Perspectives in medical education 5. Implementing a more integrated, interactive and interesting curriculum to improve Japanese medical education

Impact of Integrated Teaching Sessions for Comprehensive Learning and Rational Pharmacotherapeutics for Medical Undergraduates

Background:

It is postulated that integrated teaching method may enhance retention of the knowledge and clinical applicability of the basic sciences as compared to the didactic method.

Aim:

The present study was undertaken to compare the integrated teaching method with the didactic method for the learning ability and clinical applicability of the basic sciences.

Materials and Methods:

The 2^nd year MBBS students were divided into two groups randomly. The study was conducted into two stages. In the first stage, conventional didactic lectures on hypertension (HT) were delivered to one group and multidisciplinary integrated teaching to another group. For the second stage, diabetes mellitus groups were swapped. Retention of the knowledge between the groups were assessed through a multiple choice questions (MCQ) test. Feedback of the students and faculty was obtained on a 5 point Likert scale. For the comparison, student's data were regrouped into four groups, i.e., integrated HT, didactic HT, integrated diabetes and didactic diabetes.

Results:

There was no significant difference of MCQ score between integrated HT, didactic HT, and integrated diabetes group. However, the score obtained in didactic diabetes was significantly more (P = 0.00) than other groups. Majority of the students favored integrated teaching for clinical application of basic science and learning of the skill for the future clinical practice. Faculties considered integrated method as a useful method and suggested frequent use of this method.

Conclusion:

There was no clear difference in knowledge acquisition; however, the students and faculties favored integrated teaching method in the feedback questionnaire.

A first report of East Asian students' perception of progress testing: a focus group study

BACKGROUND

Progress testing (PT) is used in Western countries to evaluate students' level of functional knowledge, and to enhance meaning-oriented and self-directed learning. However, the use of PT has not been investigated in East Asia, where reproduction-oriented and teacher-centered learning styles prevail. Here, we explored the applicability of PT by focusing on student perceptions.

METHODS

Twenty-four students from Years 2, 3, and 5 at Jichi Medical University in Japan attended a pilot PT session preceded by a brief introduction of its concept and procedures. Variations in obtained test scores were analyzed by year, and student perceptions of PT were explored using focus groups.

RESULTS

Formula scores (mean ± standard deviation) in Years 2, 3, and 5 were 12.63 ± 3.53, 35.88 ± 14.53, and 71.00 ± 18.31, respectively. Qualitative descriptive analysis of focus group data showed that students disfavored testing of medical knowledge without tangible goals, but instead favored repetitive assessment of knowledge that had been learned and was tested on a unit basis in the past in order to achieve deep learning. Further, students of all school years considered that post-test explanatory lectures by teachers were necessary.

CONCLUSIONS

East Asian students' perceptions indicated that, in addition to their intensive memorization within narrow test domains compartmentalized by end-of-unit tests, the concept of PT was suitable for repetitive memorization, as it helped them to integrate their knowledge and to increase their understanding. Post-test explanatory lectures might lessen their dislike of the intangible goals of PT, but at the expense of delaying the development of self-directed learning. Key issues for the optimization of PT in East Asia may include administration of PT after completed end-of-unit tests and a gradual change in feedback methodology over school years from test-oriented post-test lectures to the provision of literature references only, as a means of enhancing test self-review and self-directed learning.

Effectiveness of integrated teaching module in pharmacology among medical undergraduates

Context:

Over the years with advancement of science and technology, each subject has become highly specialized. Teaching of medical students has still remained separate in various departments with no scope of integration in majority of medical institutes in India. Study was planned to have an experience of integration in institute and sensitize faculty for integrated teaching–learning (TL) method.

Aims:

To prepare and test effectiveness of integrated teaching module for 2^nd year MBBS student in pharmacology and to sensitize and motivate faculties toward advantages of implementing integrated module.

Settings and Design:

Education intervention project implemented 2^nd year MBBS students of Government Medical College and New Civil Hospital, Surat.

Subjects and Methods:

Students of second MBBS were divided into two groups. One group was exposed to integrated teaching sessions and another to traditional method. Both the groups were assessed by pre- and post-test questionnaire, feedback and focus group discussions were conducted to know their experience about process.

Results:

A total of 165 students of the 2^nd year MBBS were exposed to the integrated teaching module for two topics in two groups. One group was taught by traditional teaching, and another group was exposed to the integrated TL session. Both the groups have shown a significant improvement in posttest scores but increase in mean score was more in integrated group. During analysis of feedback forms, it was noted that students preferred integrated TL methods since they help in better understanding. Faculty feedback shows consensus over the adaptation of integrated TL methods.

Conclusions:

Integrated TL sessions were well-appreciated by students and faculties. To improve the critical reasoning skills and self-directed learning of students, integrated TL is highly recommended for must know areas of curriculum.

Content analysis of medical students' seminars: a unique method of analyzing clinical thinking

BACKGROUND

The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar).

METHODS

The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students' verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking.

RESULTS

The most basic level of verbal simple responses accounted for a majority (85%) of the total students' verbal comments. Only 15% of the students' comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students' verbal response time for the four sessions with the male instructor was 6.9%; total mean students' verbal response time for the four sessions with the female instructor was 19% (p < 0.05).

CONCLUSIONS

This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.

