Welcome to JIAMSE Volume 19-1
Hello everyone! This is the first issue of a four issue year. At the 12th annual meeting in Salt Lake City, it was decided to expand the Journal to four issues per year and include all types of publications in the volume, rather than separating according to Supplement material and regular volume publications. This will facilitate the documentation of your publications for your educator portfolios.
Volume 19-1 has a Letter to the Editor with a possible solution to the two Medical Education Cases Studies we have published earlier, two new innovations, four research articles, and a new Medical Education Case Study that will interest you. Let me remind you that “solutions” or your opinions on the Medical Education Case Studies can be sent to us, as Letters to the Editor, and will be peer reviewed. They count as a documentable publication. Let me also remind you to look toward your own teaching program and determine whether there is something innovative, successful, and perhaps unique to what you do and that might be of value to someone else who is teaching or even starting out in the education field. Such material can be written up and submitted to JIAMSE in one of our many possible formats for publication (see the website: www.iamse.org). With four volumes per year, the turnaround times will be relatively short and also, as always, our editorial policy is very user-friendly. I look forward to receiving your contributions.
Uldis N. Streips, Ph.D.
I have read two of the medical cases in recent issues of JIAMSE which deal with examination question “security”. Our experience at the University of Louisville, School of Medicine bears on this case.
For years our course in Medical Microbiology and Immunology released the examinations to the medical students. After many years, it became difficult to come up with new, relevant questions. Even in a dynamic field such as ours, it becomes hard to ask a question in new, valid ways. We would keep stems and change answers, or change stems for same answers. Anyway, this all became moot, when our school went to Block Testing. We run classes for five semester weeks, give the students four days free, and test them all day Friday of the sixth week on all the subjects presented in the five weeks (Streips, et al. JIAMSE, 2006, 16:10-18). The questions are scrambled and presented in 6 sections of 50 questions each. The test is carefully assembled, proofread, validated, integrated, and made as close to NBME type question sets, as possible. The test is also sequestered. Once they take it, the section is removed and the students don’t see the test again until review. The test is only revealed with answers in a review session, where they can’t take notes but can challenge questions. This allows them to discuss questions with peers and learn in that way, as well. However, with 300 questions it is impossible for them to pass on this test to next year students, aside from a question or two. We have a bank of questions which obviates this method as well. We have had no changes in success rates for questions in question analysis as long as we have done the examination process this way.
I feel we have the best of both worlds and the best answer for the cases proposed in the Journal. The students “see” the questions after taking the test, can discuss and learn, challenge answers, but cannot pass the question on to later classes. That way there is no copy of the exam floating around, which would be accessible to some people but not others. Also, students cannot study from our question set for the exams, but must study the material as they would for the USMLE Step 1.
This innovation is related to the integration of radiology sessions into a first-year basic science anatomy course. The authors used a Picture Archiving and Communication System (PACS) to provide computerized tomography (CT) radiology images that enhanced visual learning in anatomy and provided an interactive exchange among faculties and students.
Student achievement in first year basic science courses is commonly measured with multiple choice examinations to assess knowledge acquisition. Measuring growth/achievement in “doctoring courses” is more challenging. The goals of our Patient Centered Medicine (PCM I) course include developing effective patient-doctor communication skills, learning to work as members of multi-disciplinary health care teams, and demonstrating knowledge of ethics, cultural competency, and medical economics. Course instruction includes large group activities (lectures, films, patient interviews), faculty facilitated small group activities (discussions and standardized patient encounters), and individual self-directed learning (readings, journal writing.) Faculty facilitators evaluate students weekly in small groups; an end-of-year OSCE evaluates communication skills. To assess the broader array of course competencies, we implemented a creative final course evaluation that is enjoyable for both students and faculty.
Each spring toward the end of PCM I, students collaborate in their small groups (10 -11 students) to select a health care system problem and potential solution, and to develop a 10 minute creative presentation (skit, song, poem, dance), to present to the whole class. Over the past two years, topics/themes have included improving the quality and safety of health care, complementary/alternative/integrative medicine, culturally competent care, ethical challenges in health care, and interfacing spirituality, religion, faith, and medicine. Faculty rate the presentations (2 = Excellent, 1 = Good, 0 = Fair/Poor) on the extent that acquisition of the course competencies is demonstrated, on evidence of working collaboratively, and on overall creativity.
Student evaluations of the final exercise have been overwhelmingly positive. Students enjoy the change of pace, collaborating with classmates, engaging in the project, and the satisfaction of having produced a good quality final presentation. Negative comments related to the project taking more time than expected, and to the difficulty in getting the group together for planning. Although there was some resistance in year one, the exercise now appears to be part of school “culture,” an expectation for the end of PCM I and the M1 year. Faculty report that watching the performances is enjoyable, and an effective way for students to demonstrate growth and achievement in the Patient Centered Medicine course.
This case highlights the challenges both faculty and entering medical students face when faith-based practices collide with schedules. Specifically in this case, the faculty member ponders the balance between accommodation and avocation for an entering Muslim student attempting to maintain all religious holidays, fasts and prayer five times/day.
