MSE Articles

ABSTRACT

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.

ABSTRACT

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.

ABSTRACT

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.

ABSTRACT

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.

Dear JIAMSE readers!

Welcome to JIAMSE volume 18-2. This is an important issue, because with this issue we implement the decision reached at the IAMSE meeting in Salt Lake City to publish the Journal four times a year with every type of contribution included. Consequently, in this issue you will find research manuscripts, innovations, a case report, MERGE, letter to the editor, and also instructions for publication. Publishing four times a year will allow us to get your manuscripts published more quickly.

All we need to make this publication schedule a success is your cooperation. First of all, please contribute all that you do innovative at your schools for peer-review, as an innovation, an article, opinion, or letter to the editor. Remember your “solution” to the educational cases is also considered as a publication following editorial review. Educational publication may not be easy for many of you, as it was not for me, who are used to publishing classical bench research. This is one reason why we ran a workshop in Salt Lake City for publication in JIAMSE and other education venues, though we hope you would consider JIAMSE first for your work. This workshop will be repeated in Leiden at the next IAMSE meeting. However, even if not easy, our editorial team is very user-friendly and will work with you to make your work as publishable as possible.

I look forward to your submissions and in the meanwhile enjoy the educational work presented in JIAMSE Volume 18-2.

All best,

Uldis N. Streips, Ph.D.
Editor-in-Chief

The World Wide Web is always changing. New sites are added, some of the sites that we are familiar with are removed or become inaccessible (password protected) and others are revamped and/or the content is modified. In the process, the Uniform Resource Locator (URL) may no longer work, even when a site still exits, because the locator has been changed.

If you know of a website that basic science teachers, clinical instructors, and students working in the medical sciences would find useful, please consider submitting a review to The Medical Educator’s Resource Guide. You can do so by sending the review by e-mail (jrcotter@buffalo.edu).

Group-based learning is a powerful educational experience, satisfactory for both students and faculty. Parker Small’s POPS platform has been available for over 30 years and is widely used. The Clinical Correlation Exercises (CCE) platform is a derivative of POPS originated at the Medical University of South Carolina (MUSC), which emphasizes differential diagnosis and laboratory tests. At MUSC, the student feedback is highly positive; 90-94% of the student agree/strongly agree that “POPS and CCE are effective platforms to integrate clinical material in the Infection and Immunity course”

The POPS website (http://etl2.library.musc.edu/pops/) includes links to the following cases, in both Word and pdf formats (except when noted):

•AIDS
•Elderly with Pneumonia
•Hepatitis
•Immediate Hypersensitivity
•Immunodeficiency Disease
•Influenza: Serologic Diagnosis and Epidemiology
•Jaundiced Baby
•MI Sick (PDF only)
•Opportunistic Infections
•Painful Rash
•Paternity
•Tetanus Immunity
•Tuberculosis (2 versions)
•Transplantation Immunology (2 versions)

All cases can be freely downloaded and modified by the users. Users that modify cases are requested to forward an electronic copy of their version to virellag@musc.edu.

First – THANKS so much for agreeing to write a case for our Medical Education Case Study. This is a valuable contribution to our journal and to our readership, as they think about how to effectively work with situations in their own institutions. All in the effort to improve how we each educate ourselves and others in our medical education responsibilities.

Examples of areas that might be of interest:

1.Course director interaction with students.
2.Individual faculty interaction with curriculum office.
3.Faculty affairs office issues revolving around teaching and tenure/promotion, faculty development, etc.
4.Use of IT in teaching.
5.Student affairs issues

Our request of you is:

1.Write a description of your dilemma or interesting situation that you are interested in how others might respond. This description should end with one or a few questions that you expect responses to address. This should be about 2 pages (single space, Times New Roman, 12 font, 1inch margins on all sides).
2.If possible give a “catchy” title to the case. If not “catchy”, at least give it a descriptive title. In either case try to keep the title length to about 50 characters or less.
3.Provide your name, title and institutional affiliation and location. Students and residents – please provide your year of training (i.e. MS 1, PG2, or fellow) as your titles.
4.Send your document to Kathryn.mcmahon@ttuhsc.edu
5.Upon review of the case, if modifications are needed, send your revisions within 2 weeks of receipt.

We will ask respondents to

1.Read the case and give us their “first impression” response to the questions you pose.
2.Draft a short (3 to 4 paragraph) response to the questions posed or at least one of the questions posed in the case.

Any questions or comments can be sent to Kathryn.mcmahon@ttuhsc.edu.

First – THANKS so much for agreeing to be a respondent for our Medical Education Case Study. This is a valuable contribution to our journal and to our readership as they think about how to effectively work with situations in their own institutions. All in the effort to improve how we each educate ourselves and others in our medical education responsibilities.

Our request of you is:

1.Read the case and give us your “first impression” response to the questions posed.
2.Draft a short (3 to 4 paragraph) response to the questions posed or at least one of the questions posed in the case.
3.Provide your name, title and institutional affiliation and location. Students and residents – please provide your year of training (i.e. MS 1, PG2, or fellow) as your titles.
4.Send your document to Kathryn.mcmahon@ttuhsc.edu within 2 weeks of receipt.

Any questions or comments can be sent to Kathryn.mcmahon@ttuhsc.edu.

