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PubMed2004

'What makes it really good, makes it really bad.' An exploration of early student experience in the first cohort of the Rural Clinical School in the University of Western Australia.

INTRODUCTION: The Australian Commonwealth Department of Health and Ageing has implemented the Government's Regional Health Strategy. This strategy provides funding to universities for the establishment of Rural Clinical Schools (RCS) on a national basis. The strategy aims to secure a rural education and training network to increase the availability and viability of rural health services in the long term. The University of Western Australia set up the RCS in 2002 with the objective of setting up a full 5th year medical course in remote communities (RRAMA [Rural Remote and Metropolitan Area Classification] 4-7) for the 2003 academic year. There were 21 students in five areas: Kalgoorlie/Esperance (9 students), Broome (4 students), Port Hedland (3 students) and Geraldton (5 students). These students covered the 5th year curriculum with internal assessment and final examinations, in the same manner as city students. Only the delivery was different, according to geographical location. METHODS: Structured questionnaires using open-ended questions were distributed to students on two occasions. At the sixth month, semi-structured interviews were held with each student. The interviews were transcribed and a thematic analysis of the data was undertaken. Constant comparison of data was undertaken, themes identified and relationships among the themes clarified. RESULTS: In general, students were very happy with the teaching and learning opportunities they had during the first half of the year. However the initial themes of curriculum content, curriculum delivery, and assessment, were eclipsed by an overarching theme of anxiety and its management. The issue of student anxiety was addressed during the analysis. A number of factors were identified which ameliorated student anxiety or contributed to increased anxiety. From this evaluation a number of contributory factors to such student anxiety were identified. The investigators became more cognisant of the impact of group dynamics and of the need to structure the 'unstructured' environment of rural and remote medicine. In this way, students focus on only a few learning tasks at a time. They complete each topic with at least one other student so they can share the experience. The key role of each site coordinator also became apparent. The site coordinator should know the curriculum thoroughly and transmit this information to other teachers and preceptors at their site. It was also found desirable that the RCS was clear as to which assessment processes were flexible and which were 'fixed'. The medical school must clarify which curriculum content is essential, which is desirable and which is additional. Issues of workload must be monitored, and good work practices must be encouraged and supported. It was found that the high level of commitment to learning lead to the potential for burnout, generating the student comment: 'What makes the RCS really, really good makes it really bad...' CONCLUSION: Setting up an innovative program is always a major task, but setting up five different offices with four centers of learning separated by thousands of kilometers has not been undertaken, apparently, anywhere else in the world. It has been a 'fast uphill journey' that has been subject to evolving change as the RCS has adapted to conditions not expected from an academic point of view. Key contributory factors to student anxiety were identified and organizational strategies were implemented immediately, where possible, to reduce such anxiety. These insights were also used in the preparation for, and implementation of, the 2004 curriculum.

Journal Article↗
PubMed2000

A comparative study of students' performance in preclinical physiology assessed by short and long essays.

The performance of 540 medical (MBBS) and 55 dental (BDS) students in short essay questions (SEQs) in preclinical physiology was compared with their performance in long essay questions (LEQs). The cohort was made up of 88 repeating and 452 non-repeating MBBS students and 12 repeating and 43 non-repeating BDS students. The SEQs and LEQs used for the study were those administered to the students in the paper II of the Part I MBBS/BDS examination. The results showed that all the students did significantly better in LEQs than in SEQs. When the students were sub-divided into repeaters and non-repeaters, performance in LEQs was still significantly better in all cases, except in the BDS repeaters where the difference was not significant. The study also showed that the BDS students did significantly better than the MBBS students in LEQs. Further analysis showed that the latter was due to a much better performance in LEQ 4 by the BDS students. In the SEQs, MBBS non-repeaters did better than repeaters while the situation was reversed with the BDS students. For all categories of students, on no occasion was the mean score in the LEQs or the SEQs up to 20.0, which is the 50% score and pass mark in this examination. The likely reasons for the better performance of the students in LEQs than in SEQs were discussed. The better performance of the BDS students in LEQs is believed to be due to the double exposure time of the BDS students to the topics from which LEQ 4 is drawn. From our results, it was concluded that LEQs are more useful than SEQs in assessing these students. In addition, the highly significant cross-correlation between scores in questions 1, 2, 3 and 4 suggested that the inherent problem of examiners' subjective judgement in essay marking could be minimized in both SEQs and LEQs. Finally, failure to achieve a mean score of 50% (pass mark) in both SEQs and LEQs suggested that the students are weak in essay writing. Possible reasons for this were suggested.

