Can the 'assessment drives learning' effect be detected in clinical skills training?--implications for curriculum design and resource planning

PURPOSE

The acquisition of clinical-technical skills is of particular importance for the doctors of tomorrow. Procedural skills are often trained for the first time in skills laboratories, which provide a sheltered learning environment. However, costs to implement and maintain skills laboratories are considerably high. Therefore, the purpose of the present study was to investigate students' patterns of attendance of voluntary skills-lab training sessions and thereby answer the following question: Is it possible to measure an effect of the theoretical construct related to motivational psychology described in the literature--'Assessment drives learning'--reflected in patterns of attendance at voluntary skills-lab training sessions? By answering this question, design recommendations for curriculum planning and resource management should be derived.

METHOD

A retrospective, descriptive analysis of student skills-lab attendance related to voluntary basic and voluntary advanced skills-lab sessions was conducted. The attendance patterns of a total of 340 third-year medical students in different successive year groups from the Medical Faculty at the University of Heidelberg were assessed.

RESULTS

Students showed a preference for voluntary basic skills-lab training sessions, which were relevant to clinical skills assessment, especially at the beginning and at the end of the term. Voluntary advanced skills-lab training sessions without reference to clinical skills assessment were used especially at the beginning of the term, but declined towards the end of term.

CONCLUSION

The results show a clear influence of assessments on students' attendance at skills-lab training sessions. First recommendations for curriculum design and resource management will be described. Nevertheless, further prospective research studies will be necessary to gain a more comprehensive understanding of the motivational factors impacting students' utilisation of voluntary skills-lab training in order to reach a sufficient concordance between students' requirements and faculty offers, as well as resource management.

Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

BACKGROUND

Evidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial.

METHODS

The educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed) and 6th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor's questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test.

RESULTS

289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group.

CONCLUSIONS

Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities.

Learner feedback and educational outcomes with an internet-based ambulatory curriculum: a qualitative and quantitative analysis

BACKGROUND

Online medical education curricula offer new tools to teach and evaluate learners. The effect on educational outcomes of using learner feedback to guide curricular revision for online learning is unknown.

METHODS

In this study, qualitative analysis of learner feedback gathered from an online curriculum was used to identify themes of learner feedback, and changes to the online curriculum in response to this feedback were tracked. Learner satisfaction and knowledge gains were then compared from before and after implementation of learner feedback.

RESULTS

37,755 learners from 122 internal medicine residency training programs were studied, including 9437 postgraduate year (PGY)1 residents (24.4 % of learners), 9864 PGY2 residents (25.5 %), 9653 PGY3 residents (25.0 %), and 6605 attending physicians (17.0 %). Qualitative analysis of learner feedback on how to improve the curriculum showed that learners commented most on the overall quality of the educational content, followed by specific comments on the content. When learner feedback was incorporated into curricular revision, learner satisfaction with the instructive value of the curriculum (1 = not instructive; 5 = highly instructive) increased from 3.8 to 4.1 (p < 0.001), and knowledge gains (i.e., post test scores minus pretest scores) increased from 17.0 % to 20.2 % (p < 0.001).

CONCLUSIONS

Learners give more feedback on the factual content of a curriculum than on other areas such as interactivity or website design. Incorporating learner feedback into curricular revision was associated with improved educational outcomes. Online curricula should be designed to include a mechanism for learner feedback and that feedback should be used for future curricular revision.

Experience of developing and implementing a motivation induction course for konyang university medical college freshmen

PURPOSE

This study aimed to develop a new course for Konyang University College of Medicine freshmen to motivate them with regard to their vision and medical professionalism and experience various learning methods of medical education.

METHODS

The course was developed by 4 faculty members through several intensive meetings throughout the winter of 2010. A 4-credit course was designed for 61 freshmen of Konyang University College of Medicine to provide structured guidance and an introduction to their medical education and increase their motivation with regard to their studies and school life. The course lasted for 4 weeks (February 28 to March 25), and every session of the program was evaluated by the students.

