International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of S?o Paulo School of Medicine in Ribeir?o Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.     

Ethics,jurisprudence, and economics in the medical school curriculum.

Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians'' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students.     

'Pals'. A medical student public service program.

We designed a public service and educational program to aid children and families coping with chronic illness and to augment medical student education. Medical students developed relationships with chronically ill children and families based on the Big Brother-Big Sister program model. In addition, students attended bimonthly seminars on childhood chronic illness and family dynamics. Medical students learned about the psychosocial aspects of illness through these relationships and reported that the program contributed to their sense of worth as caregivers. By fostering students'' innate altruism, medical schools may succeed in cultivating caring and humanism in their student physicians. We propose a model that encourages medical students to relate personally with patients and their families. A program such as this has the potential to nurture compassion in medical students, contribute to medical education, and provide support to patients and families.     

探索病理学教学改革,培养高素质医学人才

病理学是医学院校的重要基础课,高质量的病理学教学是培养高素质医学人才的必要基础。从更新教学内容,科学运用新的教学方法及多种现代化教学手段等方面探讨了当代病理学教学改革。     

Bullying among medical students in a Saudi medical school

ABSTRACT: BACKGROUND: Bullying and sexual harassment of medical students by their teachers appears to be widespread phenomenon. However, nothing is published about its prevalence in conservative countries such as Saudi Arabia. This survey aims to ascertain the extent of these mistreatments among students in a Saudi medical school. FINDINGS: A cross-sectional questionnaire survey was conducted on a group of 542 clinical years' medical students in a Saudi medical school to explore students' perceptions of their educational environment including exposure to different kinds of bullying. Bullying was defined as "a "persistent behaviour against a medical student that is intimidating, degrading, offensive or malicious and undermines the confidence and self- esteem of the recipient". Results revealed that more than one quarter (28.0 %) of the surveyed students reported exposure to some sort of bullying during their clinical . Ninety percent of the reported insults were verbal, 6 % sexual and 4 % physical. Males were more exposed but difference was not statistically significant. CONCLUSIONS: Bullying among Saudi medical students is an existing problem. A policy against bullying and harassment should be adopted in all of medical colleges to monitor this phenomenon and support students who have been bullied.     

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。     

The interface between medical anthropology and medical ethnobiology

Medical anthropology is concerned with both the causes and consequences of human sickness, and its various theoretical orientations can be grouped into four major approaches: medical ecology, critical medical anthropology, interpretative medical anthropology, and ethnomedicine. While medical anthropologists of all theoretical persuasions have examined why people get sick, the analysis and understanding of patterns of treatment has been largely confined to ethnomedicine. Historically, more emphasis has been placed on the personalistic or supernatural aspects of ethnomedical systems than on naturalistic or empirical components. While this focus has produced valuable insights into the role of ritual and belief in healing, it has led to the impression that traditional medicine is primarily symbolic. Moreover, it ignores the theoretical bases of traditional healing strategies and the practical means by which most of the world heals itself, namely plants. Recently there has been more interest in the empirical character of ethnomedical systems, and in this paper we consider the role that medical ethnobiology has played in this shift of focus. We begin with a brief history of medical anthropology to illuminate why naturalistic medicine was neglected for so long. We then review exemplary research in two areas of medical ethnobiology – ethnophysiology and medical ethnobotany – that address the study of naturalistic aspects of medical systems. We conclude with suggestions for future research at the interface between medical ethnobiology and medical anthropology that will contribute to both fields.     

形成性评价在医学微生物教学中的应用体会

形成性评价注重的是学习过程和师生互动,由反馈-鼓励-指导三个环节组成.形成性评价有利于对学生自主学习和创新思维能力的培养.本文就医学微生物教学中形成性评价的应用从提高教师的认识、具体实施过程以及应用过程中的收获谈了自己的体会.     

Medical students as medical educators: opportunities for skill development in the absence of formal training programs

All physicians, at some point in their career, are responsible for the education of their peers and junior colleagues. Although medical students are expected to develop clinical and research skills in preparation for residency, it is becoming clear that a student should also be expected to develop abilities as a teacher. A handful of institutions have student-as-teacher programs to train medical students in education, but most students graduate from medical school without formal training in this area. When such a program does not exist, medical students can gain experience in education through participation in peer teaching, course design, educational committees, and medical education scholarship. In doing so, they attain important skills in the development, implementation, and evaluation of educational programs. These skills will serve them in their capacity as medical educators as they advance in their careers and gain increasing teaching responsibility as residents, fellows, and attending physicians.     

Demonstrating social accountability in medical education

The author considers the University of Toronto''s Health, illness and the Community course for undergraduate medical students, described in this issue by Wasylenki and associates (see pages 379 to 383). Social accountability in medical education demands a community orientation and hence an emphasis on outreach. Medical schools should expand their clinical service to the community, provide community-based residency placements and offer continuing medical education in rural and regional centres. Accountability also requires community involvement in planning and implementing research projects. Placing students in a community setting as part of the curriculum is praiseworthy, but it is not sufficient to ensure social accountability. What is needed now is a more comprehensive acceptance by faculties of medicine of the mandate of community-centred learning, together with well-targeted funding for education and research initiatives.     

Undergraduate medical education.

