An evaluation of case-based teaching: evidence for continuing benefit and realization of aims

A cross-sectional evaluation of case-based teaching (CBT), a novel physiology learning environment for medical undergraduates, revealed that second, third, and fourth year students, together with their tutors, valued CBT as an experience that met its three major aims. The initiative not only integrated physiology with related basic sciences and clinical medicine but importantly linked students' developing knowledge of theory to practice. CBT was also valued by students as their first introduction to clinical skills, with most tutors believing that it was the nonthreatening environment that helped students gain confidence for their first "real patient" encounters. The greatest support for CBT came from third year medical students, at the crossroads between their preclinical and clinical environments. Fourth year students, now encountering real patients, had moved on to developing their skills in the hospital environment.     

Formative assessment can be fun as well as educational

An understanding of the hormonal basis of normal growth and development, including the changes occurring at puberty, is important foundation knowledge for contemporary medical practice in most fields of medicine. A quiz, testing the important physiological concepts of growth and puberty, was designed using the format of the well-known television game "Who Wants to Be a Millionaire." An evaluation of this formative assessment activity revealed that a cohort of first-year undergraduate medical students valued learning with peers in an enjoyable, interactive environment, where they were able to admit to uncertainties and clarify answers. It also showed that making an educational activity fun need not detract from the focus of giving feedback on learning. Formative assessment, known to produce learning gains in a range of educational settings, is an important activity in contemporary medical education. With a greater emphasis on self-directed learning and less well-defined curriculum boundaries, feedback helps students to understand and apply the important physiological concepts that underpin the practice of medicine.     

Can medical students teach? A near-peer-led teaching program for year 1 students

The General Medical Council states that United Kingdom graduates must function effectively as educators. There is a growing body of evidence showing that medical students can be included as teachers within a medical curriculum. Our aim was to design and implement a near-peer-led teaching program in an undergraduate medical curriculum and assess its acceptability among year 1 students. Students received six tutorials focusing on aspects of cardiac, respiratory, and blood physiology. Tutorials ran alongside standard module teaching. Students were taught in groups of ～30 students/group, and an active teaching approach was used in sessions where possible. Using anonymous evaluations, student feedback was collected for the program overall and for each tutorial. The program was voluntary and open to all first-year students, and 94 (of 138) medical students from year 1 at Brighton and Sussex Medical School were recruited to the study. The tutorial program was popular among students and was well attended throughout. Individual tutorial and overall program quantitative and qualitative feedback showed that students found the tutorials very useful in consolidating material taught within the module. Students found the small group and active teaching style of the near-peer tutors very useful to facilitating their learning experience. The end-of-module written examination scores suggest that the tutorials may have had a positive effect on student outcome compared with previous student attainment. In conclusion, the present study shows that a near-peer tutorial program can be successfully integrated into a teaching curriculum. The feedback demonstrates that year 1 students are both receptive and find the additional teaching of benefit.     

Combination of didactic lectures and case-oriented problem-solving tutorials toward better learning: perceptions of students from a conventional medical curriculum

The Department of Physiology of Pramukhswami Medical College at Anand, Gujarat, India, started using problem-based learning in a modified way along with didactic lectures to improve students' understanding and motivate them toward self-directed study. After the didactic lectures were taken for a particular system, clearly defined short clinical problems related to that system were given to the students in the tutorial classes. Each tutor was assigned three to four groups of five to six students each. Problems were accompanied with relevant questions so as to streamline the thought processes of the first-year undergraduates. The tutor then facilitated the study process, and the students discussed among themselves to derive their solutions. At the end of the sessions, feedback was taken from the students through a planned questionnaire on a three-point scale. Of a total of 278 students over a span of 3 yr from 1999 to 2002, 74.4% of students favored a judicious mixture of didactic lectures and case-oriented problem solving in tutorial classes to be an efficient modality in understanding a system under study, and 84% of students stated the mixture of didactic lectures and case-oriented problem solving to be beneficial in relating a clinical condition to the basic mechanism; 82% of students believed that this module helped with better interactions among their batch mates, and 77.2% of students hoped to perform better in the university examination due to this new teaching/learning modality. They also expressed that this gave them ample motivation to do self-directed learning. It may therefore be concluded from the results of the present study that it is possible to have a problem-based learning module in the form of case-oriented problem-solving tutorials coexistent with the traditional didactic lecture module in the first year of medical education under a conventional curriculum.     