Anatomy as the backbone of an integrated first year medical curriculum: design and implementation

Morehouse School of Medicine chose to restructure its first year medical curriculum in 2005. The anatomy faculty had prior experience in integrating courses, stemming from the successful integration of individual anatomical sciences courses into a single course called Human Morphology. The integration process was expanded to include the other first year basic science courses (Biochemistry, Physiology, and Neurobiology) as we progressed toward an integrated curriculum. A team, consisting of the course directors, a curriculum coordinator, and the Associate Dean for Educational and Faculty Affairs, was assembled to build the new curriculum. For the initial phase, the original course titles were retained but the lecture order was reorganized around the Human Morphology topic sequence. The material from all four courses was organized into four sequential units. Other curricular changes included placing laboratories and lectures more consistently in the daily routine, reducing lecture time from 120 to 90 minute blocks, eliminating unnecessary duplication of content, and increasing the amount of independent study time. Examinations were constructed to include questions from all courses on a single test, reducing the number of examination days in each block from three to one. The entire restructuring process took two years to complete, and the revised curriculum was implemented for the students entering in 2007. The outcomes of the restructured curriculum include a reduction in the number of contact hours by 28%, higher or equivalent subject examination average scores, enhanced student satisfaction, and a first year curriculum team better prepared to move forward with future integration.

The new Japanese postgraduate medical education and quality of emergency medical care

BACKGROUND

The new postgraduate medical education (PGME) was recently introduced to improve quality of emergency care in Japan.

OBJECTIVES

To compare the quality of care and confidence in provision of emergency medicine between physicians who completed the old and new PGME programs.

METHODS

A cross-sectional survey was sent to 279 physicians of postgraduate years 4-9, and 208 responses (75%) were received. Quality of care in emergency medicine was measured using 26 questions on treatment choices for various clinical conditions. Each question had six responses, including a single correct choice. Effect size was obtained by dividing the total difference in score by the standard deviation of the score distribution. Confidence in emergency medicine was rated using four self-reported items on the level of confidence in treating acute illnesses in various emergency medicine settings.

RESULTS

The mean score for quality of care was significantly higher in the new PGME group (15.3) compared to the old PGME group (12.8). The difference in scores was 2.5 (p < 0.01) and the effect size (0.47) indicated a moderate difference. Linear regression of total scores adjusted for physician covariates produced similar results of an adjusted score difference of 2.5 (p < 0.01) and an adjusted effect size of 0.47. The new PGME group also had significantly greater confidence in provision of emergency medicine based on significant differences between the groups for all four self-reported items (all p < 0.05).

CONCLUSIONS

Japanese physicians who complete the new PGME program are likely to provide higher quality of care and have greater confidence in emergency medicine compared to those who completed the old PGME program.

Perspectives in medical education 9. Revisiting the blueprint for reform of medical education in Japan

Reform of medical education at Keio University has been underway since 2003. We measure the progress made since then in five specific categories that span fifteen recommendations presented in our "Blueprint for Reform" at the outset of the effort. These are effectiveness of leadership, curriculum reform, recognition of teaching, clinical competence, and comprehensive training in general internal medicine (GIM). First, effective leadership is being sustained through a succession of Deans, although a potentially crippling loss of leadership in the Department of Medical Education must be offset through timely appointment. Second, curriculum reform is awaiting the implementation in 2012 of an integrated, organ system-based curriculum with an emphasis on ward clerkships, but the introduction of PBL has been delayed indefinitely. Third, teaching is being recognized through the use of student feedback to reward good teachers and through funds for six full-time equivalent salaries dedicated to medical education, but promotions still depend exclusively on research, without consideration of teaching ability. Fourth, clinical skills training is still lacking, although enthusiasm for it seems to be building, thanks to the presence on the wards of a (still miniscule) cadre of dedicated teachers. Finally, exposure to GIM remains non-existent; however, visionary leadership in a newly-independent Emergency Department and the wide variety of medical problems seen there provide a remarkable opportunity to craft a uniquely Japanese solution to the problem. The changes implemented to date are impressive, and we remain enthusiastic about the future, even as we recognize the magnitude of the task that lies ahead.

Perspectives in medical education 8. Enhancing preclinical education in Japan with a clinically focused, interactive anatomy curriculum

Reform of preclinical medical education in Japan requires changes in the curriculum to make it more clinically focused and interactive. At present, course content in Anatomy is usually designed and taught with little or no clinical direction and involves a heavy emphasis on by-rote learning to memorize often minor facts that have little importance in clinical medicine. As a result, the content is boring, it is learned solely for the purpose of passing exams and it is promptly forgotten, with little sense of its need in clinical practice. Successful reform of the curriculum in Anatomy requires two critical changes. The first is that content must be made interesting to students by emphasizing its clinical importance, through a close collaboration between preclinical and clinical departments, Thus, the Surgical Faculty must be incorporated in the organization and teaching of the Anatomy curriculum. Core content can thereby be pared down to only what is considered essential to provide a foundation for the later clinical years, and the clinical importance of that content will, in turn, be self-evident to students. The second change that must be implemented is to make the learning process more appealing to the students. This can be facilitated by the use of any of several commercial IT programs that make learning in Anatomy both dynamic and engaging. These dual strategies will considerably enhance the learning of one of the most basic subjects in the medical school and ensure that the review and retention of the material are enhanced.