a group and help their peers achieve the group’s objectives. The group reports required a collaborative effort since all students in the group received the same grade. Our experience has shown that using students instead of faculty members to facilitate a small group activity fosters active learning in a collegial environment. Students can perform successfully as group facilitators with minimal training and support.
IM18	MOCK MALPRACTICE TRIAL FORMAT TESTS STUDENTS’ CLINICAL CASE PRESENTATION SKILLS Darshana Shah, Ph.D.* and A. Betts Carpenter, MD. Ph.D., Department of Pathology, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV 25701 U.S.A. Marshall University School of Medicine’s second-year medical students worked in teams to debate the validity and interpretation of clinical-pathologic findings in a “mock-medical malpractice trial” setting. This new case-based teaching format gave us an opportunity to evaluate the advantages and disadvantages of the new teaching concept that is based on the principles of teamwork and critical thinking. It also gave us an opportunity to evaluate the newly adopted clinical presentation-based curriculum that has new methods of instruction to complement the traditional lecture format. During the "mock medical malpractice trial”, students role-played plaintiff, defendant, attorneys, judges, and each side's expert witnesses. A clinical pathology conference on tuberculosis was taken from the New England Journal of Medicine and used as the basis for our mock trial. The class was divided into five groups. Students were highly encouraged to work together within their group. Separate groups were also encouraged to work together. An image file of the pictures and figures from the article was provided to the groups. Students were given the freedom to choose a different interpretation of the data provided. For example, it was fair for the defense team to have another pathologist testify with a different interpretation of the pathologic findings. One individual was selected to be the main presenter for each group. The trial was strictly student-driven, and the instructors were present only as facilitators. Student feedback on this approach to clinical case-based teaching was overwhelmingly positive. Surveys indicated that this new teaching format stimulated student enthusiasm for learning and improved student-faculty communication. Our findings also indicate that this learning format may enhance the student’s depth of knowledge on the subject of pulmonary tuberculosis.
IM19	Integrating Basic Science and Clinical Medicine using a “Heath Fair” Format for Case-Based Teaching Darshana Shah, Ph.D.*, A. Betts Carpenter, M.D. Ph.D., Department of Pathology and Sarah McCarthy, M.D., Associate Dean of Academic Affairs, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV 25701 U.S.A. Traditional lecture- and discipline-based teaching is focused and efficient, but does not emphasize active learning and the development of life-long learning skills. Many students find it difficult to appreciate the practical value of the information given to them. Consequently, many students struggle to retain basic information once they leave the classroom. As medical science educators, we need to find new ways to maintain enthusiasm through active learning. To address this problem, a new integrated approach to teaching was developed at Marshal University using a “health fair” approach. After learning about pathophysiology of the breast, students were presented with a clinical case of breast cancer. Students rotated in small groups through different “health fair” stations talking to experts. These stations represented a typical sequence of events in the detection, diagnosis, and treatment of patients. Students learned through hands-on experience at every station. These breast cancer stations included: (1) Physical examination (primary care physician), (2) Mammogram (radiologist), (3) Fine needle aspiration: (pathologist), (4) Biopsy (surgeon), (5) Microscopic examination of breast excision (pathologist), (6) Chemotherapeutic drugs (pharmacologist), and (7) Ethics. Similarly, after learning about cardiovascular pathophysiology, the students attended a “health fair” concerning a patient with an acute myocardial infarction. These stations included: (1) Physical examination and differential diagnosis (primary care physician), (2) Clinical laboratory findings (pathologist), (3) EKG (cardiologist), (4) Treatment (pharmacologist), (5) Diet (nutritionist), (6) Behavior modification therapy (psychologist), and (7) Imaging studies and patient management (primary care physician and cardiologist). Our survey results indicate that this innovative teaching technique creates enthusiasm for learning, and may increase retention span.	ORAL
IM20	NEUROSCIENCE IMAGES: A CD-ROM TUTORIAL OF NEUROANATOMY WITH LEARNING RESPONSE QUIZ QUESTIONS Diane E. Smith 1*, and William I. Campbell2, Department of Cell Biology & Anatomy, and 2. Learning Resources, LSU Health Sciences Center, New Orleans, LA 70112 U.S.A. Neuroscience Images is a pc-based CD-ROM designed to assist medical and graduate students in becoming familiar with the anatomical structures and pathways of the central nervous system as well as the relationship of these structures to each other. This collection of neuroanatomical images may be used in conjunction with a lab manual (available separately) or as a stand-alone tutorial. It is also anticipated that this CD will be helpful to residents in reviewing neuroanatomy for licensing exams. The quiz section in each chapter is designed with learning response answers which provide the user with images and comments for the incorrect as well as the correct response. The simplicity of accessing these labeled images and quiz questions enables the student to study in whatever environment he or she finds most conducive to learning.
