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PubMed2004

A problem-based e-Learning prototype system for clinical medical education.

The purpose of this system is to establish virtual medical school (VMS) as the platform of e-learning center, which integrates collaborative and self-directed learning environment by virtual group, classroom and library, and automatically converts valuable clinical case from Hospital Information System (HIS) database into virtual patient by online authoring tools for problem-based e-learning. In this system, the VMS provides a problem-based e-learning environment, and utilizes HIS to capture and store valuable clinical cases. All medical students and residents now have the opportunity to learn from these typical cases online. The VMS at National Taiwan University has the potential to develop into a national medical education network for the meditation and provision of comprehensive medical resources. The system will use the international standard SCORM 1.2 to develop teaching material and assist with the HL7 v2.4, CDA v1.0 standards to connect Electronic Medical Record (EMR) systems in the hospital. It can provide resources sharing among medical centers by using high transportation ability of Grid Computing integrated with the broadband video platform, Access Grid, and personal multiple point videoconference platform, Multi-video, to popularize the application of e-learning in clinical medical education.

Clinical Medicine↗
PubMed2000

Getting nutrition education into medical schools: a computer-based approach.

Despite awareness of the importance of nutrition as part of medical student's education, numerous barriers exist to incorporating nutrition education into the medical school curriculum. Chief among such barriers is that most medical schools do not have faculty trained specifically in nutrition. A curriculum is needed that can deliver comprehensive nutrition information that is consistent across medical schools. One way to deliver this information is to use computer-assisted instruction (CAI). To meet the different needs of medical schools and provide a consistent base of nutrition information, we developed a series of interactive, multimedia educational programs (Nutrition in Medicine) that teach the basic principles of nutritional science and apply those principles in a case-oriented approach. Curriculum content is derived from the American Society for Clinical Nutrition consensus guidelines. These modules offer the advantages of accessibility, self-paced study, interactivity, immediate feedback, and tracking of student performance. Modules are distributed free to all US medical schools. Preliminary data from surveys gathered by our team at the University of North Carolina at Chapel Hill indicate that 73 US medical schools use, or are planning to use, these modules; more schools are currently evaluating the programs. Successful implementation of CAI requires easy program access, faculty training, adequate technical support, and faculty commitment to the programs as a valuable resource. CAI fails when the program is just placed in the library and students are told to use it when they can find the time.

Computer-Assisted Instruction↗
PubMed2003

Harvey Cushing's Canadian connections.

During his surgical career between 1896 and 1934, Harvey Cushing made eight visits to Canada. He had a broad impact on Canadian medicine and neurosurgery. Cushing's students Wilder Penfield and Kenneth McKenzie became outstanding leaders of the two major centers in Canada for neurosurgical treatment and training. On his first trip to Canada, shortly after completing his surgical internship in August 1896, Cushing traveled with members of his family through the Maritime Provinces and visited hospitals in Quebec and Montreal. Eight years later, in February 1904, as a successful young neurosurgeon at the Johns Hopkins Hospital, he reported to the Montreal Medico-Chirurgical Society on his surgical experience in 20 cases of removal of the trigeminal ganglion for neuralgia. In 1922, as the Charles Mickle Lecturer at the University of Toronto, Cushing assigned his honorarium of $1000 to support a neurosurgical fellowship at Harvard. This was awarded to McKenzie, then a general practitioner, for a year's training with Cushing in 1922-1923. McKenzie returned to initiate the neurosurgical services at the Toronto General Hospital, where he developed into a master surgeon and teacher. On Cushing's second visit to McGill University in October 1922, he and Sir Charles Sherrington inaugurated the new Biology Building of McGill's Medical School, marking the first stage of a Rockefeller-McGill program of modernization. In May 1929, Cushing attended the dedication of the Osler Library at McGill. In September 1934, responding to the invitation of Penfield, Cushing presented a Foundation Lecture-one of his finest addresses on the philosophy of neurosurgery-at the opening of the Montreal Neurological Institute. On that same trip, Cushing's revisit to McGill's Osler Library convinced him to turn over his own treasure of historical books to Yale University.

Canada↗
PubMed1997

Attitudes of nursing students towards the seminar method of teaching.

After experiencing problems associated with student-centred teaching methods, the researcher resolved to undertake a study on the attitudes of the student nurses towards the seminar method of teaching. A survey was undertaken among twenty five third and fourth year student nurses. The instrument for collecting data was a questionnaire. From the study it is clear that: negative attitudes exist towards the seminar method of teaching in spite of students' awareness of its contribution to self-directed learning. The majority of student nurses of the basic nursing programme are adolescents who resent any time consuming academic commitment which interferes with their private life. Lack of correlation between teaching methods used at high school and those used at the nursing college leads to poor adjustment to seminar method as a student-centred, independent learning method. Library facilities are inadequate which makes it more difficult and more time consuming for student nurses to find suitable material for preparation of quality presentations.

