Using lessons from American Indian health professionals at a health science center.
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Biomedical subjects
S Kalishman
Publications and source records attributed to S Kalishman.
Student assessment.
This chapter looks at changes in assessing medical students implemented by the eight schools participating in The Robert Wood Foundation's "Preparing Physicians for the Future: Program in Medical Education." The eight schools took a variety of approaches, some working incrementally, others making large, cross-departmental changes. Each school's support for or constraints to change influenced its approach in assessment. The authors describe the ways in which students were assessed within their courses and clerkships. They look at specific forms of assessment, such as self-assessment, feedback, and standardized-patient assessment. For most of the schools, changes in student assessment were controlled by course or clerkship directors and managed by faculty. Often, changes in assessment came after changes in curriculum. Changes were easier to make in the first two years of medical school than in the clinical years. The authors also discuss the integration of assessment within the curriculum, comprehensive performance-based assessments, and situations where change in assessment did not occur. They discuss the politics of change, and offer a summary of the eight schools' assessment experiences and the lessons learned.
Clinical Clerkship↗
A survey of graduates in practice from the University of New Mexico's conventional and community-oriented, problem-based tracks.
PURPOSE: To survey graduates in practice from the first four classes of the University of New Mexico School of Medicine's (UNMSOM's) parallel curricular tracks, and compare data about the graduates' practice patterns, learning behaviors, and satisfaction with the profession of medicine. METHOD: Between 1979 and 1993, the UNMSOM had two tracks for the first two years of medical school: a conventional track and the Primary Care Curriculum (PCC), a community-oriented, problem-based track. In 1990, a survey was conducted of the 140 graduates from the first four classes (1983-1986) who had completed their postgraduate training: 40 from the PCC and 100 from the conventional track. Statistical methods included two-way analyses of variance, logistic regression, and chi-square, adjusted by Bonferroni methods. Comparisons between tracks are reported after adjustments were made for specialty effects. RESULTS: Thirty-three graduates (83%) from the PCC and 87 (87%) from the conventional tracks responded. The PCC graduates were much more likely to work in medically underserved areas, practice in publicly funded health care settings, and care for non-paying patients. The PCC graduates more often identified patient problems and curiosity as providing motivation for their learning. They more frequently studied clinical medicine and community health topics and spent time in community activities. The PCC graduates felt better prepared for practice by their undergraduate medical education. There was no difference between the graduates of the two tracks in the sizes of the populations in which they practiced, in the criteria they used for deciding on referrals to other physicians, in the ranges of community resource utilization, or in the degrees of satisfaction within their chosen professions. Large percentages of graduates from both tracks (67% conventional and 79% PCC) considered themselves to be practicing either primary care or a combination of primary care and non-primary care. In addition, 38% of all the graduates practiced in the state of New Mexico. More PCC graduates chose careers in family practice; however, no significant difference was found in a comparison between the proportions of PCC and conventional-track graduates who chose primary care careers. CONCLUSION: Track differences favorable to the PCC were evident in relation to the two major goals established by the program: to attract graduates to careers in primary care in rural and underserved areas and to provide graduates with self-directed, lifelong learning skills. Some expected track effects were not found.
Academic Medical Centers↗
Performances on the NBME I, II, and III by medical students in the problem-based learning and conventional tracks at the University of New Mexico.