RESULTS

The 'motivation induction course' consisted of the following sessions: university-wide: 'leadership camp' and 'special lectures for future vision;' college-wide: 'major immersion session,' 'Enneagram workshop,' 'STRONG workshop,' 'medical professionalism,' and 'team-based learning.' The group results were presented in a poster and by oral presentation and were awarded prizes for the best performance. Special features included: group discussion session on medical ethics, which used scenarios that were developed by a medical humanity course committee and visiting all departments and mentors of the medical college to fulfill their curiosity of their future major or workplace. Overall, the course was evaluated as satisfactory (M=4.22, SD=0.81).

CONCLUSION

Although there was some dissatisfaction, the overall experience of the "motivation induction course" was a success. The course will continue to be valuable for freshmen in adapting to medical school and its culture and in defining one's view of a good doctor.

Problems and issues in implementing innovative curriculum in the developing countries: the Pakistani experience

BACKGROUND

The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME.

METHODS

Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty and students of the designated colleges. Rigor was ensured through independent coding and triangulation of data.

RESULTS

The reasons for delay in implementation differed amongst the policy makers and faculty and included thematic issues at the institutional, programmatic and curricular level. Majority (92% of the faculty) felt that COME curriculum couldn't be implemented without adequate infrastructure. The administrators were willing to provide financial assistance, political support and better coordination and felt that COME could improve the overall health system of the country whereas the faculty did not agree to it.

CONCLUSION

The paper discusses the reasons of delay based on findings and identifies the strategies for curriculum change in established institutions. The key issues identified in our study included frequent transfer of faculty of the designated colleges and perceived lack of: Continuation at the policy making level. Communication between the stakeholders. Effective leadership.

Implementation of the interdisciplinary curriculum Teaching and Assessing Communicative Competence in the fourth academic year of medical studies (CoMeD)

INTRODUCTION

Implementation of a longitudinal curriculum for training in advanced communications skills represents an unmet need in most German medical faculties, especially in the 4rth and 5th years of medical studies. The CoMeD project (communication in medical education Düsseldorf) attempted to establish an interdisciplinary program to teach and to assess communicative competence in the 4th academic year. In this paper, we describe the development of the project and report results of its evaluation by medical students.

METHODS

Teaching objectives and lesson formats were developed in a multistage process. A teaching program for simulated patients (SP) was built up and continuous lecturer trainings were estabilshed. Several clinical disciplines co-operated for the purpose of integrating the communication training into the pre-existing clinical teaching curriculum. The CoMeD project was evaluated using feedback-forms after each course.

RESULTS

Until now, six training units for especially challenging communication tasks like "dealing with aggression" or "breaking bad news" were implemented, each unit connected with a preliminary tutorial or e-learning course. An OSCE (objective structured clinical examination) with 4 stations was introduced. The students' evaluation of the six CoMeD training units showed the top or second-best rating in more than 80% of the answers.

DISCUSSION

Introducing an interdisciplinary communication training and a corresponding OSCE into the 4th year medical curriculum is feasible. Embedding communication teaching in a clinical context and involvement of clinicians as lecturers seem to be important factors for ensuring practical relevance and achieving high acceptance by medical students.

A curriculum development simulation in a graduate program

OBJECTIVE

To implement and evaluate a curriculum development seminar in which graduate students experienced circumstances that occur when faculty members develop and attempt to secure colleague approval for a curriculum.

DESIGN

Learning activities for the graduate seminar included classroom lectures, active learning, and a group project in which simulated faculty committees created new curriculums for the pharmacy practice department's 3 research areas.

ASSESSMENT

Responses on pre- and post-seminar surveys indicated that graduate students' self-confidence in their ability to conduct key curriculum development activities increased (p < 0.05). In a post-seminar focus group, graduate students stated that they valued participating in the faculty simulation, learning about curriculum development and research programs other than their own, and collaborating with their peers.

CONCLUSION

A curriculum development faculty simulation was an effective tool for preparing graduate students for curriculum development responsibilities and generated valuable documents that the department could use in the revision of the 3 pharmacy practice graduate school curricula.