Attitude↗
PubMed2002

Reaching and teaching new medical students.

OBJECTIVE: Each year 150 new medical students enter UCLA. During Foundations week they are introduced to the resources and services, which will support their studies, as well as to the problem-based learning (PBL) approach of instruction. The library is responsible for introducing print and digital resources and illustrating how these support the PBL approach. This has been a challenge, given students' belief that they already know about libraries and the limited time frame (roughly 45 minutes) allotted to us. This year we developed a collaborative, student-centered, active learning approach. Students were exposed to a variety of relevant resources and given the opportunity to critique them for appropriateness to their PBL case of the week. DESCRIPTION: Sessions were designed for 50 students at once in the instructional microcomputing facility (IMF), with two or three students sharing each workstation. Since the IMF is equipped with classroom control software, librarians could display resources on each workstation while discussing them. Since we wish to encourage students to begin at our Web page, we wore t-shirts with the logo "Start@Biomed" and our URL. Instruction started with a "Guided Tour of the Biomedical Library Web Page" during which we discussed general services, highlighted special features, including Web-based tutorials and subject guides, and illustrated how to connect to relevant resources such as PubMed, MDConsult, STAT!Ref, and MEDLINEPlus. The student groups then critically reviewed one resource identified by a card next to their workstation by answering the following questions in writing: Would this resource address your specific PBL learning issue? If not, what type of learning issue would it address? Describe an outstanding feature or a barrier to use for this resource? After ten minutes, students were asked to report to the entire group. The use of a hand-held mike, which we passed among the students, added an element of fun to the proceedings and simulated a talk show atmosphere. DISCUSSION: This emphasis on active learning, critical thinking, and problem solving was a successful way to introduce students to the library and its resources, and reinforced the library's role in PBL. The friendly, casual talk-show approach, coupled with our Start@Biomed t-shirts, created a setting in which we became real partners in the learning enterprise. Students reported they enjoyed the experience, and they are returning to us for additional help. Their written feedback, which we collected, summarized, and distributed to the entire class, illustrated a clear understanding of the resources and their usefulness. Both the medical school faculty and the librarians involved feel we have developed a useful, interesting, and appropriate way to reach beginning medical students, who often feel that they already know a great deal about using a library.

California↗
PubMed1994

Failure to reach the goal of measles elimination. Apparent paradox of measles infections in immunized persons.

BACKGROUND: Measles is the most transmissible disease known to man. During the 1980s, the number of measles cases in the United States rose dramatically. Surprisingly, 20% to 40% of these cases occurred in persons who had been appropriately immunized against measles. In response, the United States adopted a two-dose universal measles immunization program. We critically examine the effect of vaccine failure in measles occurring in immunized persons. METHODS: We performed a computerized bibliographic literature search (National Library of Medicine) for all English-language articles dealing with measles outbreaks. We limited our search to reports of US and Canadian school-based outbreaks of measles, and we spoke with experts to get estimates of vaccine failure rates. In addition, we devised a hypothetical model of a school where measles immunization rates could be varied, vaccine failure rates could be calculated, and the percentage of measles cases occurring in immunized students could be determined. RESULTS: We found 18 reports of measles outbreaks in very highly immunized school populations where 71% to 99.8% of students were immunized against measles. Despite these high rates of immunization, 30% to 100% (mean, 77%) of all measles cases in these outbreaks occurred in previously immunized students. In our hypothetical school model, after more than 95% of schoolchildren are immunized against measles, the majority of measles cases occur in appropriately immunized children. CONCLUSIONS: The apparent paradox is that as measles immunization rates rise to high levels in a population, measles becomes a disease of immunized persons. Because of the failure rate of the vaccine and the unique transmissibility of the measles virus, the currently available measles vaccine, used in a single-dose strategy, is unlikely to completely eliminate measles. The long-term success of a two-dose strategy to eliminate measles remains to be determined.

Canada↗
PubMed1991

Biotechnology awareness study, Part 2: Meeting the information needs of biotechnologists.