The field of medicine requires a lifelong commitment to education, both as a student and as a teacher. The role of medical students in teaching as well as course design has seldom been explored. As part of a curriculum change at our institution, senior medical students were integrally involved in designing, implementing, and teaching a new first year pathology course focused on independent learning. Before the 2006-2007 and 2007-2008 pathology course, the course director chose four to five senior medical students to act as teaching assistants (TAs). TAs met with the course director multiple times to discuss new course components. Due directly to involvement of the TAs, the 2007-2008 pathology course consisted of five components: lectures, small group sessions, journal club sessions, podcasts, and student case presentations. After the 2007-2008 pathology course, 41 of 42 students completed a subjective survey assessing the course as well as the use of senior medical students as TAs.
This study documents senior students operating effectively as both teachers and course designers. It also serves as a blueprint for student course designers to implement and evaluate changes and foster a culture of peer teaching. It demonstrates that first year medical students are comfortable with senior medical students as teachers; furthermore, these students have an increased interest in teaching as a result of the course. This involvement of senior medical students in the teaching and course design process may foster a culture of peer teaching and leadership that would benefit medical students, their peers, and potentially their patients.
This project assessed the effectiveness of podcasting, a new tool for content delivery in medical education, to improve first-year students’ note-writing and patient documentation skills and knowledge. Previous Objective Structured Clinical Examinations (OSCEs) revealed that many first-year students had poor note-writing skills. Therefore, a new series of six podcast episodes that taught note-writing skills, titled “SOAP Note 101,” was developed and made available on the iTunes Music Store and the institutional website. Phase I involved three groups of students, those using institutional iPods, those using their own iPods, and those without any specific commitment to access the podcasts. Subject note writing skills during a non-graded portion of an OSCE were compared for each group. Phase II used a dose-response model to assess the degree of improvement in note writing on a graded OSCE and a cognitive exam, based on the number of podcasts to which students listened. Students favorably evaluated the podcasts and their availability as supplemental content. Note-writing skills and quiz scores increased slightly as the number of podcasts that students listened to also increased. Podcasting is well-liked by medical students, and they appreciate having access to asynchronous supplemental materials. Further research is needed to evaluate ways to increase effectiveness of podcasting in medical education.
Video screen capture recordings with audio of live medical school lectures, with variable speed playback options, have been available for most basic science courses in the preclinical curriculum for 2 years, including courses in Year 1 (discipline-based curriculum primarily delivered by classroom lectures) and Year 2 (modified problem-based learning curriculum with up to 7 lectures per week). The purpose of this study was (1) to assess student perspectives on the extent and pattern of use of the digital materials, features important to students, and the perceived impact on student performance, and (2) to determine if there were differences among students in the use of the online lectures in Year 1 courses (discipline-based lecture-based curriculum) and Year 2 courses (modified problem-based learning curriculum). Survey results of four student cohorts indicated that students in both curricular types perceived that online lecture recordings were an important component for studying basic science content. With respect to type of use, 77% of Year 1 students and 53% of Year 2 students used the online lecture files in addition to attending live lectures. A greater percentage of Year 2 students indicated they watched the online lectures instead of attending class. Student views on effectiveness varied: the majority (84% of all students responding) indicated that online lectures are just as effective as or more effective than live class lectures; the remainder said they are less effective. Most students (over 80%) used the variable speed playback option. Over 75% of students indicated a positive subjective effect on study habits and exam scores (“learning the material better”). Further analysis of the value of specific features and the patterns of use of the video files will assist with strategic planning for using technology to support instruction and to improve student learning.
The first-year medical curriculum at The University of Texas Medical School at Houston (UTMSH) comprises traditional discipline-based basic science courses and an Introduction to Clinical Medicine (ICM) course in which students learn the rudiments of the patient interview and physical exam. Integration of material across diverse courses is a key aspect of modern, competency-based curricula, and can be difficult to achieve in a traditional, discipline-based curriculum. To accomplish a degree of integration, the first-year course directors developed Clinical Applications, a course that meshes information presented in the basic sciences with skills learned in the Introduction to Clinical Medicine course using a team-based learning approach.
Seven integrative problem-solving sessions were introduced into the first year curriculum, four in the first semester and three in the second. These sessions utilized clinical scenarios of patient problems, and integrated content from at least three first-year courses in each session. A concerted effort was made to incorporate concepts from first-semester courses into sessions in the second semester, thereby promoting vertical and horizontal integration. Clinical scenarios were diverse and included topics of infertility, premature birth, sickle cell anemia, HIV infection, diabetes mellitus, renal failure, cardiovascular disease, cancer, neuronal pathways and pain, and travel medicine.
Results from the inaugural year of this course suggested that clinical problem-solving exercises presented in a team-based learning format were effective for integrating basic science concepts in a traditional discipline-based curriculum. The course also facilitated communication among all the directors of first-year courses and encouraged more integration in the first-year curriculum.