The consultant's role in continuing medical education of general practitioners: the case of rheumatology.

Consultant rheumatologists were surveyed by questionnaire about their contribution to the continuing education of general practitioners, and 84% (203/243) replied. Altogether 157 respondents had participated in some form of teaching, 147 in collective teaching sessions such as lectures and 99 in the teaching of small groups. Arthritis comprised 44% of the rheumatological topics taught; there was a noticeable lack of teaching on problems commonly encountered in general practice, such as soft tissue rheumatism and injury and back pain, and on clinical skills including examination and injection of joints. Eighty eight respondents made comments and suggestions. The favoured educational strategies were small group teaching, apprenticeship schemes, and interchange between general practitioners and consultants about shared cases. This contrasts with what was typically done--namely, formal lectures on rheumatoid arthritis in postgraduate medical centres. These findings raise questions about the continuing education of consultants themselves as well as about the consultants'' role in teaching others.     

Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students

Medicine is an applied science, interpreting evidence and applying it to real life by using clinical reasoning skills and experience. COPT (clinically oriented physiology teaching) was incorporated in physiology instruction aiming to relate the study of physiology to real-life problems, to generate enthusiasm and motivation for learning, and to demonstrate the vocational relevance of physiology among students by integrating clinical experience with teaching. COPT consisted of two elements: 1) critical-thinking questions (CTQ) and 2) clinical case studies. After a few topics were taught, CTQ and case studies were given as an assignment. Answers were discussed in the next class. Two exams, each of which contained CTQ and recall questions, were conducted, one before (exam 1) and one after (exam 2) the implementation of COPT. Analysis of student performance in the examinations revealed that the students did better in exam 2 (P < 0.0001). Feedback from students indicated that this method was useful and challenging.     

A Familiar(ity) Problem: Assessing the Impact of Prerequisites and Content Familiarity on Student Learning

Prerequisites are embedded in most STEM curricula. However, the assumption that the content presented in these courses will improve learning in later courses has not been verified. Because a direct comparison of performance between students with and without required prerequisites is logistically difficult to arrange in a randomized fashion, we developed a novel familiarity scale, and used this to determine whether concepts introduced in a prerequisite course improved student learning in a later course (in two biology disciplines). Exam questions in the latter courses were classified into three categories, based on the degree to which the tested concept had been taught in the prerequisite course. If content familiarity mattered, it would be expected that exam scores on topics covered in the prerequisite would be higher than scores on novel topics. We found this to be partially true for “Very Familiar” questions (concepts covered in depth in the prerequisite). However, scores for concepts only briefly discussed in the prerequisite (“Familiar”) were indistinguishable from performance on topics that were “Not Familiar” (concepts only taught in the later course). These results imply that merely “covering” topics in a prerequisite course does not result in improved future performance, and that some topics may be able to removed from a course thereby freeing up class time. Our results may therefore support the implementation of student-centered teaching methods such as active learning, as the time-intensive nature of active learning has been cited as a barrier to its adoption. In addition, we propose that our familiarity system could be broadly utilized to aid in the assessment of the effectiveness of prerequisites.     

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.     

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.     

Problem-based learning within endocrine physiology lectures

Methods were needed to improve the interest of medical students in the 10-lecture Endocrine Physiology block at the end of the second semester of study. Other incentives for improvement included the possibility of attracting students into endocrine research electives and the pressure to improve teaching approaches that results from the high tuition they pay. The principal approach adopted was that of whole class problem-based learning sessions (PBLS) in which the lecture period begins with a brief overview of one to three simplified cases, followed by the usual didactic lecture. At the end of the lecture, each PBL case is read in detail, with several questions posed to the students. Their answers are then used to reinforce concepts from the lecture material. This method can also provide some continuity between lectures, either by using a case in several lectures to illustrate different points, or by posing a question at the beginning of class that illustrates a point from the prior lecture. The outcome of this approach has been very successful: student evaluations of the lecture block and their attendance have significantly improved.     