BACKGROUND: Problem-based learning curricula are growing in popularity, and questions have been raised about the appropriateness of standardized examinations, such as the National Board of Medical Examiners (NBME) Parts I, II, and III examinations, for assessing students in these new curricula. METHOD: Data on students' performances on the NBME I were analyzed for 508 graduates of the conventional track and 167 graduates of the problem-based Primary Care Curriculum (PCC) track at the University of New Mexico School of Medicine from the classes of 1983-1992; on NBME II, for 447 and 144 graduates, respectively (classes of 1983-1991); and on NBME III, for 313 and 100 graduates, respectively (classes of 1983-1989). The analyses also included data on the students' total Medical College Admission Test (MCAT) scores, undergraduate science grade-point averages (SGPAs), and admission subgroups within tracks. The statistical methods included analysis of covariance, Student's t-test, and the Fisher exact test. RESULTS: The students who had requested the PCC track but had been randomized into the conventional track had the highest mean scores on all the study variables (for 34 students, 521 on the NBME I, and for 19 students, 551 on the NMBE III). The high-risk students who had requested but had not been accepted into the PCC track seemed to benefit from the highly structured conventional track with regard to their NMBE I performances (467 for 18 students). The PCC students--both those who had been randomized into the PCC and those who had been selected into the PCC--had significantly lower mean scores on the NBME I (455 for 85 students and 463 for 82 students compared with 505 for the 439 students who chose the conventional track), but significantly higher mean scores on the NBME III (521 for 38 students and 522 for 62 students compared with 483 for the seven high-risk students and 487 for the 276 students who chose the conventional track). For both tracks, strong relationships were found among the scores on the three NBME examinations. For the PCC students, significantly weaker relationships were found between mean SGPAs and mean scores on the NBME I, II, and III. For both tracks, MCAT scores, especially in the lowest and highest ranges, were most predictive of performances on the NBME I and II. CONCLUSION: In the short run, the more teacher-centered and structured conventional curriculum better prepared the students for the NBME I, while in the long run, the more student-centered problem-based curriculum better prepared the students for the NBME III:
Curriculum↗
How interruptions in students' medical education affect their clinical performance evaluations.
The enrollment records of 380 medical students from the graduating class of 1983-1988 at a four-year medical school were compared with the students' performances on two measures, third-year clinical rotation grades and National Board of Medical Examiners Part II examination (NBME-II) scores. Thirty-seven students (9.7%) interrupted their progress through medical school for negative (school-initiated, academic) reasons or neutral (student-initiated, nonacademic, or personal) reasons. On both performance measures, the students in the neutral group performed similarly to regular-progress students and significantly better than students who interrupted their attendance in medical school for negative reasons.
Clinical Competence↗
Residency performance of graduates from a problem-based and a conventional curriculum.
Performance of 130 graduates in residency from a community-oriented, problem-based medical curriculum, and from a parallel, conventional track, were compared on eight dimensions: knowledge, communication with patients, independent learning ability, teamwork, patient education, critical thinking ability, attention to health care costs, and self-assessment. Ratings were obtained from three evaluators: a doctor-supervisor, a nurse and the resident him/herself. The study was undertaken to identify differences between graduates from the two curricular tracks. Differences were observed in the areas of health care costs (supervisors) and communication with patients (residents), and a trend was observed in patient education (supervisors) and knowledge (nurses), The outcomes of the study are discussed in light of the literature on residency performance, and in terms of the educational experiences that characterize the two medical curricula.
Clinical Competence↗
Injuries from fireworks.
In 1983, there were more than 8,200 victims of fireworks-related injuries treated in US emergency rooms. Half of those injured were children less than 15 years of age, and 11% of the injuries resulted in hospitalization. The eyes are the body part most often injured, followed by hands and fingers. Burns account for the majority of injuries. Every type of fireworks legally available has resulted in serious injury or death. Firecrackers, bottle rockets, and sparklers contribute to the most hospitalizations. States that allow a wide variety of fireworks to be sold for personal use have a rate of fireworks-related fires 50 times greater than states that strictly limit the availability of fireworks. The rate of fireworks-related injuries is more than seven times greater in the less restrictive states.
Adolescent↗
Floor furnace burns to children.
Three children with grid-like second-degree burns of their extremities from contact with floor furnace registers prompted an examination of this thermal hazard. Average temperature of the gratings was 294 degrees F (146 degrees C), with a range of 180 degrees to 375 degrees F (82.2 degrees to 191 degrees C). All of the furnaces tested were positioned at the entrance to bedrooms and had so little clearance that it was impossible to walk around them without contact with their surface. Infants and toddlers are at particular risk: 1 or 2 seconds of exposure would be expected to produce a serious burn. Suggestions for preventing burns from floor furnaces include turning them off when young children are at home; installing barrier gates to prevent children from coming in contact with the registers; and developing a surface coating or replacement grate with less hazardous thermal properties.
Accidents, Home↗