DEVELOPMENT OF A CASE-BASED CURRICULUM EXERCISE FOR A DIVERSE LEARNING COMMUNITY
Seyed Massoud Hosseini, Mustafa Dastani, Hedye Akbari, Mahsa Baradaran, Bibi Maryam Hosseini & Hossein Karimi Moonaghi
Mashhad University of Medical Sciences
As the teaching arm of the Boston City Hospital and Boston Medical Center, Boston University School of Medicine (BUSM) has a strong historical commitment to diverse patient populations. The faculty and student bodies are similarly diverse in ethnic, social, economic, academic, and other variables. Institutionally, our commitment to teach and support our diverse community is an integral facet of our educational philosophy. We believe that a commitment to diversity enables us to make important contributions to the health care professions, including teaching cultural competency and transforming the health care workforce to mirror the patients they serve.
As course manager for the first year Medical Genetics course at BUSM, implementation of these principles, particularly in the context of our small group sessions, is a priority. These sessions are highly collaborative in nature and therefore are an ideal place to tap into the wide range of experience of our students.
A new case study, based on the experiences of an African American medical student, has been developed for use in the Medical Genetics course. The case also includes elements designed to resonate with individuals of European descent, and it covers universal genetic principles important to medical professionals in a variety of specialties. Further, the small groups themselves were created upon the foundation of existing advising groups to maximize student diversity in terms of pathway of admission and Myers-Briggs type indicator.
Pairing case-based discussion and diverse student groups creates an engaging curricular exercise designed to explore clinical issues related to diversity. Students reported an especially strong motivation to work with the case to understand issues of clinical importance. Feedback from students also provided insight into elements influencing group dynamics, elucidating the complex interplay between student advising and student learning environments. Because most other courses in our medical school utilize some form of small group teaching, variations of these strategies could be expanded to globally strengthen our commitment to our diverse student body.
LEARNING STYLES AND EDUCATIONAL ACHIEVEMENT OF NURSING STUDENTS
Seyed Massoud Hosseini, Bibi Maryam Hosseini, Hossein Karimi Moonaghi & Ramin Sarchami
Mashhad University of Medical Sciences
Teachers should consider the personal differences of students and determine factors in which may put effect on students’ educational achievement. A descriptive study carried out to determine the learning style of undergraduate nursing students and their marks in an Iranian university.
Students learning styles were assessed using Kolb learning style inventory. Its validity and reliability was determined before implementation. Data of students’ marks were extracted from their educational records. 195 nursing students participated in this study. Data were analyzed by descriptive and analytical methods, using SPSS 11.5.
Findings indicated that most of students were female (83%) with mean age 22 year. The dominant learning style of students was assimilating (53.8%) and the rest of them had converging (28.9%), diverging (11.2%), and accommodating (6.1%) styles. Although the students with assimilating and converging styles had better marks, but there was not significant relation between learning styles and students’ marks.
Learning style is an important factor for determining students’ differences and their learning interests. But, it seems, this issue has no unique role in predicting students’ achievement. Because, educational achievement is a complex issue and may not be predicted only by learning style. It is needed to carry out more research on Kolb learning style in relation to other variables such as personal professional interests, attitudes and motivations.
EFFECTIVE TOOLS FOR SMALL GROUP FACILITATOR DEVELOPMENT
Marieke Kruidering, Christian Burke, Tracy Fulton, Katherine Hyland* & Susan Masters
University of California, San Francisco
San Franscisco, CA 94143
Given the importance of small group learning in medical education, resources for faculty development are vital. After failing to find existing resources that fit our needs, we collected best practices from expert educators and distilled them into concrete faculty development tools. These tools include video clips and a workshop facilitator guide.
We report on the efficacy of these faculty development tools.
A team of educators, professional media experts, and students used storyboarding to create scripted videos demonstrating different facilitation styles. We developed a facilitator guide to provide 1) background on characters and scenarios in the videos, and 2) a framework for leading a faculty development workshop. We ran several workshops using these materials: three short workshops for small group facilitators in the preclerkship curriculum, and one longer workshop in an ongoing faculty development series.