LBL结合PBL在物理诊断教学过程中的初步探索

目的:比较传统教学模式和问题教学法及二者结合教学法的不同优劣势,找出物理诊断学最佳教学方法。传统教学模式采用授课为主的教学法(lecture based learning,LBL),单单强调了教师的重要性,而忽视学生的主观能动性,不利于调动和培养学生自学和灵活运用所学知识的能力。问题教学法(Problem-based learning,PBL),其强调学生自身的主观能动性,弱化了教师在教学中的主体地位,学生有偏离教学主线的风险。因而如果将LBL与PBL有机结合在一起,将可能有利于提高学生的学习效率和学习效果。方法:选取97名全科医学本科学员,在物理诊断课程教学过程中,采用完全随机的方法分为2组,采用LBL教学方法组48人,采用LBL结合PBL教学方法组49人,通过分别对理论、实践分层打分,确定优秀、合格、不合格的比率,采用Mann-Whitney U检验最终评定2组教学方法的授课效果。结果:在理论考试中,2组学员在优秀、合格、不合格的分层评定上均无明显差异(P0.05),而在实践考核中,LBL+PBL组学员成绩在优秀这一分层评定中,优于LBL组,差异具有统计学意义(P0.05)。结论:LBL和PBL教学方法结合应用于物理诊断教学中,符合物理诊断教学的特点,更容易被学生接受,对于知识的识记和应用更有好处,从而更利于培养高素质医学人才,值得在物理诊断教学中进一步推广。     

A blended approach to active learning in a physiology laboratory-based subject facilitated by an e-learning component

Learning via online activities (e-learning) was introduced to facilitate existing face-to-face teaching to encourage more effective student preparation and then informed participation in an undergraduate physiology laboratory-based course. Active learning was encouraged by hypothesis formation and predictions prior to classes, with opportunities for students to amend their e-learning submissions after classes. Automatic or tutor feedback was provided on student submissions. Evaluation of the course was conducted via student questionnaires, individual student interviews, and analysis of student marks in examinations and of the e-learning component. Student feedback on this entire subject in the university-wide quality of teaching survey was very high by University of Melbourne standards and most encouraging for the first implementation of such a curriculum modification. Results from further detailed surveys of student interactions and engagement and correlation analysis between student responses were also very supportive of the effectiveness of the course. There were no significant differences between examination marks in the new course with e-learning and the previous year without e-learning. However, there was a significant correlation between assessment of student e-learning work and their final examination mark. Correlation analysis between various survey responses helped interpret results and strengthened arguments for e-learning and suggested future improvements for student use of e-learning. This mode of e-learning used to support face-to-face learning activities in the laboratory can be adapted for other disciplines and may assist students in developing a greater appreciation and a deeper approach for learning from their practical class experiences.     

Essence and origin of Mendel's discovery

In early 19th-century Moravia, breeders of animals and plants joined with other interested citizens in the Moravian and Silesian Agricultural Society to debate economic priorities. Several of the senior members had a profound influence upon breeding theory: J.K. Nestler, Professor of Natural History and Agriculture at the University of Olomouc, left a collection of influential writings. In the context of sheep breeding he defined 'inheritance capacity' (Vererbungsf?higkeit), 'hereditary history' (Vererbungsgeschichte) and 'developmental history' (Entwicklungsgeschichte). His linking of the last two terms, as two sides of the same coin, puts Mendel's use of the second one in context. Professor F. Diebl taught the same topics as Nestler at the Philosophical Institute in Brno, with a bias towards plants. Diebl's lectures were attended by Mendel who gained top marks in three examinations. Diebl stressed the importance of artificial pollination to produce new varieties and recognised peas and beans as suitable subjects for the procedure. Prelate Cyrill Napp, abbot before Mendel, had a deep interest in heredity and how it was transmitted through both sexes. He generously supported Mendel's research. A happy blend of economic and academic influences, together with original talent and inner drive, led to Mendel's great discovery.     

以病例为基础的讨论式教学模式在临床教学中的应用

目的:探讨以病例为基础讨论式学习(case-based discussion and learning,CBDL)在临床教学中的应用效果。方法:将40位临床医学本科专业学生随机分为两组,其中20人采用CBDL教学,20人采用传统教学,并且通过理论基础考试和临床技能考试的形式评价学生的学习效果,通过问卷的形式调查学生对教学方法的满意度。结果:CBDL教学组的理论考试、临床技能考试及总成绩得分均较传统教学组明显提高(P0.01),CBDL教学组学生对教学的满意度分别为:教学方法 100%,教学效果90%,小组功能95%,教师评价95%。结论:CBDL教学法较传统教学方法更能提高学生的基础和临床能力,为临床工作中独立解决问题打下了基础。     

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.     