Internet-based medical education

The Internet is revolutionizing medical education and medical practice by enabling teachers and students to utilize and integrate many forms of data in ways that cannot be done via classic textbooks. In cardiovascular medicine, dynamic images are essential for understanding cardiac function, coronary anatomy, and myocardial perfusion, as well as for learning cardiovascular pathophysiology and the typical and atypical presentations of disease states. Cardiosource, an educational Web site developed by the American College of Cardiology, illustrates the ways in which the Internet is being used to improve medical education and practice.     

Evolution of the New Pathway curriculum at Harvard Medical School: the new integrated curriculum

In 1985, Harvard Medical School adopted a "New Pathway" curriculum, based on active, adult learning through problem-based, faculty-facilitated small-group tutorials designed to promote lifelong skills of self-directed learning. Despite the successful integration of clinically relevant material in basic science courses, the New Pathway goals were confined primarily to the preclinical years. In addition, the shifting balance in the delivery of health care from inpatient to ambulatory settings limited the richness of clinical education in clinical clerkships, creating obstacles for faculty in their traditional roles as teachers. In 2006, Harvard Medical School adopted a more integrated curriculum based on four principles that emerged after half a decade of self-reflection and planning: (1) integrate the teaching of basic/population science and clinical medicine throughout the entire student experience; (2) reestablish meaningful and intensive faculty-student interactions and reengage the faculty; (3) develop a new model of clinical education that offers longitudinal continuity of patient experience, cross-disciplinary curriculum, faculty mentoring, and student evaluation; and (4) provide opportunities for all students to pursue an in-depth, faculty-mentored scholarly project. These principles of our New Integrated Curriculum reflect our vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership.     

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

医学专业学生确立自主学习观的必要性和重要性

目前,高等医学教育的主要任务是培养学生的综合能力,对于医学院校的学生来说,掌握扎实的医学基础知识至关重要。然而,大多医学专业的学生习惯于被动接受老师传授的知识,而严重缺乏主观能动性。医学知识涉及的内容广、难度大,初学者很难迅速掌握其精髓之处,因此确立一种高效的学习模式帮助医学生更好的理解并掌握专业理论是医学院校教育改革的重点。自主学习能力是现代教育学所提倡的相对于传统学习模式的一种现代化学习理念。自主学习的主体是学生,自主学习的过程要求主体发挥其主观能动性,自我督促、自我激励,以独立自主的方式完成高效的学习,帮助学生牢固地掌握专业理论,同时又可以灵活的运用在临床实践中。本文通过对自主学习的含义进行阐述,分析医学生确立自主学习观的必要性和重要性,并对如何确立自主学习观提出相应的建议,以推进我校教育体制改革的进度,进一步完善医学教育教学的质量。     

What can experience add to early medical education? Consensus survey

Objective To provide a rationale for integrating experience into early medical education (“early experience”).Design Small group discussions to obtain stakeholders'' views. Grounded theory analysis with respondent, internal, and external validation.Setting Problem based, undergraduate medical curriculum that is not vertically integrated.Participants A purposive sample of 64 students, staff, and curriculum leaders from three university medical schools in the United Kingdom.Results Without early experience, the curriculum was socially isolating and divorced from clinical practice. The abruptness of students'' transition to the clinical environment in year 3 generated positive and negative emotions. The rationale for early experience would be to ease the transition; orientate the curriculum towards the social context of practice; make students more confident to approach patients; motivate them; increase their awareness of themselves and others; strengthen, deepen, and contextualise their theoretical knowledge; teach intellectual skills; strengthen learning of behavioural and social sciences; and teach them about the role of health professionals.Conclusion A rationale for early experience would be to strengthen and deepen cognitively, broaden affectively, contextualise, and integrate medical education. This is partly a process of professional socialisation that should start earlier to avoid an abrupt transition. “Experience” can be defined as “authentic human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional.”     