The second part of the biotechnology awareness study focused on health sciences libraries and how well they are meeting the needs of biotechnologists working in the study's nine medical centers. A survey was conducted over a three-month period to assess the demand for biotechnology-related reference services at nine libraries and the sources the librarians used to answer the questions. Data on monographic and current serial holdings were also collected. At the end of the survey period, librarians were asked for their perceptions about biotechnology research at their institutions and in their geographic areas. Their responses were compared to the responses the scientists at the nine schools gave to the same or similar questions. Results showed few biotechnology-related reference questions were asked of the librarians. The recorded questions dealt with a range of biotechnology subjects. MEDLINE was used to answer 77% of the questions received during the survey period. More detailed notes in MeSH and a guide to online searching for biotechnology topics were suggested by the librarians as ways to improve reference service to this group of researchers. Journal collections were generally strong, with libraries owning from 50% to 87% of the titles on a core list of biotechnology journals compiled for this study. All libraries subscribed to the five titles most often cited by the scientists surveyed. Generally, librarians were unaware of the biotechnology-related research being done on their campuses or in their geographic areas.

Awareness↗
PubMed2004

Search strategies for population and social subjects in a medical school curriculum.

This case study describes strategies developed for medical students to conduct Specific (as opposed to Sensitive) searches in PubMed so they can quickly locate several relevant references to articles on the population and social aspects of medicine. The Specific search strategy protocol for population and social aspects of medicine involves use of the MeSH Database, certain features of the Detailed Display in the MeSH Database, and applying Limits. By teaching the Specific form of search strategy, busy users can learn a handful of basic techniques that should yield a useful proportion of references, thereby ensuring these users' frequent success.

Computer User Training↗
PubMed2004

Evaluation of evidence-based medicine search skills in the clinical years.

The librarians of the Health Sciences Library worked with the director of the Primary Care Clerkship to reinforce the principles of Evidence-Based Medicine (EBM) searching, taught during the first two years of medical school, through an intensive workshop. The purpose of the program was to ensure that students apply EBM principles in a timely and effective manner in clinical situations. Working in teams led by a resident and librarian, students researched real cases and then evaluated the effectiveness of their approach to the problems. This paper outlines the rationale for the team approach, reviews the administration of a computer-based workshop, and discusses the evaluation process. Evaluation focused on both the current workshop and its implications for the informatics program presented to students during years one and two.

Evidence-Based Medicine↗
PubMed2003

Mass psychogenic illness following oral cholera immunization in Ca Mau City, Vietnam.

INTRODUCTION: Targeted cholera immunization of high-risk populations in Vietnam is conducted based on routine surveillance data. Following mass immunization of schoolchildren in Ca Mau City using an oral bivalent killed cholera vaccine, adverse reactions were noted. METHODS: Salient data were collected in a systematic fashion including the review of medical records; interview of the school principal, teachers, students, parents and doctors; and review of the storage and handling of the vaccine. FINDINGS: On 18 December 2001, 234 children at a primary school in Ca Mau City received the cholera vaccine. Within 1h of immunization, three children in one of the classrooms complained of trembling, nausea and headache and were brought to the library and soon other children followed. Out of 234, 97 (42%) pupils were affected and brought to the Municipal Health Center or Ca Mau Provincial Hospital. Those who were affected were younger (mean age=9.6 years; 95% CI=9.4-9.7) compared to those who were not affected (mean age=10 years; 95% CI=9.7-10.3; t-test=-2.4; P-value=0.02). The proportion of affected females among those who had received the vaccine (49/114 or 43%) was similar to the proportion in males (48/120 or 40%; RR=1.07; 95% CI=0.79-1.46). The most frequent presenting complaint was cold extremities (60%) followed by headache (27%). All affected children recovered and were discharged in a few hours. None reported any sequelae or relapse. Once the situation was recognized, the cholera immunization campaign was continued. Laboratory tests of vaccine samples from the same batch detected no abnormality or contaminating agent. DISCUSSION: The findings suggest that the children at primary school number 1 suffered from a mass psychogenic illness. This incident was unusual in that a similar number of boys and girls were affected, in contrast to the frequently reported preponderance of female cases. Furthermore the underlying cause was very quickly diagnosed, medical interventions were kept to a minimum, and no relapse was observed. Future vaccination campaigns have to assure that the families are informed in advance.

Administration, Oral↗
PubMed2000

[Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective; traction not effective; results of systematic reviews].

OBJECTIVE: To inventory the current state of the art regarding the effectiveness of conservative treatment of chronic low back pain. DESIGN: Systematic reviews. METHOD: The relevant literature from the period January 1966-September 1999 was retrieved via Medline, Embase, PsychLit and the Cochrane Library and via reference lists in the articles found. The methodological quality of the studies was assessed using criteria for internal validity. On the basis of the number of examinations, their quality and the consistency of the findings, conclusions were subdivided into four levels of strength of scientific evidence. RESULTS: There was strong evidence that exercise therapy and multidisciplinary treatment programmes were effective in chronic low back pain, and moderate evidence that non-steroidal anti-inflammatory drugs (NSAIDs), back schools and behavioural therapy were effective in chronic low back pain. There was also strong evidence that traction was not effective in chronic low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Reorganization of the information technology program at a United States medical school: is there a lesson for academic medical informatics in Japan?