Pressures from students and teachers, from professional bodies, and from changes in the way health care is delivered are all forcing a rethink of how medical students should be taught. These pressures may be more intense in London but are not confined to it. The recommendation the Tomlinson report advocates that has been generally welcomed is for more investment in primary care in London. General practitioners have much to teach medical schools about effective ways of learning, but incentives for teaching students in general practice are currently low, organising such teaching is difficult and needs resources, and resistance within traditional medical school hierarchies needs to be overcome. Likewise, students value learning within local communities, but the effort demanded of public health departments and community organisations is great at a time when they are under greater pressure than ever before. The arguments over research that favour concentration in four multifaculty schools are less clear cut for undergraduate education, where personal support for students is important. An immediate concern is that the effort demanded for reorganising along the lines suggested by Tomlinson will not leave medical schools much energy for innovating.     

Empathy in UK medical students: differences by gender, medical year and specialty interest

The importance of empathetic communication in the context of patient care has been suggested as a crucial element in the delivery of high-quality medical care. Although some countries have measured empathy among medical students, little is known formally about the state of affairs regarding empathy in the UK with regard to gender, medical years and speciality. This paper presents the results from a cross-sectional study that explored the relationship between undergraduate medical students' empathy scores relevant to gender, medical school year and future career ambitions. The Jefferson Scale of Physician Empathy, a self-administered questionnaire, was used for collecting data. It was decided to incorporate the scale into a web application that was only accessible through a confidential hyperlink. A total of 853 (68.2%) medical students completed the survey. Female students (n=470) scored significantly (t((819))=-6.63; 95% CI=-0.30, -0.16) higher than male students (n=351). No significant differences were observed between empathy mean scores and medical school year. Students choosing people-oriented specialities had significantly higher mean scores in comparison to students preferring technology oriented specialities. Three hypotheses were tested in this study. The hypothesis that female students would score higher than male students was supported by the results. The findings did not support the hypothesis that empathy scores decline during the medical school years. Finally, the findings did support the hypothesis that those preferring peopleoriented specialities would score higher on the empathy scale than students choosing technology oriented specialities. Some recommendations are made and the limitations of study are discussed.     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

Competencies in premedical and medical education: the AAMC-HHMI report

One hundred years ago, Flexner emphasized the importance of science in medicine and medical education. Over the subsequent years, science education in the premedical and medical curricula has changed little, in spite of the vast changes in the biomedical sciences. The National Research Council, in their report Bio 2010, noted that the premedical curriculum caused many students to lose interest in medicine and in the biological sciences in general. Many medical students and physicians have come to view the premedical curriculum as of limited relevance to medicine and designed more as a screening mechanism for medical school admission. To address this, the Association of American Medical Colleges and the Howard Hughes Medical Institute formed a committee to evaluate the premedical and medical school science curricula. The committee made a number of recommendations that are summarized in this essay. Most important were that competencies replace course requirements and that the physical sciences and mathematics be better integrated with the biological sciences and medicine. The goal is that all physicians possess a strong scientific knowledge base and come to appreciate the importance of this to the practice of medicine. While science education needs to evolve, Flexner's vision is as relevant today as it was 100 years ago.     

Mapping the factors that influence the career specialty preferences by the undergraduate medical students

It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty ‘matched their capabilities’ and 82 (37.2%) perceived their selection as “innovative field in medicine”. Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees’ capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.     

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.     

Teaching medical students how to break bad news

PROGRAM OBJECTIVE: To teach medical students to break bad news to patients and their families empathically and competently. SETTING: Seven teaching hospitals affiliated with the University of Toronto since 1987. PARTICIPANTS: All medical students in their third preclinical year. PROGRAM: The course presents a 6-point protocol to guide students in breaking bad news and comprises 2 half-day (3-hour) teaching sessions. Each session incorporates a video presentation, a discussion period and small-group teaching, consisting of exercises followed by 4 different role-playing scenarios conducted with the use of standardized patients. The course was evaluated through 2 questionnaires, 1 administered before and 1 after the course, which measured changes in the students'' attitude and strategy. Questionnaires were administered during 5 of the years since the course was started. A total of 914 precourse and 503 postcourse questionnaires were completed, of which 359 matched pairs of precourse and postcourse questionnaires were analysed to study any changes due to the course. OUTCOMES: Precourse questionnaires showed that 68% of the students had thought about the task of breaking bad news often or very often. Of the 56% of students who had seen clinicians performing this task, 75% felt that they had seen good examples. The proportion of the students who had a plan for how to conduct such an interview rose from 49% before the course to 92% after it, and the proportion who felt they might be reasonably competent in breaking bad news rose from 23% before the course to 74% after it. CONCLUSIONS: The subject of breaking bad news is important to medical students, and it is practicable to design a course to teach the basic techniques involved. Most students perceive such a course as enjoyable and useful and find that it increases their sense of competence and their ability to formulate a strategy for such situations.     

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.     

Antibiotic abuse: the testimony of medical students.

Surveys of the use of antimicrobial drugs on students during antimicrobial drugs on students during their first 15 months in medical or dental school indicate that they have been treated with these agents at least three times as frequently as seems reasonable, and that the tetracyclines, ampicillin, penicillin G and erythromycin are the chief drugs overused. Antimicrobiol therapy is frequently instituted for probable viral respiratory tract infections and without any attempt to establish a bacteriologic diagnosis. It is likely that anitmicrobiol agents are used more widely in treating the general public in Canada than in treating medical students. Improvements in the rational use of this important group of drugs could increase the quality and probably reduced the cost of medical care.