Education, Dental↗
PubMedDate not supplied

Respiratory findings in art and medical students. Effects of the art environment.

BACKGROUND: Art students are exposed to many noxious agents during their training, in contrast to medical students, who are not exposed to known environmental pollutants. OBJECTIVES: In order to investigate the potential effects of toxic agents in the art students' environment, we studied respiratory findings in a cohort of 117 art students and 128 medical students, matched for age, sex and smoking. METHODS: Acute and chronic respiratory symptoms were evaluated by modifying the British Medical Research Council questionnaire. Lung function studies were performed with a spirometer (Jaeger, Germany) measuring maximum expiratory flow-volume (MEFV) curves. On these curves we calculated the forced vital capacity (FVC), one second forced expiratory volume (FEV1) and the maximal expiratory flow at 50% and the last 25% of the FVC (FEF50, FEF25). RESULTS: Significantly higher prevalences of most of the chronic respiratory symptoms were recorded in art students compared to medical students (p < 0.05). Art students who were smokers had significantly higher prevalences of many of the chronic respiratory symptoms than nonsmoking art students. Among medical students these differences were not statistically significant (NS). High prevalences of acute symptoms related to the study environment were recorded for art students. Odds ratios in male and female art students were significant for chronic cough, chronic phlegm and chronic bronchitis for the risk factor of smoking. Significantly decreased lung function values compared to predicted values were recorded mostly for FEF50 and FEF25 in male and female art students. Smoking and non-smoking art students had similar reductions of lung function. Lung function data in medical students were within predicted values. CONCLUSIONS: Our data indicate that art students may be at risk of developing chronic respiratory symptoms and lung function changes as a result of their environmental exposure and their smoking habits.

Adult↗
PubMed1996

Prediction of self-destructive behaviour among Makerere University students.

Student suicides at Makerere University have occurred sporadically and no systematic programme of suicide prevention has been developed. In addition, no clear guidelines have been worked out to guide the operations of the university counselling centre. A study on the possible predictability of suicide behaviour among students was conducted from October 1992 to June 1995. Study objectives included the identification of possible characteristics of suicidal students; the determination of the proportion of students who will seek counselling services at the university hospital in the course of their studies; and the identification of characteristics of counsellees. Study participants were the entire group of the 1992/93 academic year intake. Six hundred and nineteen students consented to complete a self-administered questionnaire, especially designed to identify suicidal and or depressed persons. The students were then followed up for three years during which data on student attendance at the counselling centre were collected. The results were analysed using the EPI INFO computer software. The results indicated that some students (at least 5.5%) who enrolled at Makerere university annually will probably require counselling services in the course of their studies; and it is possible to recognise students who might require counselling services early at the time of their enrollment at the university. The following recommendations are made to improve counselling services for students: all students should be inducted at the time of their entry into the university; counselling services should be made attractive to students; students should be involved in providing counselling services, particularly at emergency level; a prompt and attractive referral system for students requiring psychiatric care should be established; a telephone hot-line to be managed by the students should be established and; further research is needed to improve counselling services for students at Makerere university.

Adult↗
PubMed2002

Surgical procedure skills of graduating medical students: effects of sex, working, and research experience.