Reorganization of the information technology program at Baylor College of Medicine commenced with the goal of obtaining a client-focused organization instead of a classically departmental structure. Legacy organizations independently established by request or serendipity had gaps and overlaps in services and could no longer respond to new issues, such as integration of several hospitals, resource sharing of health care delivery, administration of a shared library, and an academic informatics program. The renewal of the information technology program has led to departments of Telecommunications, Enterprise Services, Client Services, and Medical Informatics, and has also allowed cross-departmental projects led by a technology architect. In contrast with that of Baylor, the approach of the Yamaguchi University School of Medicine in Japan may be construed as economic efficiency at the cost of client services. Effective client services by friendly and efficient staff groups is the most important factor for an academic information technology program, if the goal is to reorganize in anticipation of future challenges to the medical center.

Computer Systems↗
PubMed2000

Providing consumer health information in the rural setting: Planetree Health Resource Center's approach.

Both lifestyle and geography make the delivery of consumer health information in the rural setting unique. The Planetree Health Resource Center in The Dalles, Oregon, has served the public in a rural setting for the past eight years. It is a community-based consumer health library, affiliated with a small rural hospital, Mid-Columbia Medical Center. One task of providing consumer health information in rural environments is to be in relationship with individuals in the community. Integration into community life is very important for credibility and sustainability. The resource center takes a proactive approach and employs several different outreach efforts to deepen its relationship with community members. It also works hard to foster partnerships for improved health information delivery with other community organizations, including area schools. This paper describes Planetree Health Resource Center's approach to rural outreach.

Community-Institutional Relations↗
PubMed2004

Lifelong learning skills: how experienced are students when they enter medical school?

Widening participation initiatives together with changes in school curricula in England may broaden the range of lifelong learning skills experience of new undergraduates. This project examines the experience levels of current students, as a comparative baseline. First-year medical students completed a questionnaire on arrival, investigating their practice of 31 skills during the previous two years. Responses show that most students have regularly practised transferable skills. However, significant numbers report little experience, particularly in IT skills such as email, using the Internet, spreadsheets and databases. Some remain unfamiliar with word processing. Library research, essay writing and oral presentation are also rarely practised by substantial numbers. One-third of students lack experience of evaluating their own strengths and weaknesses. Current students already show diversity of experience in skills on arrival at medical school. Changes in the near future may increase this range of experience further, and necessitate changes to undergraduate courses.

Attitude↗
PubMed2004

From library to discharge: a managing care student project.

BACKGROUND AND OBJECTIVES: The Patient Care Project (PCP) was a central component of the Undergraduate Medical Education for the 21st Century (UME-21) grant project at the University of Nebraska. With the primary goal of improving students' critical thinking skills, the PCP was directed more toward an understanding of managing care than the business aspects of managed care and emphasized written communication skills, clinical hypothesis testing, and exploring ways to solve medical and ethical questions. METHODS: All 239 students graduating in 2000 and 2001 were required to analyze the medical care received by one of their hospitalized patients. Using a criterion-based evaluation tool, students' written critiques were assessed in five specific areas, all of which required critical thinking skills. Students also received an overall grade for the project. The UME-21 Graduation Survey was used to assess changes in attitudes and behavior. Students graduating in 1999, prior to the institution of the PCP graduation requirement, served as a control group. RESULTS: The most frequently discussed topic of the PCPs was cardiovascular disease. The mean overall rating by the faculty for the PCPs was 3.7 and 3.8 in academic years 2000 and 2001, respectively (maximum=5). In a qualitative analysis of the PCPs, students demonstrated insight into their patients' overall medical care, including the use of evidence-based medicine (EBM), quality improvement, and cost containment. There were no statistically significant differences, however, between the PCP and control groups on the UME-21 Graduation Survey. Nonetheless, more students who had completed the PCP reported that they had identified the total cost of a patient's stay, designed a quality improvement loop, and obtained clinical evidence from an EBM computer database. On this same survey, all students agreed with the use of clinical practice guidelines and cost containment. CONCLUSIONS: The PCP appeared to be relevant to the students' learning needs, and they provided cogent critiques of the medical care they had rendered as well as critical analyses of their patients' discharge summaries and the cost of care including ways to reduce cost. On the other hand, we were unable to demonstrate any substantial differences in the results of the UME-21 Graduation Survey given to both the PCP and control groups. In spite of this lack of effect on students' attitudes, the PCP was perceived by the faculty to be valuable and has been incorporated into the required third-year family medicine clerkship at the University of Nebraska.

Clinical Clerkship↗