Graphical aid for determining power of clinical trials involving two groups.

Physicians need to evaluate clinical research critically, and determining the power of a study is an essential component of research evaluation. This report presents a graphical aid that permits rapid power determination for clinical trials with two groups. Power curves were developed for dichotomous outcomes by setting two tail alpha at 0.05 and varying the sample size, the control group response rate, and the clinically important difference between control and experimental groups as defined by the user. Use of the graphical aid was demonstrated to a group of 18 medical students, residents, fellows, and faculty in a 15 minute session. Evaluation of the trainees'' application of the aid showed a small average bias of -0.0003 and an average variance of 0.006. Ninety percent of power estimates were within 0.05 of the true value determined by formula. This graphical aid is recommended as a rapid and accurate method for determining power in the critical appraisal of clinical research.     

高职高专医学遗传学"三联系"教学模式初探

摘要: 根据高职高专教育规律、培养目标, 结合高职高专学制、课时及学生特点, 建立了以遗传病为主线的“教学内容与培养目标相联系, 理论教学与临床应用相联系, 实践教学与职业能力相联系”的“三联系”教学模式。三年的教改实践证明: 此种教学模式定位比较合理, 有助于激发学生的学习兴趣, 提高医学遗传学的综合 成绩。     

Creating a surgery clerkship in a changing environment: reality, simulation, and the rules of engagement

This review describes the current challenges associated with creating a successful surgical clerkship and the ways in which teacher-focused and curriculum-focused initiatives can address these challenges. The challenges are both systemic (reflected by changes in our health care system and training programs) and institutional (reflected by factors that affect curriculum design and faculty advancement). Particular attention is paid to residents as teachers, faculty as mentors, the educational impact of the operating room, and the role of simulation. Strategies for engaging students, residents, and faculty are explored. The premise and impact of a comprehensive simulation course on the clinical education of medical students is detailed. Emphasis is placed on the educational validity of accountability and engagement of both the teachers and the learners.     

Comparing biology majors from large lecture classes with TA-facilitated laboratories to those from small lecture classes with faculty-facilitated laboratories

The teaching faculty for this course sought to address their own concerns about the quality of student learning in an impersonal large lecture biology class for majors, the difficulties in getting to know each student by name, and difficulties in soliciting answers and reactions from the students during the lecture. Questions addressed by this study were, Do active-learning activities in a small and personal lecture setting enhance student learning more than active-learning activities in large impersonal lectures? and Are students more satisfied with an educational experience in a small and personal lecture setting? Based on faculty perceptions of how they best relate to their students, the prediction was that the students in the experimental group with small lecture classes and increased direct contact with the teaching faculty would learn physiological principles better than the students in the control group in the large impersonal lecture portion of the course. One of the laboratory sections of this large enrollment biology course was randomly selected to be taught with separate small lectures by the teaching faculty. In addition, the teaching faculty participated in the laboratory with these students during their experiments correlated with the lecture material. The students in both groups were compared by pre- and posttests of physiological principles, final course grades, and class satisfaction surveys.     

Screening for elder mistreatment in dental and medical clinics

doi: 10.1111/j.1741‐2358.2010.00405.x
Screening for elder mistreatment in dental and medical clinics Objective: Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening. Background: Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community‐residing adults over 60 years of age indicate that 11.4% of older adults report some form of elder mistreatment. There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings. Methods: A cross‐sectional study was conducted from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (n = 102) and dental clinics (n = 139). A mini‐mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used [elder assessment instrument (EAI‐R) for medical and Hwalek–Sengstock elder abuse screening test (HS‐EAST) for dental]. Results: For the 241 patients, we were able to compare data from the EAI‐R with the HS‐EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics since we documented patient enrolment of 20% in the medical clinics and 66% in dental clinics. Patients are willing to answer extremely‐sensitive questions related to elder mistreatment and are also willing to use computer technology for interviewing. Conclusion: Dental and medical clinics are important practice venues to screen for elder mistreatment.     

规范医学影像诊断报告书写,提高医学生及住院医师临床技能

医学影像诊断报告是正确行使医疗行为和保证医疗质量的依据,书写高质量的医学影像学诊断报告是医学生及住院医师必须掌握的一项基本功和基本技能。本文将结合我院长期的医学生及住院医师临床教学经验和实际,以神经系统影像报告为例,从医学影像诊断报告的重要性、医学生及住院医师医学影像诊断报告技能教学的现状、规范化医学影像报告书写技能的培养、评估、反馈和评价进行探讨,以期在医学生和住院医师的培养中提高其临床技能,供广大同道在医学教育与实践中借鉴和改进。     

Moral maps and medical imaginaries: clinical tourism at Malawi's College of Medicine

At an understaffed and underresourced urban African training hospital, Malawian medical students learn to be doctors while foreign medical students, visiting Malawi as clinical tourists on short-term electives, learn about “global health.” Scientific ideas circulate fast there; clinical tourists circulate readily from outside to Malawi but not the reverse; medical technologies circulate slowly, erratically, and sometimes not at all. Medicine's uneven globalization is on full display. I extend scholarship on moral imaginations and medical imaginaries to propose that students map these wards variously as places in which—or from which—they seek a better medicine. Clinical tourists, enacting their own moral maps, also become representatives of medicine “out there”: points on the maps of others. Ethnographic data show that for Malawians, clinical tourists are colleagues, foils against whom they construct ideas about a superior and distinctly Malawian medicine and visions of possible alternative futures for themselves.     