BACKGROUND: Surgical procedures constitute an important part of every physician's daily practice. However, few studies have investigated the surgical skills of graduating medical students and, especially, factors that might be related to their degree of surgical competence. The present study sought to gather information on the basic surgical skills of graduating medical students and to establish whether factors influencing the students' competence could be identified and used to improve the teaching of basic surgical skills at medical schools. METHODS: A questionnaire was sent to all final-year medical students in Finland in 1997. It was returned by 404 (participation rate 80.2%) students. The questionnaire included questions on the theoretical knowledge and successful performance of 10 basic surgical procedures: abdominal paracentesis, application of Sengstake-Blakemoore tube, rubber-band ligation of hemorrhoids, reposition and casting of Colles' fracture, knee arthrocentesis, application of tibial traction, evacuation of subcutaneous abscess, male bladder catheterization, suprapubic catheterization, and nevus excision. RESULTS: Over 90% of the final-year medical students knew the theory of performing reposition and casting of Colles' fracture, knee arthrocentesis, urinary tract catheterization, and nevus excision, but only 32% (124/393) knew the theory of applying the Sengstake-Blakemoore tube. Nevus excision had been successfully performed by over 90% of the students. Of the emergency or duty procedures, application of the Sengstake-Blakemoore tube and abdominal paracentesis had been successfully performed by 1% (4/393) and 8% (32/393) of the students, respectively, whereas Colles' fracture reposition and suprapubic catheterization had been successfully performed by 46% of the students (182/393 and 179/393, respectively). The age-adjusted odds ratios for performing Colles' fracture reposition (OR 1.59; 95% CI 1.01 to 2.50), application of tibial traction (2.00; 1.03 to 3.89), evacuation of subcutaneous abscess (2.13; 1.25 to 3.62), and suprapubic catheterization (2.23; 1.21 to 4.09) were significantly higher among males than females. Students with working experience had higher odds ratios for performing suprapubic catheterization (OR 6.75; 95% CI 1.99 to 22.84), nevus excision (5.69; 2.49 to 13.0), reposition and casting of Colles' fracture (1.72; 1.01 to 2.94), knee arthrocentesis (4.78; 2.67 to 8.53), and evacuation of subcutaneous abscess (12.9; 6.12 to 27.1) than students without such experience. Students who had done extracurricular research had significantly lower odds ratios for performing evacuation of subcutaneous abscess (0.58; 0.34 to 0.99) than students without such experience. When the five medical faculties in Finland were compared, the highest odds ratios for performing procedures were at the university in which a student logbook was systematically used. CONCLUSIONS: Final-year medical students have fairly good theoretical knowledge of basic surgical procedures, but the successful performance rates of these procedures range from 1 to 90%. Males have performed surgical procedures significantly more often than females. Working experience clearly enhanced the surgical skills of medical students. However, research experience may impair the learning of these procedures. The systematic use of logbooks seems to be useful.

Adult↗
PubMed1982

Changes in the smoking behaviour, knowledge and opinion of medical students, 1972-1981.

To examine changes in medical students' smoking behaviour, knowledge and opinion over the last decade, a survey first conducted at the University of Manchester Medical School in 1972 was repeated in 1981. A postal questionnaire was sent to 1163 students, of whom 1112 (96%) replied. A substantial decline in cigarette smoking among medical students has occurred. This largely follows trends in the general population, medical education itself having made little contribution to the change. In 1972, 29% of students were cigarette smokers compared with 17% in 1981. The fall in cigarette smoking was more marked among men students rather than women, older rather than younger students, clinical rather than pre-clinical students. Cigarette consumption had also decreased as had the use of cigars and pipes among male students. The decline was already evident prior to students beginning their medical studies. A smaller expansion of smoking experience at medical school had occurred among the 1981 students, but, as in 1972, those who took up smoking or increased their consumption exceeded those who gave up or cut down. In 1981 the likelihood of taking up smoking or becoming a regular smoker at medical school was somewhat greater for women students than for men, although the numbers concerned were small. The survey reconfirmed the importance of the social environment in smoking behaviour. Modest changes had occurred in knowledge and opinion about smoking. Both the accuracy and scope of knowledge of students about the health hazards increased between 1972 and 1981, particularly among clinical students, who remained considerably better informed than their pre-clinical colleagues. As in 1972, knowledge had little impact on smoking behaviour. By 1981 nine out of ten students regarded smoking as a major risk to health, both clinical students and smokers being more likely to take this view than in 1972. Almost all students, irrespective of their smoking behaviour, found the evidence linking smoking to serious illness to some extent convincing, and by 1981 a somewhat greater proportion, 60%, found it very convincing, the tendency to do so increasing as they progressed through their course.

Adult↗
PubMed2006

Mentor's hand hygiene practices influence student's hand hygiene rates.