Teaching baroreflex physiology to medical students: a comparison of quiz-based and conventional teaching strategies in a laboratory exercise

Quiz-based and collaborative teaching strategies have previously been found to be efficient for the improving meaningful learning of physiology during lectures. These approaches have, however, not been investigated during laboratory exercises. In the present study, we compared the impact of solving quizzes individually and in groups with conventional teaching on the immediate learning during a laboratory exercise. We implemented two quizzes in a mandatory 4-h laboratory exercise on baroreflex physiology. A total of 155 second-year medical students were randomized to solve quizzes individually (intervention group I, n = 57), in groups of three to four students (intervention group II, n = 56), or not to perform any quizzes (control; intervention group III, n = 42). After the laboratory exercise, all students completed an individual test, which encompassed two recall questions, two intermediate questions, and two integrated questions. The integrated questions were of moderate and advanced difficulty, respectively. Finally, students completed an evaluation form. Intervention group I reached the highest total test scores and proved best at answering the integrated question of advanced difficulty. Moreover, there was an overall difference between groups for student evaluations of the quality of the teaching, which was highest for intervention group II. In conclusion, solving quizzes individually during a laboratory exercise may enhance learning, whereas solving quizzes in groups is associated with higher student satisfaction.     

Reflections on Teaching Social Violence in an Age of Genocide and a Time of War

This article is a reflection by a teacher and a student on "structural-violence pedagogy," the process of teaching and learning about the structures of inequality implicated in various forms of social violence, including those of everyday life, massacre, and genocide. Using a case study of an undergraduate course in anthropology, we explore the complexity and emotionally charged nature of this field, some innovative teaching strategies, and contributions of anthropology to understanding a world marked and marred by war, genocide, racialization, and structural poverty. The teacher shapes a course of study informed by critical pedagogy and theories about violence and power. The student draws on her personal experiences, her intellectual interests, and her yearning for fuller answers to deeper questions as she seeks to reciprocate what is being taught to her. Together, teacher and student explore the promise in the power of teaching for understanding the world as it does exist.     

Lessons from EEO: Toward a Universal Evolutionary Curriculum

We propose a human-centered evolutionary curriculum based around the three questions: Who am I? Where do I come from? How do I fit in? We base our curriculum on our experiences as an evolutionary biologist/paleontologist (NE) and as a secondary level special education science teacher (GE)—and not least from our joint experience as co-editors-in-chief of this journal. Our proposed curriculum starts and ends with human biology and evolution, linking these themes with topics as diverse as the “tree of life” (systematics), anthropology, Charles Darwin, cultural evolution, ecology, developmental biology, molecular evolution/genetics, paleontology, and plate tectonics. The curriculum is “universal” as it is designed to be taught at all levels, K–16. The curriculum is flexible: “modules” may be expanded and contracted, reordered, or modified to fit specific grade level needs—and the requirements and interests of local curricula and teachers. We further propose that students utilize workbooks from online or printed sources to investigate the local answers to the general questions (e.g., “Who am I?”), while classroom instruction is focused on the larger scale issues outlined in the modules of our curriculum.     

How much structuring is beneficial with regard to examination scores? A prospective study of three forms of active learning