Musculoskeletal education in US medical schools: lessons from the past and suggestions for the future

Despite the prevalence of musculoskeletal disorders in the United States, physicians have received inadequate training during medical school on how to examine, diagnose, and manage these conditions. This article provides an overview of the existing literature on undergraduate medical musculoskeletal education, including learning objectives, researched methodology, and currently utilized assessment tools. A discussion of challenges to and suggested approaches for the implementation of medical school musculoskeletal curricula is presented.

A perspective for clinical pharmacy curriculum development and validation in asian developing nations

This perspective is a reflection of the Personal teaching experience of the authors. The aim of this perspective is to identify the weaknesses in the pharmacy curriculum development in Asian developing nations and to propose a methodological approach for curriculum validation. It has been seen that improper selection of the course contents were the common limitations found in the pharmacy curriculum in developing nations. Furthermore, lack of facilities and improper student evaluation system were the other flaws that are acting as a main challenge to pharmacy education in developing nations. A systemic way for the curriculum designing and validation can be a solution to manage the observed deficiencies. Keeping in view this motivation a set of task are defined in the form of Pharmacy Curriculum Development and Validation Model (PCDVM) that can be a guideline for the pharmacy educators for the evaluation and validation of the curriculum. Partial or full implementation of this model will enable the pharmacy institutions to deliver quality knowledge to pharmacy students which will further contribute to quality health care system in developing countries.

Validation of a Canadian curriculum in obstetric medicine

A comprehensive curriculum for obstetric medicine was created through review and synthesis of several existing sources including a recent textbook, published curricula and a review of cases seen in a specialized clinical setting. The preliminary curriculum document then underwent local validation and reformulation of educational objectives with reference to the CanMEDS framework promoted by the Royal College of Physicians and Surgeons of Canada. This draft 'Canadian' Curriculum Content Validation Instrument, covering 34 medical conditions, was then distributed to a cohort of 29 Canadian obstetric internists (the study group) for review. All responders gave feedback on each of the 402 curricular items, with a high level of inter-rater agreement. A subgroup was subsequently convened (n = 15) and Delphi methodology was used to review the major recommendations from the group, as well as nine additional problematic items, achieving a consensus on 38/43 survey items (88%). The final validated document was presented at the North American Society of Obstetric Medicine meeting in April 2010 in Toronto, Canada and distributed to study group members for local adaptation and implementation. Wider dissemination is planned in the near future.

Incorporating performance improvement methods into a needs assessment: experience with a nutrition and exercise curriculum

BACKGROUND

Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal.

OBJECTIVES

To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs.

DESIGN AND PARTICIPANTS

One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents' baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling.

MAIN MEASURES

The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported.

KEY RESULTS

Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers.

CONCLUSIONS

We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness.

Wellness: Pharmacy education's role and responsibility

The root cause of most chronic diseases in America is self-inflicted through an unhealthy lifestyle including poor diet, insufficient exercise, inability to maintain a healthy weight, tobacco use, and excessive alcohol consumption. Americans' ability to adhere to healthy lifestyles appears to be declining.1,2 The pharmacy profession, while positioned to provide an answer to this problem, has done little. In addition, academic pharmacy's primary focus is on drugs and diseases with limited instruction in the area of wellness. It is time for pharmacy education to step up and take a leadership role in enhancing the wellness of Americans.

Disparities education: what do students want?

BACKGROUND

Educating medical students about health disparities may be one step in diminishing the disparities in health among different populations. According to adult learning theory, learners' opinions are vital to the development of future curricula.

DESIGN

Qualitative research using focus group methodology.

OBJECTIVES

Our objectives were to explore the content that learners value in a health disparities curriculum and how they would want such a curriculum to be taught.

PARTICIPANTS

Study participants were first year medical students with an interest in health disparities (n = 17).

APPROACH

Semi-structured interviews consisting of 12 predetermined questions, with follow-up and clarifying questions arising from the discussion. Using grounded theory, codes were initially developed by the team of investigators, applied, and validated through an iterative process.

MAIN RESULTS

The students perceived negative attitudes towards health disparities education as a potential barrier towards the development of a health disparities curriculum and proposed possible solutions. These solutions centered around the learning environment and skill building to combat health disparities.