IM21	V-TEL DISTANCE LEARNING SMALL GROUP CONFERENCES UTILIZING OFF-SITE FACULTY FACILITATORS FOR ON-SITE STUDENT GROUPS Maya Yiadom, MSII*, Ezinma Achebe, MSII, and Nancy R. Stevenson, Ph.D. UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway NJ 08854 U.S.A. A potential problem encountered with some uses of distance learning is the separation of the facilitator from the student(s). However, in schools with multiple campuses, such as RWJMS, distance learning offers potential cost- and time-effective opportunities to maintain interaction between faculty and students at different sites, and to increase the pool of clinical facilitators available for small groups in the pre-clinical curriculum. The Medical Physiology course has developed a protocol for using a V-tel distance learning system to connect the Camden facilitators with student groups located at the Piscataway campus. Upon first using the V-tel system, the consensus of the students' and facilitators' comments indicated that the physical set-up was not conducive to small group interactions. We started a pilot project to evaluate and improve the situation. We rearranged the furniture so that tables and chairs were in a semicircle about 12 feet from the monitor and had a V-tel operator present and making adjustments throughout the conference. A questionnaire was developed to compare various aspects of the V-tel experience to the regular small group. It was administered to the two groups of students who took part in both a V-tel small group and a regular small group (with everyone in the same room) and oral comments were solicited from the facilitators. The questionnaire results, n = 11, indicate that all students or 10 out of 11 students considered that the audio and visual reception and seating arrangement did not distract from the learning activity. The facilitators agreed with the students. General comments indicated the students considered the V-tel small groups to be a practical alternative for the regular small groups. Several students commented that it took a little time to get used to the set up. Several more commented on the change in group dynamics with the V-tel system and identified ways this might be improved. Based on these results we consider 1) that our V-tel distance learning system is adequate for its use and 2) that we should continue to evaluate and improve the facilitator - student interactions. In the 2004 spring semester, we have started an evaluation of the facilitator -student interactions. Questionnaires were designed for both the students and the facilitators to look at several issues of effective communication over distance. Also, two of the authors will observe the groups with special emphasis on type and frequency of facilitator behaviors that enhance or detract from good group dynamics.
IM22	EXCELLENCE IN BASIC SCIENCES (EBS) AS AN INSTRUCTIONAL TOOL AND USE OF THIS METHOD IN THE MEDICAL CURRICULUM Uldis N. Streips, Ph.D., Department of Microbiology and Immunology, University of Louisville, School of Medicine, Louisville, KY 40292 U.S.A. Excellence in Basic Sciences (EBS), an innovative and educationally-based alternative to the Standard lecture format has been developed at the University of Louisville, School of Medicine (U.N. Streips and K.R. Bain. 2003. JIAMSE, 13:40-44). EBS is based on the premise that students put into a situation where they need to solve a problem, where they are in a challenging yet supportive environment, where they can collaborate on discovery, where they are encouraged and judged fairly, and where they can fail with no penalty and receive supportive feedback- will succeed and learn optimally. This poster presentation will present several uses of this educational system in the medical school curriculum. Examples will be provided of the type of cases used and how EBS is adapted to the 2nd year curriculum, the transition summer between first and second years, and as alternatives to lectures in the third year in clinical courses.