“Soetwyn”: Visuality,Cultural Tourism,Desire Paths and the ≠Khomani

Witdraai is home to a few hundred ≠Khomani who resettled there after the successful land claim of 1999. In all, the first phase of their claim granted them ownership of six farms totaling about 40,000 hectares of land. Before this restitution, the Bushmen had been an “Other-diaspora” dispersed by the forces of apartheid and colonialism. Being a small settlement in the vast Kalahari in Northern Cape Province, close to the Botswana border, Witdraai is rarely a cartographic highlight where the province’s main towns, cities and localities are concerned. For over a decade the ≠Khomani have been involved in trying to find solutions to the problem of appropriate development of the six farms for sustainable communal benefit. Alcohol abuse among many of the residents, however, seems to be complicating the search for lasting solutions. This article uses visual stills, collected during the 2011 trip to the Kalahari by University of KwaZulu–Natal researchers from the Centre for Communication, Media and Society (CCMS), to investigate alcohol use/abuse amongst some of the people living at or near Witdraai. The article applies “cultural mapping” of a different sort, focusing selectively on visual traces of the corporeal existence of “alcohol” in the sand-dune landscape of Witdraai against a backdrop of commercial tourist branding of the landscape.     

Digital gestützte Biodiversitätsexkursionen

Digitally supported excursions focusing on biodiversity The current study was conceived in order to constructively counteract the lack of essential experiences of nature and biodiversity knowledge of students. It combines the three fields “biodiversity”, “education” and “biology instruction“ outside the classroom in a context of environmental education in the Thuringian nature reserve Schiefergebirge/Obere Saale with regard to education as a necessary condition for any planned protection of biodiversity worldwide. The pedagogical proceeding focusing the concept of biodiversity was developed for biology instruction outside the classroom by integrating digital media into the learning process in a constructive way. On the basis of a ten-step procedure, biologically based GPS tours (“biotracks”) were created and tested in practice. For this purpose, two student excursions were designed: the first for grade 7 students in the vicinity of Heberndorf, the second for grade 9 students in the Bleilochstausee region. The results of the knowledge tests and records of the excursion journals from both groups indicate positive effects on studentś biodiversity knowledge. The pre-post questionnaires of the grade 7 students reveal the positive effects of biotracks on studentś attitudes and intentional behavior with respect to biodiversity.     

UNDERGRADUATE PSYCHIATRIC EDUCATION—Senior Medical Students Study Patients with the Clinical Team

A course in psychiatry for senior medical students, designed to give all members of the class some direct experience, particularly in therapeutic interviewing as well as in total psychiatric study of patients by the clinically integrated work of medical specialists, psychiatric social workers, and clinical psychologists in collaboration with psychotherapeutically trained and experienced psychiatrists is conducted in the following manner: A third of the class, about 25 students, is divided into four sections of six or seven members, and each section attends five hours one forenoon a week for approximately three months. Each student, after an initial demonstration interview by the instructor, sees weekly the same two clinic patients alone, for 45-minute individual interviews, followed by a one and a half hour supervisory session. After this a 50-minute seminar or treatment review conference is followed by a similar period for writing records of interviews and summaries of the therapeutic work. Of four seminars, two are conducted by the psychiatric faculty, and one each by the social worker and the psychologist. Each student reads a written summary of all his interviews with one patient for discussion by his colleagues in the section and by the faculty from all three disciplines.     

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey

Background

Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i) the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii) the instruments'' potential for differentiating between faculty, and (iii) the number of residents'' evaluations needed per faculty to reliably use the instruments.

Methods and Materials

Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical) specialty training programs in the Netherlands. Two instruments—one completed by residents and one by faculty—for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents'' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses.

Results

A total of 403 (73.8%) residents completed 3575 evaluations of 570 medical faculty while 494 (78.5%) faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach''s alpha of 0.85 for residents'' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75), communication of goals (0.90/0.84), evaluation of residents (0.91/0.81), and feedback (0.91/0.85). Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents'' evaluations per faculty are needed for assessments to attain a reliability level of 0.90.

Conclusions

The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies, can detect between-faculty differences and supply potentially useful information for improving graduate medical education.     

