Medical Science Educator Volume 20: No. 2

Generating Multiple-Choice Questions from an Existing Short-Answer Radiology Examination

Joseph Sommerfeldt & Alireza Jalali

INTRODUCTION Multiple-choice exams are used frequently in medical education. They are reliable and allow for rapid marking and immediate feedback for students.1 However, creating and writing effective multiple-choice questions is a time-intensive process that involves 3 steps: writing clear objectives, defining levels of learning and following basic test writing rules. The three basic levels of… Read more »

Do Accompanying Clinical Vignettes Improve Student Scores on Multiple Choice Questions (MCQs) Testing Factual Knowledge?

Radan Čapek, Peter McLeod, Colin Chalk & James R. Brawer


We assessed the impact of using clinical vignettes in single best option multiple choice questions (MCQs) on recall of factual pharmacology knowledge. We tested the same knowledge of isolated facts using two sets of MCQs using in-term quizzes administered to second year medical students. The MCQs used by the intervention cohort were context-rich with accompanying clinical vignettes; the MCQs used by the control cohort were context-free requiring recall of identical knowledge. The intervention cohort students correctly answered fewer MCQs (context-rich MCQs) than the control cohort (context-free MCQs). A similar difference was detected between the two cohort answers on the common MCQs . Later we retested the same knowledge on the mid-term and final examinations using the same context-free MCQs for the entire class. The students in both cohorts performed better on the retested MCQs than on newly created MCQs, but there was no significant difference between the two cohorts.

Responses on a five-item ā€œclosed responseā€ questionnaire indicated that the majority of students are favorably inclined to context-rich MCQs but some have reservations about this format. We conclude that facilitating recall of knowledge is not a compelling reason for using MCQs with accompanying clinical vignettes.

Societies Program at the University of Arizona College of Medicine Design, Implementation and Lessons Learned

Kevin F. Moynahan & Paul R. Gordon


Learning community models for medical student education are becoming an increasingly popular method to teach students clinical skills, provide appropriate mentorship, and foster medical professionalism. This paper describes the conception and implementation of such a model, called the Societies Program, at the University of Arizona College of Medicine. Incoming students are assigned to one of a highly selected group of experienced clinical educators in groups of 5 to 6 students, who remain together throughout medical school. The Societies Program introduces medical students to clinical medicine starting on the first day of medical school. Subsequently the groups meet for one afternoon per week in years 1 and 2 for a variety of clinical experiences including clinical labs, bedside teaching sessions, and personal and professional development sessions. These activities are closely linked to and integrated with the material being taught in the basic science blocks to facilitate integration of clinical and basic sciences. Within these sessions student clinical and professional skills are evaluated with a variety of competency-based formative and summative tools. All student work and reflections are compiled in an electronic portfolio designed to encourage self-reflection and student-driven learning.

Two years of data show that the Societies Program is highly valued by students and Society Mentors. This paper describes the challenges and successes encountered as the program started. More work is needed to evaluate the outcomes of this and similar programs. We hope this paper provides insight to those schools that are planning to develop or modify similar programs.

Designing Clinical Pamphlets in a Physiology Course Facilitates Learning in Chiropractic Students

Linda Hanson, K. Burns Ryan & Kashif A. Ahmad


In this manuscript we have demonstrated the effective use of pamphlet design by students taking the physiology course at a chiropractic school. The activity helped students to hone their skills by working in groups, develop creativity and apply physiological concepts to real life situations. A rubric was adopted to grade the pamphlets. At the end of the course, the students had the opportunity to present their work during a lab session and communicate with colleagues on their projects. The students benefited immensely from this unique learning experience and encouraging feedback was received on this learning activity.

Managing Growth in Medical Education

Malathi Raghavan, P Bruce D. Martin, Ira Ripstein & J. Dean Sandham


In response to concerns about future physician shortage, urgent calls have been issued in the USA and Canada to increase medical student positions by 20-30% from current numbers. Yet very little information has been published on how to successfully plan for and manage medical school expansions.