Participants in the short workshops (n=37) rated the usefulness of videos as a springboard for discussion 4.67 (sd=0.59); the overall quality of videos 4.57 (sd=0.73), and the overall quality of the training sessions 4.57 (sd=0.61) (5 = highest). Course directors report the videos make small group facilitator training more consistent and realistic. The overall quality of the longer workshop was rated 4.56 out of 5 (n=1 6). Participants reported the use of videos and brainstorming about specific challenges in small group to be valuable.
Our tools are useful for consistent and effective faculty development.
Create a stand-alone web-based version of videos to increase accessibility of these tools.
A RANDOMIZED STUDY IN 2 GERMAN MEDICAL UNIVERSITIES USING A MODIFIED FLANDERS INTERACTION ANALYSIS
Harold Lyon*, Thomas Brendel, Martin Fischer, Alexandra Hesse, Mathias Holzer, Johannes Ring & Adolph Weindl
Ludwig Maximillians University and Technical University Munich
Study focused on improvement of lecturing. Past research has shown that “empathic” teachers who are Indirect (accept, encourage, praise, ask questions) and stimulate “student talk” are more effective than those who are more Direct (lecturing, giving directions, criticizing). The Flanders Interaction Analysis (FIA) has been shown to be reliable for diagnosing teaching.
Teaching improvement defined as changes in 7 teaching behaviors: increases in faculty question asking; increases in student talk; decreases in faculty talk; increases in the Indirect to Direct teaching ratio; use of case-based teaching; increases in teacher empathy; increases in organization of teaching. These criteria were based upon large studies (classroom analyses in 42 US states and 7 countries) using FIA. We modified the FIA by adding measures of empathy and organization of teaching. We stratified (by teaching experience) and randomized 22 volunteers into 2 matched groups. One had an intervention of the modified FIA plus an expert feedback session in both semesters. The controls had the FIA but no feedback intervention. We measured expert and student evaluations of both groups following each lecture. Our hypotheses: 1) faculty in experimental group receiving the intervention would improve teaching more than controls without intervention; 2) faculty receiving intervention would improve teaching in summer after receiving winter intervention as rated by experts and by student evaluations.
Results (using a paired t-test) showed faculty in the experimental group improved significantly on all 7 measures, whereas faculty in the control group did not change significantly on 5 of 7 measures.
As a result of the study, faculty have become motivated to become better teachers and are being trained.
REVERSING THE SEQUENCE OF HISTOLOGY LECTURE AND LABORATORY DISCUSSION
Boston University School of Medicine
Boston, MA 02118
To improve the educational quality of limited teaching contact time by replacing traditional study-hall-like laboratories with small interactive discussion sessions that precede lecture, and by shifting material students can reliably prepare on their own to self-study.
Nearly a decade ago BUSM reversed the traditional sequence of lecture before lab and scheduled all of our light microscope laboratory sessions to precede their companion lectures. Two years ago, we replaced traditional glass slide and microscope laboratories with virtual microscopy, which allowed us to replace the supervised laboratory sessions with the combination of self-study laboratory exercises and faculty-facilitated interactive small-group discussions.
Lecture time becomes more efficient by eliminating the need to explain classic descriptive histology in lectures. Furthermore, students come to lecture already familiar with the relevant vocabulary and morphological relationships that are key to the lecture topic. As a result, lecturers can spend limited lecture time on important concepts, interdisciplinary links, and clinical relevance.
Adopting Virtual Microscopy (VM) enabled further pedagogical improvement. Because all students examine the same virtual slides, the laboratory guide was written to promote self-study. By shifting the laboratory exercise to self-study, the scheduled laboratory contact time was replaced by interactive sessions that allow faculty facilitators to model proper reading and cognitive processing of histology material, to demonstrate its relevance to pathophysiology, and to improve students’ test-taking skills.
Student focus groups provide feedback for continued improvement. We will continue communication with colleagues to design further horizontal and vertical integration between histology and other disciplines.
VIDEO-ASSISTED REAL-TIME SIMULATION (VARS) IN PAEDIATRICS
Jos Draaisma*, Tim Antonius, Lia Fluit, Marije Hogeveen & Jan Loeffen
Radboud University Medical Centre
Critical care situations in children have large impact on involved medical health professionals. These situations occur infrequent which implicates that each individual professional has few opportunities to gain experience. These skills involved include technical aspects (e.g. airway management) as well as non-technical skills (e.g. communication between team members). Learning on the job which has been the education model for many years has become obsolete in respect to patient as well as team safety.