Teaching human cardiovascular and respiratory physiology with the station method

We have developed a station method to offer combined cardiovascular and respiratory physiology exercises all in one laboratory period during our medical physiology course. This laboratory was designed for first-year medical students in order to minimize equipment costs, maximize efficient use of both student and faculty time, and facilitate integration of basic cardiovascular concepts with those in respiratory physiology. We designed six stations for the students to evaluate: cardiovascular and respiratory responses to dynamic exercise, cold pressor reflex, postural influences and respiratory modulation of cardiovascular functions, forced expiratory maneuvers with inverted bell spirometers, forced expiratory maneuvers and maximal inspiratory maneuvers with electronic spirometers with and without obstruction, and respiratory muscle strength. Students worked in groups of two to four and were assessed by individual laboratory reports. Although we neglected to formally assess the impact on students of changes in laboratory design, students appeared to respond enthusiastically to the laboratory and prepared knowledgeable laboratory reports.     

Are online student evaluations of faculty influenced by the timing of evaluations?

Student evaluations of faculty are important components of the medical curriculum and faculty development. To improve the effectiveness and timeliness of student evaluations of faculty in the physiology course, we investigated whether evaluations submitted during the course differed from those submitted after completion of the course. A secure web-based system was developed to collect student evaluations that included numerical rankings (1-5) of faculty performance and a section for comments. The grades that students received in the course were added to the data, which were sorted according to the time of submission of the evaluations and analyzed by Pearson's correlation and Student's t-test. Only 26% of students elected to submit evaluations before completion of the course, and the average faculty ratings of these evaluations were highly correlated [r(14) = 0.91] with the evaluations submitted after completion of the course. Faculty evaluations were also significantly correlated with the previous year [r(14) = 0.88]. Concurrent evaluators provided more comments that were statistically longer and subjectively scored as more "substantive." Students who submitted their evaluations during the course and who included comments had significantly higher final grades in the course. In conclusion, the numeric ratings that faculty received were not influenced by the timing of student evaluations. However, students who submitted early evaluations tended to be more engaged as evidenced by their more substantive comments and their better performance on exams. The consistency of faculty evaluations from year to year and concurrent versus at the end of the course suggest that faculty tend not to make significant adjustments to student evaluations.     

The specialty of colon and rectal surgery: its impact on patient care and role in academic medicine

The specialty of colon and rectal surgery, a specialty of general surgery, has evolved from the field of proctology. Clinical care has demonstrated decreased number of patients requiring intestinal stomas, improved quality of life in patients with benign anorectal disorders, and more favorable results in patients afflicted with primary and recurrent colorectal cancer. Basic science investigations have spawned from clinical questions such as the molecular biology of colorectal cancer, use of cyclooxygenase inhibitors and polyp regression, and novel cytokine antagonists in inflammatory bowel disease. Medical students are exposed to surgeons with expertise in anorectal anatomy and physiology, mechanisms of carcinogenesis and the importance of screening for detection of colorectal cancer, and novel therapies for inflammatory bowel disease. Surgical residents benefit by having a colorectal surgeon on the faculty by repetitive exposure to anorectal surgery, low pelvic anastomoses, stoma creation and closure, and surgery involving the small intestine. Senior colorectal surgeons will develop critical pathways for the healthcare delivery of patients afflicted with colorectal disease. The specialty of colorectal surgery will continue to translate into improved patient care and positively impact in academic medicine by providing expertise into student and resident training and generate highly sophisticated clinical and basic science investigations.     

Therapeutic monoclonal antibodies for respiratory diseases: Current challenges and perspectives,March 31 – April 1, 2016, Tours,France

Monoclonal antibody (mAb) therapeutics have tremendous potential to benefit patients with lung diseases, for which there remains substantial unmet medical need. To capture the current state of mAb research and development in the area of respiratory diseases, the Research Center of Respiratory Diseases (CEPR-INSERM U1100), the Laboratory of Excellence “MAbImprove,” the GDR 3260 “Antibodies and therapeutic targeting,” and the Grant Research program ARD2020 “Biotherapeutics” invited speakers from industry, academic and government organizations to present their recent research results at the Therapeutic Monoclonal Antibodies for Respiratory Diseases: Current challenges and perspectives congress held March 31 – April 1, 2016 in Tours, France.     

A Web-based course of lectures in respiratory physiology

A complete course of respiratory physiology suitable for first-year medical and graduate students has been placed on the Web for our own students and for other educational institutions. There are several reasons for doing this. The first is that the modern-day student uses a variety of options for acquiring knowledge. These include attending lectures, reading texts, iPod downloads, and surfing the internet. This Web-based course is another option that may be preferable for some students. A second reason is that it is becoming increasingly difficult for some medical schools to find faculty members who are willing and able to teach the principles of respiratory physiology. This is a potentially serious problem because a sound knowledge of respiratory physiology will always be necessary for the intelligent practice of medicine. Schools with limited faculty may find it useful to use these Web-based lectures followed by a discussion session with students. Another reason is that some schools have moved away from systematic lectures to case-based discussions, with the possibility that students will not be exposed to some of the principles of respiratory physiology. The hope is that this comprehensive course of lectures will help students to assimilate this important material as the medical school curriculum continues to expand at a rapid rate.     

On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians

We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of ‘patient’ and the role of ‘physician’. As a ‘physician’ the student operates the medical devices to clinically assess ‘patient’ colleagues and records all results in an electronic ‘patient’ record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated.The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students’ transition from preclinical to clinical subjects.