Between 2000 and 2008, the University of Manitoba gradually managed a 53% expansion in Undergraduate Medical Education (UGME) class-size. The latest installment of UGME expansion occurred in 2008-09, amidst concurrent growth in Postgraduate Medical Education. In the same year, a program to evaluate and educate international medical graduates expanded 58% and, a new Physician Assistant Education Program was implemented. To meet the challenge of maintaining quality education for all learners and to appropriately plan for resource development, a systematic inventory of teaching responsibilities and an analysis of the gap between teaching capacity in 2007-08 and future demands were done. Using a combination of qualitative and quantitative methods, pre-clinical teaching was expressed in instructor-hours while clinical teaching was expressed as learner-weeks in clinical teaching units.

The methodology and the guiding principle that data should be expressed numerically using common units across all departments and programs, aided in unequivocally identifying scarce resources and competing needs. The results, allowing for a Faculty-wide accounting of future commitments, set in motion a teaching-based pro-rating system to allocate funding across departments in a transparent manner. Our methodological approach and experience will be of interest to faculty and administration involved in expansion of health professionalsā€™ education.

Student Perceptions of Preclerkship Pelvic Examinations

Amber Lievens-Widenski & Linda E. May


This study tested the hypothesis that practice pelvic examinations on teaching patients within the second year medical school curriculum improve student perceptions of competency and preparedness for clinical rotations. After IRB approval, 260 second year medical students were asked to complete two voluntary, anonymous electronic surveys: one prior to their practice exam and one afterwards. Eighty-eight students (34%) completed the pre-exam survey; 76 students (90%) indicated they never had performed a pelvic exam. Seventy-one students (27%) completed the post-exam survey. Before the activity, 39 (45%) students did not know how to use a speculum; 57 (67%) could not bi-manually locate the cervix; 69 (81%) could not bi-manually locate the uterus; 72 (85%) could not bi-manually locate the ovaries; 74 (87%) could not assess pubococcygeus muscle tone; and 31 (36%) students were not familiar with the appearance of a cervix. Following the experience, 71 (100%) students knew how to use a speculum; 70 (99%) could bimanually locate the cervix; 66 (93%) could bimanually locate the uterus; 57 (80%) could bi-manually locate the ovaries; 44 (62%) could assess pubococcygeus muscle tone; and 70 (99%) students knew what a cervix looked like. Students indicated that the practice pelvic exam improved their perception of preparedness (n=70, 99%) and confidence (n=64, 90%) for performing the pelvic exam and 64 (90%) students reported that the experience helped reduce their anxiety about performing pelvic exams. The practice pelvic exam activity considerably improved student self-perceived competency and preparedness for clinical rotations, which may help their future performance.

Message from Editor-in-Chief

Uldis N. Streips, Ph.D.

Hello IAMSE and international reader family of JIAMSE. This is my final issue as Editor-in-Chief. As of July 1, JIAMSE will have a new editor.

Issue 20-2 represents our best effort to date. There is a variety of presentations from manuscripts to Letters to the Editor. There is a medical case on what do when a student cheats. There are monographs on medical education and research papers. I trust every one of you will find a contribution which will resonate with your own needs in medical education.

My time as editor has seen the journal grow from two issues a year with about 6-7 papers, mostly as research and commentary, to where we publish 4 times a year with an equivalent level of accepted papers, and we have developed several ways to be able to publish a peer-reviewed effort. While we have never had as extensive a volume as 20-2, our, per issue, number of contributions has steadily risen every year that I have been Editor-in-Chief. We have achieved some national listing for the journal, and our reputation as a quality journal has grown significantly. More listings are in the future and the prestige we have achieved will not fade.

I am proud of what we have achieved as an editorial board. None of this could have been achieved without the selfless and superior help of Dr. Marshall Anderson, and the superb editorial board consisting of Drs. Bolender, Crandall, Knoop, Cotter, McMahon, Seifert, May, and Lambert. Thanks to all of them for making my job easier.