Our team incorporated video-assisted real-time simulation training (VARS) to obtain and maintain the skills necessary for critical care.This training allows the learner to make mistakes, and learn from them without harming a patient. Immediate post event debriefing facilitates the development of new strategies, and increases self-efficacy in the technical as well as non-technical domains.
We developed VARS training for use in paediatric medicine using a staged model. Medical students focus on theoretical aspects as well as physical parameters of a critically ill child. Paediatricians in training focus on technical skills, while more experienced medical professionals also train non-technical skills. We both use low- and high-fidelity manikins, and developed a special training manikin for the use of extracorporal membrane oxygenation.
We will present our preliminary results with simulation training for technical as well as non-technical skills necessary for critical care medicine in children. We will illustrate this by showing characteristic interactions and behaviours such as team working, decision making and elements of communication.
Video-assisted real-time simulation seems a very promising educational method for training technical as well as non-technical skills in acute paediatric critical care medicine.
CAN THE SELF-EFFICACY OF STUDENTS BE INCREASED BY AN INTERACTIVE TRAINING PROGRAM?
Jos Draaisma*, Esther Coolen & Jan Loeffen
Radboud University Medical Centre
Life-support training can lead to an increase in knowledge, skills and change of attitudes. One factor influencing attitude is self-efficacy.
A previous study suggested that life support training during medical education in the Netherlands has no demonstrable effect on the student’s self-efficacy. Students appeared to have less self-efficacy for the recognition of vital signs and for cardiopulmonary resuscitation (CPR) in children than in adults.
We developed a structured, interactive central clinical training program (CCTP) including paediatric life support training before the paediatric clerkship. This study evaluates the change in self-efficacy generated by this program.
Three student clerkship groups (n=82) were asked to rate their self-efficacy regarding recognition of vital signs and CPR in children and adults using a visual analogue scale before and at the end of the CCTP and at the end of the clerkship.
65 (79%) of 82 students completed the study. Self-efficacy for the recognition of vital signs and for CPR in children (p<0.001) and adults (p<0.01 tot p<0.001) increased strongly. This occurred during the CCTP without a further increase during clerkship.
The self-efficacy for these skills in children at the end of the clerkship was comparable to the self-efficacy for these skills in adults at the start of the CCTP.
A structured, interactive program including paediatric life support training significantly improves the self-efficacy of students. Moreover, the self-efficacy for adult and paediatric life support skills increases. The absence of a further increase during clerkship was disappointing.
FOLLOW THE YELLOW BRICK ROAD TO GET TO CLINICAL DIAGNOSIS
Nancy Fernandez-Garza*, Diana Montemayor-Flores & Donato Saldívar-Rodríguez
Universidad Autonoma de Nuevo Leon
Monterrey NL 64610
To get a precise clinical diagnosis, it is necessary to go through sequential previous diagnoses. For the expert, this is a simple process that he/she executes in an automatic way; nevertheless, for the novice this represents an unknown process. For this reason it is important to analyze the different diagnostic levels that build this intellectual route as well as the sequence it happens.
We analyzed the intellectual route the expert goes through in order to get to a clinical diagnosis as precise as possible. This process implies in first place the identification of the affected structure, followed by the affected function, signs and symptoms and etiology. The integration of these leads to the final clinical diagnosis.
As a consequence of this analysis we identified the following sequence of diagnostic levels: morphologic, functional, semiologic and etiologic. These are the main diagnoses that are made before we get the final clinical diagnosis that directs the patient management.
The knowledge of the way that leads to the final clinical diagnosis allows medical teachers to design methodological strategies to make the student aware of the process, and through its systematic practice become an expert using it in an automatic way.