BACKGROUND: There were 3 objectives for this prospective quasiexperimental study. The first was to determine the effect of mentor's hand hygiene practices on student's hand hygiene rates during clinical rotations. The second was to assess the difference in hand hygiene rates for students with and without prior medical experience. The third was to assess the student's opinion and beliefs regarding hand hygiene. METHODS: Sixty students enrolled in a certified nursing program were selected to participate in the study. Each study group was observed twice during the 30-day span. The first observational period was conducted on day 1 of clinical rotation. The second observational period was conducted on day 30 of clinical rotation. Students were observed for hand hygiene. Also assessed were medical experience, sex, gloving, age, and mentor's hand hygiene practices. After observational period 2, a brief questionnaire was given to students to determine their opinion and beliefs regarding hand hygiene. The questionnaire was divided into 5 sections: student's commitment to hand hygiene, their perception of hand hygiene inconvenience, the necessity of hand hygiene, the student's ability to perform hand hygiene, and their opinion on the frequency of medical staff's hand hygiene. RESULTS: The mentor's practice of hand hygiene was the strongest predictor of the student's rate of hand hygiene for both observational periods (P < .01). Furthermore, students without prior medical experience had a significant increase in hand hygiene rates when comparing observational period 1 to observational period 2 (P < .01). Glove usage was associated with increased hand hygiene rates by 50% during observational period 1 (P = .01) and 44% during observational period 2 (P < .01). Male students during observational period 1 practiced hand hygiene 30% less often than female students (P < .01); however, during observational period 2, there was no significant difference between hand hygiene rates for males and females (P = .82). Questionnaires were completed by 47 students, who reported a strong commitment to hand hygiene, belief in its necessity, and ability to perform hand hygiene (with scores in the high 90s on a 10 to 100 rating scale). CONCLUSION: Mentor's use of hand hygiene and glove usage was associated with increased hand hygiene among students. Even though students reported strongly positive attitudes toward hand hygiene, students had a low overall rate of hand hygiene.

Adolescent↗
PubMed2001

Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation.

OBJECTIVES: The personality of medical students may have an important impact on both their academic performance and emotional adjustment during medical school. There has been little systematic study of the impact of perfectionism on medical students. The present study sought to compare the perfectionism profile of medical students with that of a general arts student group and to examine the relationship among perfectionism, distress symptoms and academic expectations and satisfaction. DESIGN: Medical students (n=96) and arts students (n=289) completed a baseline assessment including two multidimensional perfectionism scales. The medical students also completed measures of distress symptoms, personality (neuroticism, conscientiousness) and questions about their perceptions of their academic performance. Of the medical students, 58 completed a second set of questionnaires 6 months later (time 2). SUBJECTS: First-, second- and third year medical students and first-year arts students. RESULTS: In comparison with arts students, the perfectionism profile of medical students showed higher personal standards, lower doubts about actions and lower maladaptive perfectionism scores. In the medical students adaptive perfectionism (achievement striving) was significantly correlated with baseline academic performance expectations and conscientiousness and was predictive of dissatisfaction with academic performance at time 2. Maladaptive perfectionism (excessive evaluative concerns) was significantly correlated with baseline distress symptoms and neuroticism and was predictive of symptoms of depression and hopelessness at time 2. CONCLUSIONS: Perfectionism in medical students differs systematically from perfectionism in general arts students. Distinguishing adaptive and maladaptive aspects of perfectionism is important in understanding the cross-sectional and longitudinal implications of perfectionism for medical students.

Adult↗
PubMed1998

Older medical students' performances at McGill University.

PURPOSE: To compare admission data and academic performances of medical students younger and older than 25, and to qualify older students' experiences and perceptions in medical school. METHOD: The authors reviewed 1988-1991 data for applications to the McGill University Faculty of Medicine. Data included GPAs and MCAT scores, as well as ratings for reference letters, autobiographical statements, and interviews. For those same years, the authors measured students' academic performances in the preclinical and clinical years. The authors compared the data by students' age: "younger" students, aged 17 to 24; and "older" students, aged 25 and above. All enrolled students took the Derogatis Stress Profile, and the older students participated in focus groups. RESULTS: The older applicants had lower GPAs and MCAT scores, but higher interview and reference letter ratings. For older accepted students, basic science course scores were lower than those of younger students, but clinical scores did not differ significantly between the groups. The two groups had similar stress levels, although older students tested lower in driven behavior, relaxation potential, attitude posture, and hostility. In focus groups, the older students spoke of learning style differences, loss of social support, and loss of professional identity. CONCLUSION: Different scores in admission criteria suggest that McGill uses different standards to select older medical students. Older students admitted under different criteria, however, do just as well as do younger students by their clinical years. A broad-based study of admission criteria and outcomes for the older student population is warranted.

Adolescent↗
PubMed1999

A mentoring program for underrepresented-minority students at the University of Rochester School of Medicine.