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?     

The Adequacy of Education for General Practice: A Medical Educator's Viewpoint

The effect on medical education of the doubling of medical knowledge every 10 years is discussed. A brilliant student who might successfully master all the present facts and theories by graduation would be seriously out of date 10 years later, and hopelessly so by retirement age unless he continued his education while in practice. Lengthening the undergraduate course is not considered an effective solution, nor is increasing the general practice internship to two years. Emphasis should be placed on self-education by the medical student, on the inculcation of habits of study and motivation to encourage lifelong learning, and on the provision of more adequate programs of continuing education for the practising doctor. Teachers in medical schools require a better understanding of and interest in the learning processes of their students rather than concentrating on the exposition of their own knowledge.     

新形势下医学课程整合的现状与建议

随着医学教育方式不断被创新与改善,单一的医学课程教育模式已经不能满足于新形势下医学生的培养。医学课程整合可以将学科知识串联在一起,形成有机的融合。其具有综合性、多元化的特点,便于医学生对所学知识的理解与应用。目前,在实行医学课程整合中存在着师资力量薄弱、学生素质参差不一、医学院校课程设置不合理、教学资源缺乏以及缺少统一的课程整合的评价标准等现状问题。因此有效的实施医学课程整合,仍需各医学院校因地制宜采取相应措施,通过调整课程结构、提升师生素质,建立起有效的评价措施等手段来促进与改善医学课程整合。     

“小组学习”模式在基础医学课程中的实践应用：以医学免疫学为例

将"小组学习"模式应用于基础医学课程"医学免疫学"的教学,在理论课堂采用案例导学、问题导学、角色转换导学和专题讨论导学,实践教学过程针对课堂实验、实验选修课和大学生创新创业项目进行层次化导学。综合运用思维导图、问卷星、成长袋等多元化教学方法和手段,编写思政案例库进行专业课课程思政,结合小组过程性考核进行多元化考核评价。该模式通过培养学生自主学习能力、小组合作能力、实践能力、创新能力和人文素质,为培养高素质、高能力的应用型医学人才奠定基础。该教学模式得到了绝大多数学生的认同,可为基础医学及其他相关课程的开展及高校人才培养提供思路和参考。     

微生物学课程基于教师深度教学新策略的实践应用

随着教育的不断发展,深度学习已成为教育教学追求的目标。本文通过深度教学意识、激发学生积极人格、利用多元化信息资源、营造学习成果展示氛围、深化教学反思和教学评价层次等方面进行新策略的教学实践后,学生学会了在新旧知识之间建立联系,锻炼了高阶思维能力并养成了终身学习的习惯,有效达成了深度教学的目标。     

Using computer-based tutorials to encourage reflection

There is some evidence to suggest that undergraduate biology students need to be given more opportunities for reflection in their education. Some argue that computer-based learning packages may be able to offer such opportunities. This paper presents four different approaches to defining what reflection is and how it can be promoted. These approaches are then used to discuss and review the different ways in which computer-based tutorials can be used to promote lateral thinking. An example of a web-based biology tutorial called ‘How Now Mad Cow’ is described and preliminary evaluation results are presented, in order to illustrate how students may be encouraged to reflect and what factors may influence that. Finally, the role of the tutor in enspiring students to reflect while using computer-based tutorials is discussed. This distinguishes between the role of the tutor in designing a computer-based tutorial, and the role of the tutor in determining and facilitating how a student uses a tutorial once it has been designed.     