INTRODUCTION AND RESULTS: The MUSC medical microbiology and immunology course is an 11 credit hour, integrated, second-year course that in the 2007-2008 academic year included 36 contact hours of small group learning exercises. This represented a 20% increase in small group contact hours from 2001-2002. Small group exercises included both Patient Oriented Problem Solving (POPS) and Clinical Correlation Exercises (CCE), the increase in contact hours being entirely made up by new POPS.

Over the same period, the percentage of students who strongly agreed that small group exercises were more effective than lectures in improving retention of material increased from 59% to 77% (a 30% increase). The largest increases in student satisfaction appeared to correlate with the addition of post-tests to CCE exercises in 2006-2007, a modification suggested by students in past evaluations. Post-tests were previously only given after POPS exercises.

POPS and CCE are open-book learning exercises administered to groups of four students. The POPS format splits the information into four different packages, so that students have to share information during the activity. The CCE exercises are a derivative of POPS, originated at MUSC, which emphasize differential diagnosis and laboratory tests. Students receive identical information, including a detailed faculty-generated discussion of each case.

METHODS: From 2001-2008 approximately 35 groups of 4 students met for 15 (2001-2004) or 18 (2005-2008) two hour small group sessions over the 15 week course. Fourteen faculty in 7 classrooms facilitated student groups and administered post-tests. Students were allowed to form groups of their choosing, but student groups and faculty facilitators were constant for the duration of the course. Attendance was mandatory. Post-tests were 10-14 question computer-graded quizzes. Students were provided with explanatory answer keys immediately after each quiz. Quiz grades were recorded, but were mostly used for student self-assessment. Student assessment of the course was by PACE or E-value web-based course evaluation (response rate >90%).

CONCLUSIONS: The data suggest a general increase in satisfaction with group learning techniques among second-year medical students over the past 6 years, which may have been enhanced by addition of post-tests with immediate feedback at the end of all exercises.

RESOURCES:

National POPS Website:
http://etl2.library.musc.edu/pops/med_ed/mededportal_pops.doc

National CCE Website:
http://etl2.library.musc.edu/pops/med_ed/mededportal_cce.doc

Small group teaching, and problem-based learning (PBL) in particular, demands greater time from faculty than a lecture format, but rewards active learning for development of clinical reasoning skills. How can faculty time be used judiciously, and still retain a small group format? We instituted an integrative PBL model at the end of the 2^nd year curriculum that combined faculty, subject material, quiz and examination items, as well as contact hours across 3 existing courses. Each course previously had its own small group sessions. Time was saved with fewer faculty development sessions, substitution of wrap-up sessions for small group hours, and by having students work on their own for a two hour session without faculty facilitators. There was a 56% reduction in faculty time required with the integrative format. Student adherence to goals of the sessions were enforced through required attendance, quizzes that covered the content of the sessions, randomly calling on students during wrap-up sessions to discuss the findings, and having each small group compose a summary of their findings for each session. The students were engaged, as reported by faculty facilitators, the faculty were enthusiastic, students called on in wrap-up session gave excellent responses, and ratings from student evaluations were equivalent to those of other small groups for the whole year. This integrative format had advantages through placement at the end of the 2^nd year: this wasn’t the first PBL session of the year and students were familiar with the format, the knowledge base of students was considerable, and there was a core of faculty already assigned to small group teaching. Through integration, the small group size went down (7 to 8 students per group, instead of 8 to 10 in existing courses), and in the student-run session the student roles were sometimes different from those with faculty present – some students became more active participants. The major disadvantages of this format included coordinating schedules of faculty from multiple departments, providing multiple faculty review sessions given by development person because of irregular faculty schedules, and course directors other than the lead author made little attempt to familiarize themselves with wrap-up format.

Our Medical Biochemistry course is a compact, primarily lecture-based course. There are four instructors in the course, each with different teaching styles, emphases and goals. The high density of lectures causes a problem for students who do not adopt strong study habits from the outset of the course since there is no opportunity to catch up. Additionally, the very distinct teaching styles of the participating faculty leave many students frustrated and confused about how and what they should be studying. After trying various strategies with mixed success over the past several years, we have recently implemented a tool that helps to solve both of these problems. The course director worked with the other teaching faculty to write a set of USMLE-format quiz questions that cover key concepts from each lecture. After one or a small set of lectures has been presented, a 5-10 question quiz is released on the course WebCT site. Students have 3 days to complete each open-book quiz. They are encouraged to consult other students and use reference materials. In the spirit of self-assessment, students may re-submit the answers once to improve their score. The WebCT program is set for timed access to the quizzes and manages the grades. The 41 quizzes (317 total questions) count for a total of 10% of the course grade, enough to engage the attention of the students. As the course progresses the quiz questions become progressively more complex, building on previous material. The frequency and progressive nature of the quizzes encourage students to adhere to a more optimal study schedule and to retain previous concepts. These quizzes have increased consistency throughout the course and have helped to focus attention on the key objectives of the more complex lectures. All of the students participated and achieved an average cumulative quiz score of 93%. The vast majority of students reported that the quizzes were very (85%) or moderately (10%) helpful. Importantly, the mean on the comprehensive final exam increased 11% compared to that on a similar exam given the two previous years.