Mentoring underrepresented-minority (URM) students poses a special challenge because most medical schools have few URM faculty and many non-URM faculty hesitate to be mentors for URM students. Some medical students perform less well in the clinical years than would be expected from their pre-clinical performances. One factor is some students' difficulty in adapting to the culture of medicine, which mentors can help students overcome. The University of Rochester School of Medicine created the Medical Student Mentoring Program to address the needs of URM students and non-URM faculty who could be mentors. The program, offered in 1995-96 and 1996-97, trained mentors, created a bicultural support group for URM students, and provided structured mentoring. Interviews were conducted with faculty and students to identify critical areas that influence the success of URM students in their clinical years; URM faculty, residents, and advanced students shared their experiences with the program students at reflection group meetings. Mentors participated in an initial orientation. Of the 42 students eligible during 1995-1997, 30 participated and were assigned to 15 mentors. At the end of the program's first year, the students and mentors gave their reactions, and although there were some differences in their viewpoints, overall they considered the program useful. Non-URM faculty appreciated the support and guidance that allowed them to mentor URM students more effectively. The program ran formally for two years, and some of the mentoring relationships continued into the third year. Loss of funding and change in administrative leadership contributed to the ending of this program. Mentoring continues to be a priority at the medical center, and a new mentoring program has been developed for URM and non-URM medical students.

Adult↗
PubMed2003

Educational benefits of diversity in medical school: a survey of students.

PURPOSE: Many U.S. medical schools have abandoned affirmative action, limiting the recruitment and reducing the admission of underrepresented minority (URM) students even though research supports the premise that the public benefits from an increase in URM physicians and that URM physicians are likely to serve minority, poor, and Medicaid populations. Faculty and students commonly assume they benefit from peer cultural exchange, and the published evidence for the past two decades supports this notion. This research examined the students' perceptions of the educational merits of a diverse student body by surveying medical students at two schools. METHOD: In 2000, medical students from all four years at Harvard Medical School and the University of California, San Francisco, School of Medicine were enrolled in a telephone survey about the relevance of racial diversity (among students) in their medical education. Students responded to the interviewer's questions on a five-point Likert-type scale. RESULTS: Of the 55% of students who could be located, 97% responded to the survey. Students reported having little intercultural contact during their formative years but significantly more interactions during higher education years, especially in medical school. Students reported contacts with diverse peers greatly enhanced their educational experience. They strongly supported strengthening or maintaining current affirmative action policies in admissions. The responses and demography of the Harvard and UCSF students did not differ significantly, nor did they differ for majority students and URM students-all groups overwhelmingly thought that racial and ethnic diversity among their peers enhanced their education. CONCLUSIONS: Diversity in the student body enhanced the educational experiences of students in two U.S. medical schools.

California↗
PubMed2006

Follow the patient: process and outcome evaluation of medical students' educational experiences accompanying outpatients.

BACKGROUND: To instill patient-centred attitudes in medical students, several medical schools in Japan have recently started to offer educational experiences in which medical students accompany outpatients throughout entire visits to hospitals. OBJECTIVE: To evaluate the processes and outcomes of the educational experience of Year 5 medical students accompanying outpatients at Nagoya University Hospital. METHODS: An integrated, multimethod approach was adopted using a written survey with open-ended questions for students, focus groups with students, and a written evaluation survey for patients. In all, 99 students completed the survey, 19 students participated in 3 focus groups, and 46 patients participated in the evaluation. RESULTS: Many students were sceptical about the objectives of the exercise. We were able to gain insight into student perceptions about facets of the exercise such as the ratio of students to patients and whether or not students should wear white coats. In particular, there was consensus among students about the importance of the debriefing session after the experience. Students achieved different learning outcomes depending on their particular individual experiences. In the student survey, 49% were satisfied with this experience, 6% were dissatisfied, and 43% were neither. In contrast, patients were highly satisfied with the experience (mean score 4.2 out of 5.0 on a Likert scale). Some students expressed concern about being a burden to patients, while many patients reported feeling emotionally supported by being accompanied by students. CONCLUSION: An integrated approach to programme evaluation, using quantitative and qualitative methods, was useful in the process and outcome evaluation of this new educational experience. The results have been taken into consideration for quality improvement of this curricular element.

Ambulatory Care↗
PubMed2005

Early identification of 'at-risk' students by the parents of paediatric patients.