So, with this Editor-in-Chief statement, my time as Editor- in-Chief ends. I have enjoyed this job, and it has been very satisfying to see so many international contributions come to fruition of publication. I hope you all will continue publishing in JIAMSE.

My very best to all of you,

Uldis N. Streips, Ph.D.
Distinguished Teaching Professor
University of Louisville
School of Medicine
Master Teacher, IAMSE
Editor-in-Chief, JIAMSE

Letter to the Editor

Scott J. Pearson, Gabriel Virella* & William Schwartz

CAMPS (computer-assisted medical problem-solving), created in 1985 by Dr. William Schwartz, Professor of Pediatrics at the University of Pennsylvania, Medical School, was introduced at the Medical University of South Carolina (MUSC) as part of the Microbiology and Immunology course in 1988. We developed ten cases in Infectious Diseases that are an integral part of the curriculum.

In a CAMPS case, the students take a history, perform a physical examination, and order laboratory tests based on their preliminary differential diagnosis and then decide about therapy and patient disposition. They are periodically quizzed about their actions. An available feature of the simulations is the possibility to ask the students to write a SOAP note. After entering a diagnosis, they receive their grade (based on templates established by experts) with a detailed analysis of their performance and a faculty-prepared summary. The studentsā€™ grades are forwarded to the teaching staff. The student is automatically requested to redo the case if the grade is below a given cut-off. At MUSC, CAMPS have been used in the basic science to add clinical context to medical microbiology. At the University of Pennsylvania, Dr. Schwartz used CAMPS to train students in the Pediatric rotations, requiring that they would write a new case as part of the rotation requirements.

In the past 5 years, a reprogramming of CAMPS was undertaken to adapt CAMPS to platform-independent Web delivery using PHP as scripting language and MySQL as the database engine. WebCAMPS has been extensively tested on a MacOSX server, but should work equally well on a Windows server and on Linux/Unix servers. Case modification and creation of new cases is extremely easy with the WebCAMPS platform, which may be used for simulation purposes in other areas besides microbiology/immunology.

Student feedback surveys have been very positive about WebCAMPS since its inception. In the fall of 2009, 80% of the students filling the course evaluation agreed with WebCAMPS’ effectiveness.

Using Basic Science to Develop an Innovative Program in Complementary and Alternative Medicine

Hakima Amri* & Aviad Haramati


The growing interest in Complementary and Alternative Medicine (CAM) and the increasing incorporation of its modalities in the United Statesā€™ healthcare system have exposed a number of problems in the field. These include a shortage of qualified CAM providers, scarcity of evidence-based research, lack of trained scientists in the field, and the ubiquitous marketing of frequently uncontrolled CAM products. Thus, the development of a comprehensive and scientifically sound educational infrastructure has become a crucial initial step in redirecting these adverse trends.

With support from the NIH-sponsored curricular CAM initiative, faculty from the department of physiology and biophysics at Georgetown University developed a M.S. program in CAM in 2003. This unique, first of its kind, science-based graduate program offers a masterā€™s degree (MS) in physiology with an emphasis on CAM. The CAM-MS degree in physiology is designed to enable students to critically assess various CAM modalities, apply scientific rigor, and carry out evidence-based CAM research. The curriculum includes core science courses and CAM-related classes. Additionally, in order to emphasize the application of academic knowledge and further strengthen problem-solving skills, the students complete an eight-week summer practicum in a professional CAM-related environment.

Here, we report on our innovative and interdisciplinary CAM graduate program where creative teaching is implemented by basic scientists and enhanced by the application of their disciplines in tandem with the clinical expertise of CAM practitioners in the community. Thus, the faculty in the Department of Physiology & Biophysics is developing emerging cross disciplinary areas of study and interest in order to prepare new generations of future physicians, health professionals, educators, and researchers capable of objectively assessing the safety and efficacy of various CAM modalities, and introducing scientific rigor to much needed research into the various aspects of CAM therapies.

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