Many studies have demonstrated a superiority of active learning forms compared with traditional lecture. However, there is still debate as to what degree structuring is necessary with regard to high exam outcomes. Seventy-five students from a premedical school were randomly attributed to an active lecture group, a cooperative group, or a collaborative learning group. The active lecture group received lectures with questions to resolve at the end of the lecture. At the same time, the cooperative group and the collaborative group had to work on a problem and prepare presentations for their answers. The collaborative group worked in a mostly self-directed manner; the cooperative group had to follow a time schedule. For the additional work of preparing the poster presentation, the collaborative and cooperative groups were allowed 50% more working time. In part 1, all groups worked on the citric acid cycle, and in part 2, all groups worked on molecular genetics. Collaborative groups had to work on tasks and prepare presentations for their answers. At the end of each part, all three groups were subjected to the same exam. Additionally, in the collaborative and cooperative groups, the presentations were marked. All evaluations were performed by two independent examiners. Exam results of the active lecture groups were highest. Results of the cooperative group were nonsignificantly lower than the active lecture group and significantly higher than the collaborative group. The presentation quality was nonsignificantly higher in the collaborative group compared with the cooperative group. This study shows that active lecturing produced the highest exam results, which significantly differed from collaborative learning results. The additional elaboration in the cooperative and collaborative learning setting yielded the high presentation quality but apparently could not contribute further to exam scores. Cooperative learning seems to be a good compromise if high exam and presentation scores are expected.     

Enseignement médical permanent à Laval: Programme extra-muros (automne 1964)

The 1964 fall program of Continuing Medical Education sponsored by Laval University during September and October comprised 55 medical meetings held in 18 regions of the eastern part of the Province of Quebec for the benefit of practitioners. The prerogative of selecting topics rested with the medical board of the regional hospital, together with determination of the time and date of the meeting. The teaching was essentially clinical and practical: presentation of patients, cases or files, followed by a short period of questions and answers, and finally a lecture (30-40 minutes) on an aspect of the selected subject; each meeting lasted at least four hours. A committee appointed by the Faculty of Medicine, Laval University, selected the teacher, co-ordinated the whole program and ensured the quality of the presentation. Attendance varied from 50% to 100% of the doctors in a given region.     

Mapping urban ecology education in the UK

Abstract

Urban ecology has matured as a field of investigation. This paper explores how well it has transitioned into the educational curricula of UK Higher Education Institutions (HEIs) by mapping the presence of urban ecological or environmental topics across undergraduate and postgraduate programmes. The prevalence of different topics, the level at which they are taught, and the disciplinary areas in which they are housed, are quantified. Urban ecological topics are found in programmes across 50 of 147 HEIs (34%), mainly taught in ancillary fashion to support wider subjects, though some specialist modules and even programmes do exist. Only one HEI incorporates a compulsory (core) dedicated urban ecology module at undergraduate level. Much urban ecology teaching takes place at advanced undergraduate and postgraduate levels. Applied topics are usually taught from an environmental science perspective, with common examples including urban hydrology, climate, and green infrastructure; probably to address global concerns about urban sustainability and resilience. In particular there is scope for greater incorporation of urban ecology topics and themes into biological and ecological programmes, and utilising cities as labs to explore these topics. The paper concludes with a discussion of some of these possibilities.     

Don't dump the didactic lecture; fix it

Numerous articles have been published on the merits of active learning, and collectively they present a body of compelling evidence that these methods do enhance learning. In presenting arguments for active learning, it is often suggested that the traditional didactic lecture is more passive in nature and less effective as a teaching tool. However, a well organized lecture remains one of the most effective ways to integrate and present information from multiple sources on complex topics, such as those encountered in the teaching of physiology. This article presents an argument for enhancing lectures by incorporating active learning activities within their framework, and it is noted that engagement of the student is a key element making active learning activities work. Finally, suggestions are provided on the basis of the author's experience of things instructors can do to make lecture-based courses more engaging to students and, hence, promote learning.     

Endocrine physiology in a patient-centered learning curriculum

The medical curriculum at the University of North Dakota School of Medicine and Health Sciences has recently been redesigned into a problem-based/traditional hybrid model that utilizes an integrated organ systems-based approach to teach basic and clinical sciences. The number of lecture hours in general has been greatly reduced, and, in particular, lecture hours in physiology have been reduced by 65%. Students learn basic science in small groups led by a faculty facilitator, and students are responsible for a great deal of their own teaching and learning. The curriculum is centered around patient cases and is called patient-centered learning (PCL). The curriculum includes traditional lectures and laboratories supporting faculty-generated learning objectives. Endocrine physiology is taught in year one, utilizing four weeks of patient cases that emphasize normal structure and function of endocrine systems. Endocrine physiology is revisited in year two, which is primarily focused on pathobiology. The PCL curriculum, with emphasis on the endocrine component, is described in detail along with key portions of an endocrine case.