Applying instructional design theories to bioinformatics education in microarray analysis and primer design workshops

The need to support bioinformatics training has been widely recognized by scientists, industry, and government institutions. However, the discussion of instructional methods for teaching bioinformatics is only beginning. Here we report on a systematic attempt to design two bioinformatics workshops for graduate biology students on the basis of Gagne's Conditions of Learning instructional design theory. This theory, although first published in the early 1970s, is still fundamental in instructional design and instructional technology. First, top-level as well as prerequisite learning objectives for a microarray analysis workshop and a primer design workshop were defined. Then a hierarchy of objectives for each workshop was created. Hands-on tutorials were designed to meet these objectives. Finally, events of learning proposed by Gagne's theory were incorporated into the hands-on tutorials. The resultant manuals were tested on a small number of trainees, revised, and applied in 1-day bioinformatics workshops. Based on this experience and on observations made during the workshops, we conclude that Gagne's Conditions of Learning instructional design theory provides a useful framework for developing bioinformatics training, but may not be optimal as a method for teaching it.     

全球化背景下医学伦理学教学改革的探索

医学伦理学理论和实践根植于一定时期的社会经济、文化和教育,并随之发生改变和发展。随着全球经济一体化的进展完善,不同国家的文化和教育已在全球范围内互联互通并进而影响异乡本土医学文化。从目前我国医学伦理学教育和实践看,医学伦理学教学及评价体系已不能满足日新月异的全球化医学发展进程。本文从传统医学文化和医学伦理学的理论渊源入手,针对我国医学伦理学教学实践中存在的德性培育重视不足、临床决策能力培养缺失、标准化评价体系缺失等主要问题,探析教学改革的路径,以促进医学伦理学教学理论和实践的发展。     

Treatment of specific macrovascular beds in patients with diabetes mellitus

Background

A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts.

Methods

This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year.

Results

We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score.

Conclusions

This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.     

Who wants to be a physician? An educational tool for reviewing pulmonary physiology

Traditional review sessions are typically focused on instructor-based learning. However, experts in the field of higher education have long recommended teaching modalities that incorporate student-based active-learning strategies. Given this, we developed an educational game in pulmonary physiology for first-year medical students based loosely on the popular television game show Who Wants To Be A Millionaire. The purpose of our game, Who Wants To Be A Physician, was to provide students with an educational tool by which to review material previously presented in class. Our goal in designing this game was to encourage students to be active participants in their own learning process. The Who Wants To Be A Physician game was constructed in the form of a manual consisting of a bank of questions in various areas of pulmonary physiology: basic concepts, pulmonary mechanics, ventilation, pulmonary blood flow, pulmonary gas exchange, gas transport, and control of ventilation. Detailed answers are included in the manual to assist the instructor or player in comprehension of the material. In addition, an evaluation instrument was used to assess the effectiveness of this instructional tool in an academic setting. Specifically, the evaluation instrument addressed five major components, including goals and objectives, participation, content, components and organization, and summary and recommendations. Students responded positively to our game and the concept of active learning. Moreover, we are confident that this educational tool has enhanced the students' learning process and their ability to understand and retain information.     

An interactive modeling lesson increases students' understanding of ploidy during meiosis

Chromosome structure is confusing to students at all levels, and chromosome behavior during meiosis is a notoriously difficult topic. Undergraduate biology majors are exposed to the process of meiosis numerous times during their presecondary and postsecondary education, yet understanding of key concepts, such as the point at which haploidy is established, does not improve substantially with repeated exposure. Based on student's drawings, 96% of intermediate-level biology majors have unclear or incorrect ideas about meiosis. Students have difficulty diagramming the process of meiosis starting with three unreplicated pairs of chromosomes, and even when they can produce an accurate diagram, they are unclear how to assign the terms "haploid" and "diploid." We designed an interactive lesson based on constructivist theory to address these issues in a large lecture class. Pretest and posttest scores showed a significant improvement in students' understanding of ploidy compared to a parallel class taught in the traditional way (e.g. using the textbook diagrams). In interviews afterward, those students whose scores improved on exams specifically pointed to the features of the in-class modeling that were deliberately incorporated for that purpose.