ROLE OF BODY TRACKER IN THE PROMOTION OF HEALTHY HABITS IN BEGINNER AND ADVANCED MEDICAL STUDENTS
Mark Hernandez* & Patrick Goff
Ross University School of Medicine
Promotion of healthy personal habits during early medical education may encourage students to adopt those personal habits later in their career. To determine whether medical students make healthy choices when it comes to diet and exercise we provided 1st year medical students studying in the Caribbean a questionnaire designed to investigate their eating strategy. We also followed their participation in Body Tracker sessions designed to provide them with accurate determination of their weight, BMI, and percent body fat.
We collected information through an eating survey provided by the American Heart Association (n = 70). We also recorded attendance of students (n = 354) participating in Body Tracker Sessions throughout the first year.
A large proportion of 1st semester medical students are aware of the number of calories they consume (77%), and avoid eating fast-food (57%). Beginner medical students are less likely to participate in the Body Tracker program, but participation was greater consistently as students progressed with the medical education.
Medical students are very conscious and aware of the choices they make for healthy eating. Early sessions designed to target beginner medical students after the first week of class were fruitful and led to higher attendance and participation consistently throughout the first 12 weeks. Their participation was less compared to their fellow peers who were into the more advanced level in their medical education. Body Tracker served as a tool to promote healthy habits and continued to attract the beginning medical students as they progressed into advanced medical status.
INCORPORATION OF RADIATION ONCOLOGY INTO THE MEDICAL SCHOOL CURRICULUM: A TWO-YEAR ANALYSIS OF THE ONCOLOGY EDUCATION INITIATIVE
Boston University School of Medicine
Boston, MA 02118
As part of the Oncology Education Initiative, we incorporated structured didactics by a Radiation Oncology attending physician into the curriculum of the required Radiology clerkship. We report on students’ overall attitudes toward this Initiative.
After exposure to the didactic session, we administered a cross-sectional survey of fourth-year medical students rotating through a required radiology clerkship in the classes of 2007 and 2008.
Of the 301 students, 258 (86%) participated in both the didactic session and questionnaire. All 258 (100%) students felt that oncology was an important component of undergraduate medical education; while 241/258 (93%) felt radiation oncology was also important. 174/258 (67%) reported limited knowledge about radiation oncology prior to the Initiative. An alarming 158/258 (61%) and 171/258 (66%) did not feel there was adequate exposure to cancer care in the pre-clinical and clinical years, respectively. Subsequent to the didactics, 243/258 (94%) were motivated to learn more about radiation oncology and 240/258 (93%) reported a better understanding of the multidisciplinary nature of cancer care. 250/258 (97%) felt that the radiology clerkship was an opportune time to receive radiation oncology teaching.
Graduating medical students do not feel adequately prepared to manage patients with cancer, particularly those undergoing radiation therapy. To the best of our knowledge, our medical school is the first to create a formal didactic program of radiation oncology taught alongside radiographic interpretation and immediately reinforced in a clinical setting.
Even a concise introduction to radiation oncology provides exposure to the field and shift attitudes about the need for further study.
VIRTUAL ELECTRON MICROSCOPY IN CELL BIOLOGY
Sylvia Mione*, Klaus Bacher, Ria Cornelissen & Hubert Thierens
Virtual microscopy of histological glass slides can emulate conventional light microscopy. Up till now, such a digital simulation does not exist for ultrathin electron microscopic slides. Due to the relative inaccessibility of electron microscopy, evaluation of subcellular structures by (bio)medical students is performed with the aid of photographic prints. In this study, the generation and evaluation of virtual electron microscopic slides is discussed.
A T-lymphoblastic cell was used as an example. Electron microscopic pictures were taken at 2 magnifications (25000 and 50000), processed in an analogue or digital way and stitched to reconstruct the image of the total cell. This image is viewed with the free on- line available virtual microscopy viewer OlyVIA?. Since the discernibility of 3 separate layers of a membrane approaches the resolving power of a TEM (1-2 nm using conditions for biological specimens), the possibility of distinguishing the trilaminar structure of cellular membranes on the virtual pictures was the requisite.
Virtual images obtained at an original magnification of 25000, scanned at a resolution of 800 dpi could compete in quality with pictures developed directly from negatives obtained by electron microscopy. It is possible to navigate and zoom into details in a way emulating electron microscopy.
Virtual electron microscopy is innovative and offers new perspectives to interpret cytological pictures and to teach cell biology in an interactive and unique way.