CONCLUSIONS

While many of the students' opinions were corroborated in the literature, the most striking differences were their opinions on how to develop good attitudes among the student body. Given the impact of the provider on health disparities, how to develop such attitudes is an important area for further research.

Teaching feedback to first-year medical students: long-term skill retention and accuracy of student self-assessment

BACKGROUND

Giving and receiving feedback are critical skills and should be taught early in the process of medical education, yet few studies discuss the effect of feedback curricula for first-year medical students.

OBJECTIVES

To study short-term and long-term skills and attitudes of first-year medical students after a multidisciplinary feedback curriculum.

DESIGN

Prospective pre- vs. post-course evaluation using mixed-methods data analysis.

PARTICIPANTS

First-year students at a public university medical school.

INTERVENTIONS

We collected anonymous student feedback to faculty before, immediately after, and 8 months after the curriculum and classified comments by recommendation (reinforcing/corrective) and specificity (global/specific). Students also self-rated their comfort with and quality of feedback. We assessed changes in comments (skills) and self-rated abilities (attitudes) across the three time points.

MEASUREMENTS AND MAIN RESULTS

Across the three time points, students' evaluation contained more corrective specific comments per evaluation [pre-curriculum mean (SD) 0.48 (0.99); post-curriculum 1.20 (1.7); year-end 0.95 (1.5); p = 0.006]. Students reported increased skill and comfort in giving and receiving feedback and at providing constructive feedback (p < 0.001). However, the number of specific comments on year-end evaluations declined [pre 3.35 (2.0); post 3.49 (2.3); year-end 2.8 (2.1)]; p = 0.008], as did students' self-rated ability to give specific comments.

CONCLUSION

Teaching feedback to early medical students resulted in improved skills of delivering corrective specific feedback and enhanced comfort with feedback. However, students' overall ability to deliver specific feedback decreased over time.

Caring for the underserved: exemplars in teaching

The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received. The 3 best exemplars for teaching pharmacy students the awareness, attitudes, knowledge, and skills needed to care for the underserved were selected and are described in this manuscript. Included are 1 didactic, 1 experiential, and 1 international experience. These exemplars in educating students on working with the underserved provide schools with models which could be adapted to fit individual programmatic curricular needs.

Evidence of knowledge acquisition in a cognitive flexibility-based computer learning environment

BACKGROUND

A computer-based learning experience was developed using cognitive flexibility theory to overcome the pitfalls often encountered in existing medical education. An earlier study (not published) showed significant pretest-posttest increase in scores, as well as a significant positive correlation between choosing to complete the module individually or in pairs.

METHOD

This experience was presented as part of a second-year course in medical school with randomized assignment for students to complete the program as pairs or individuals.

RESULTS

Sixty-six scores of 101 medical students (31 from students working as singles and 35 from 70 working in pairs) were analyzed. Out of 47 possible points, the mean pretest score was 15.1 (SD = 6.4, range 13.7-15.9). The mean posttest score was 22.9 (SD = 5.2, range 21.1-24.2). Posttest scores were statistically significantly higher than pretest scores (p<.001, Cohen's d = 1.17, average gain 7.8 points). Both pairs and singles showed pre-to-post test score gains, but the score gains of pairs and singles were not significantly different.

CONCLUSION

This learning module served as an effective instructional intervention. However, the effect of collaboration, measured by score gains for pairs, was not significantly different from score gains of students completing the assignment individually.

A model intensive course in geriatric teaching for non-geriatrician educators

INTRODUCTION

Because of the aging demographics nearly all medical specialties require faculty who are competent to teach geriatric care principles to learners, yet many non-geriatrician physician faculty members report they are not prepared for this role.

AIMS

To determine the impact of a new educational intervention designed to improve the self-efficacy and ability of non-geriatrician clinician-educators to teach geriatric medicine principles to medical students and residents.

DESCRIPTION

Forty-two non-geriatrician clinician-educator faculty from 17 academic centers self-selected to participate in a 3-day on-site interactive intensive course designed to increase knowledge of specific geriatric medicine principles and to enhance teaching efficacy followed by up to a year of mentorship by geriatrics faculty after participants return to their home institutions. On average, 24% of their faculty time was spent teaching and 57% of their clinical practices involved patients aged over 65 years. Half of all participants were in General Internal Medicine, and the remaining were from diverse areas of medicine.