IM23	Student use and perceptions of self evaluation tests in a Dental Materials curriculum Christina Strydom, B.Ch.D, M.Sc (Dental Sciences), Restorative Dentistry, Faculty of Dentistry, University of the Western Cape, Tygerberg, 7505 SOUTH AFRICA Over the last four years students at the University of Stellenbosch School of Oral Health Sciences had access to computer-driven self-evaluation multiple-choice quizzes (MCQs) as an additional study aid in a student-centered outcomes-based curriculum of the subject Dental Materials. The self-evaluation tests were introduced in the believe that doing the self-evaluation tests (1) would help the student to master the terminology and learn the more detailed "must-know" facts of the subject; (2) would help the students to grasp difficult concepts; and (3) would tell the student whether (s)he has mastered a specific theme and is ready to move on to the next theme. Fifty to 100 MCQ-questions were drawn up to cover each course theme. Comments were provided to explain incorrect answers to questions concerning difficult-to-grasp concepts, or to refer the student back to the appropriate study notes. A quiz in a specific theme consists of 10 randomly-delivered questions and students were informed that they could do the tests as many times as they prefer, but that a minimum number of tests was required to earn a continuous evaluation mark. As student feedback in the 2001- and 2002- year groups indicated that more than 80% of the students found the self-tests to be useful, a more detailed self-completed questionnaire containing close-ended responses and an open-ended question was submitted to the 2003-year group to identify student perceptions of the helpfulness of the self tests to prepare them for tests and exams, including their helpfulness to make students feel more in control of their studies. The data indicated that the majority of the students agreed that the self tests not only helped them to study more effectively (80%) and to feel more prepared (100%) and more in control (80%) of their studies, but that they also helped the students to improve their factual (92%), as well as their conceptual knowledge (88%). We also tried to relate the perceived helpfulness of the self-tests to the students’ general study performance. All the respondents who rated their study performance to be in the lower third of the class, agreed that the self tests helped them to study more effectively, while 80% indicated that they would have failed their final exams without the help of the self-tests. The results of this feedback indicate that the self tests are not only a useful learning resource for most students, but that they may be even more useful to students who struggle with their studies.	ORAL
IM24	The Family Physician / Geriatrician Teaching Attachment: A Model for Teaching Medical Students Geriatric Assessment in Home Visits Howard Tandeter* , Roni Peleg, Sasson Menahem, Vera A. Fried and Aya Biderman. Department of Family Medicine, and Department of Geriatrics, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, ISRAEL Medical School teaching is fragmented into different disciplines. It is sometime difficult to cross these lines when trying to teach areas that are common to different disciplines (due to minimal or no cooperation between them). In Israel, the geriatric clinical clerkships teach mostly about the hospitalized elder patient. There is almost non-ambulatory experience in this rotation. Meanwhile, primary care physicians provide most of the health care to the elderly in the community. This paper describes an innovation in the curriculum of the fifth-year family medicine clerkship at Ben-Gurion University Medical School in Israel designed to improve the teaching of geriatrics in the ambulatory setting. During the clerkship, family physicians perform a home visit to one of their home-ridden elderly patients with a small group of medical students. During this visit, a geriatrician from the local hospital is included to the group for teaching purposes. Most students participating in this experience rated it positively, as did the participant family physicians and geriatricians. In conclusion, this liaison-attachment teaching experience allowed the students to learn aspects of geriatrics that are spared during their geriatric clerkship, the family physician to use this opportunity as a consultation for his homebound patients, and the tertiary care geriatrician to teach in the community. Our experience shows that the lines that separate disciplines in undergraduate medical education may be crossed effectively, generating inter-disciplinary cooperation, with better results for students.