EVALUATION

Tests of geriatrics medical knowledge and attitudes were high at baseline and did not significantly change after the intervention. Self-rated knowledge about specific geriatric syndromes, self-efficacy to teach geriatrics, and reported value for learning about geriatrics all improved significantly after the intervention. A quarter of the participants reported they had achieved at least one of their self-selected 6-month teaching goals.

DISCUSSION

An intensive 3-day on-site course was effective in improving self-reported knowledge, value, and confidence for teaching geriatrics principles but not in changing standardized tests of geriatrics knowledge and attitudes in a diverse group of clinician-educator faculty. This intervention was somewhat associated with new teaching behaviors 6 months after the intervention. Longer-term investigations are underway to determine the sustainability of the effect and to determine which factors predict the faculty who most benefit from this innovative model.

Toward Interdisciplinary Care: Bridging the Divide between Biomedical and Alternative Health Care Providers

PURPOSE

Responding to suggestions that physicians are obligated to inquire fully about complementary and alternative medicine (CAM) use and its scientific evidence, to acknowledge patients' health beliefs and practices, and to accommodate diverse healing practices, our interdisciplinary CAM integration project created an advisory committee (AC) composed of CAM practitioners and institutional personnel to incorporate CAM- related information into health professions training. We report on the collaborative process and describe group members' perceptions of medicine and clinical teaching.

METHODS

Information collected from the first two years' quarterly meetings, the first annual retreat, and other venues was analyzed in conjunction with semi-structured in-person interviews of 10 biomedical and CAM practitioner committee members. Data were analyzed using qualitative methodology and N5 software to identify themes and patterns.

RESULTS

Analysis confirmed expectations that allopathic and CAM AC members held different views of health and healing. Member comments reflected points of tension that clustered into three intertwined themes: what constitutes evidence, interaction with the patient, and the relative importance of experience in learning. Recommendations for designing interdisciplinary CAM curricula are presented.

CONCLUSION

Differences between CAM and allopathic providers were frequent but did not obviate common goals or collaboration. Results demonstrate the potential for collaboration between these groups and our activities may be useful to others seeking to implement interdisciplinary care, particularly between CAM and allopathic providers.

Using a human patient simulation mannequin to teach interdisciplinary team skills to pharmacy students

OBJECTIVES

To determine the effectiveness and student acceptance of using a human patient simulation (HPS) training module focused on interdisciplinary teamwork skills.

DESIGN

During their second-professional year, all pharmacy students were in enrolled in Principles of Pharmacotherapy 4: Cardiovascular Diseases and Patient Care Lab IV, a problem-based learning course. As part of the patient care laboratory, students participated in a simulated case of an acutely ill patient with a hypertensive emergency. During the simulation, students performed a history and physical examination. They then worked as a team to make treatment recommendations to the nursing and physician staff members. Following the exercise, a facilitated debriefing session was conducted. Students completed satisfaction surveys to assess the quality and effectiveness of the session.

ASSESSMENT

Over 98% of students agreed or strongly agreed that they learned material relevant to their current studies. When compared to student lectures, 90% of students felt that they learned clinical patient care better when using a HPS mannequin in simulated patient scenarios.

CONCLUSION

HPS-based learning offers a realistic training experience through which clinical knowledge and interpersonal teamwork skills can be taught. Students enjoy the experience and find it relevant to their future practice. Simulation-based training may teach certain topics better than traditional lecture formats and as such could help to fill gaps in the current pharmacy curriculum.

A ten-month program in curriculum development for medical educators: 16 years of experience

BACKGROUND

Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.

OBJECTIVE

To describe and evaluate a longitudinal mentored faculty development program in curriculum development.

DESIGN

A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.

PARTICIPANTS

One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.

MEASUREMENTS

Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.

RESULTS

Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.

CONCLUSIONS

This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.

Student perspectives on pharmacy curriculum and instruction in Egyptian schools

OBJECTIVES

To determine student attitudes and opinions towards pharmacy education in Egyptian universities to provide information for designing delivery of a revised pharmacy curriculum.

METHODS

Students were recruited from the pharmacy faculties at a government-sponsored university and a privately funded university. Data were gathered using a structured questionnaire and statistically analyzed. Responses from open questions were subjected to thematic analysis.

RESULTS

Students spent widely differing amounts of time on non-classroom study, little of which was self-directed. This was reflected in the low frequency of use of library facilities and the preference of students for passively acquired information. Themes that emerged on how students would improve the curriculum were to increase the use of computers and the Internet; make the course more relevant to pharmacy practice and/or clinical pharmacy; improve and expand the practical components of the course; increase their own involvement in learning; and increase their understanding of subjects as well as their knowledge. For many of the questions, there was a significant different between the responses of students at the 2 universities.

CONCLUSIONS

Students relied on classroom teaching and devoted little time to self-directed study. However, students were aware of international developments in pharmacy education and practice and are receptive to change.

Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers

BACKGROUND

General internists commonly provide medical care for older adults and geriatric education to trainees, but lack the necessary knowledge and skills to fulfill these tasks.

OBJECTIVE

Assess the geriatric training needs of academic general internists in 3 hospital systems in Portland, OR.

DESIGN

Ten focus groups and 1 semi-structured interview. Interview transcripts were analyzed using thematic analysis, a well-recognized qualitative technique.

PARTICIPANTS

A convenience sample of 22 academic general internists and 8 geriatricians from 3 different teaching hospitals.

MEASUREMENTS

We elicited stories of frustration and success in caring for elderly patients and in teaching about their care. We asked geriatricians to recount their experiences as consultants to general internists and to comment on the training of Internists in geriatrics.

RESULTS

In addition to deficits in their medical knowledge and skills, our Internists reported frustration with the process of delivering care to older adults. In particular, they felt ill prepared to guide care transitions for patients, use multidisciplinary teams effectively, and were frustrated with health care system issues. Additionally, general internists' approach to medical care, which largely relies on the medical model, is different from that of geriatricians, which focuses more on social and functional issues.

CONCLUSIONS

Although our findings may not be broadly representative, improving our general internists' abilities to care for the elderly and to teach learners how to do the same should address deficits in medical knowledge and skills, barriers to the processes of delivering care, and philosophical approaches to care. Prioritizing and quantifying these needs and measuring the effectiveness of curricula to address them are areas for future research.

A practical guide to developing effective web-based learning

OBJECTIVE

Online learning has changed medical education, but many "educational" websites do not employ principles of effective learning. This article will assist readers in developing effective educational websites by integrating principles of active learning with the unique features of the Web.

DESIGN

Narrative review.

RESULTS

The key steps in developing an effective educational website are: Perform a needs analysis and specify goals and objectives; determine technical resources and needs; evaluate preexisting software and use it if it fully meets your needs; secure commitment from all participants and identify and address potential barriers to implementation; develop content in close coordination with website design (appropriately use multimedia, hyperlinks, and online communication) and follow a timeline; encourage active learning (self-assessment, reflection, self-directed learning, problem-based learning, learner interaction, and feedback); facilitate and plan to encourage use by the learner (make website accessible and user-friendly, provide time for learning, and motivate learners); evaluate learners and course; pilot the website before full implementation; and plan to monitor online communication and maintain the site by resolving technical problems, periodically verifying hyperlinks, and regularly updating content.

CONCLUSION

Teaching on the Web involves more than putting together a colorful webpage. By consistently employing principles of effective learning, educators will unlock the full potential of Web-based medical education.

Internet resources for curriculum development in medical education: an annotated bibliography

Curriculum development in medical education should be a methodical and scholarly, yet practical process that addresses the needs of trainees, patients, and society. To be maximally efficient and effective, it should build upon previous work and use existing resources. A conventional search of the literature is necessary, but insufficient for this purpose. The internet provides a rich source of information and materials. This bibliography is a guide to internet resources that are of use to curriculum developers, organized into 1) medical accreditation bodies, 2) topic-oriented resources, 3) general educational resources within medicine, and 4) general education resources beyond medicine.