INTRODUCTION: Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. METHOD: A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. RESULTS: Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean +/- SD, 59% +/- 5 versus 64% +/- 7; P < 0.05). Obtaining 1 low IPS score was associated with a subsequent faculty summative assessment score below the class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. CONCLUSIONS: Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students.

Education, Medical, Undergraduate↗
PubMed1998

Providing care in an infectious disease clinic. Why students volunteer.

This qualitative study explores the motivations of dental students who volunteered as care providers for patients identified as carriers of infectious diseases. The study involved 12 students, seven 4th year and five 3rd year students who worked 1-2.5 days per week in an infectious disease clinic in a dental school in the northeastern United States. 4 faculty members who also volunteered their time in the clinic supervised the students. Personal interviews were conducted with each student to determine their reasons for volunteering and to explore the perceived significance of their experiences in the clinic. Internal validity was established through group interviews wherein responses during the personal interviews were discussed with the students. All 12 students were interested in Oral Medicine and all 4th year students had completed a course on HIV-AIDS for their selective requirement. Students expressed willingness to care for patients who are medically compromised in anticipation of an increase of this type of patients in their future practice. Previous exposure to a family member or friend or patients (non-dental) who were terminally ill or to patients with HIV was another common reason. All 12 students preferred to work in the infectious disease clinic more than in other school clinics. They felt that there was more faculty-student interaction and a more stimulating learning atmosphere that the faculty created. The students felt that the patients treated in the clinic were more appreciative. Students also claim they experienced more team spirit among their fellow students and staff and that the clinic atmosphere was more relaxed and less competitive. Students got the most satisfaction from helping patients who were perceived to have had problems in accessing care prior to their visit to the clinic. Results of the study show that the students volunteered to treat patients who are known to have infectious diseases such as HIV/AIDS because they find personal and academic satisfaction from working in a clinic which provides care to individuals with specific medical needs.

Attitude of Health Personnel↗
PubMed1999

[The frequency profile of tuberculin skin testing among students in nursing school].

The frequency profile of tuberculin skin testing (TST) among students in nursing school was studied. Students received a TST upon matriculation. The TST was done by the method of Mantoux, in which 0.1 ml of PPDs was administered intradermally, and the diameters of skin rash and induration were read by the medical doctor at 48 hours. When TST results are negative--that is, the diameter of skin rash is below 10 mm (in Japan, the TST results are judged by skin rash diameter rather than that of induration)-BCG vaccination is given. Those receiving the BCG vaccination are retested with a TST one year later. When the second TST was also negative both the BCG vaccination and TST were followed for two more years. Those students testing TST-negative are not permitted to take clinical training in the tuberculosis ward. Student's mean age on entrance was 18.6 +/- 2.1 years old, and all but three were female. About 70% of students entering in 1996 to 1998 had a history of previous BCG vaccination. In 14% their positive TSTs could be attributed to probable infection with tuberculosis in childhood. In the remaining 16%, details as to TST and BCG vaccination status are unknown. The frequency distribution of TST results was bimodal, showing one peak at 6 mm and another at 12 mm (skin rash diameter). The percentage of negative and positive reactors are 47.1% and 52.9%, respectively. The TST-negative students entering in 1994 to 1996 were given the BCG vaccination. Twenty-four of 134 students (17.9%) remained negative at the second TST, and 6 students (4.5%) at the third year, even after two repeated BCG vaccinations. The TST results were chronologically observed in the above 6 students after BCG vaccination. The TST results of two students showed positive in September, 1996 and June, 1997. While four students showed positive in September, 1996, all ultimately reverted to negative when retested in June, 1997. Those students had negative results for TST at the initial test in 1998 had the two step-tuberculin skin testing. All eight students with negative TST had the history of BCG vaccination. The second TST showed positive except one student whose scar after BCG vaccination was not observed on the arm. The TST is currently recommended in hospital tuberculosis-control programs. If TST-negative, medical staff and students may not work in the tuberculosis ward. However, after BCG vaccinations is given, and subsequent TST conversion is confirmed, they are then able to work or to have training in the ward. From our results, there is 4.5% non-convertors even after 2 years of repeated BCG vaccinations. However, these non-converters turned positive four months after BCG vaccination, only to revert to negative nine months later. These students are considered to have delayed hypersensitivity to PPD after BCG vaccination. However, their reactivity waned in the short period of nine months after the conversion of their TST's. Therefore, it is concluded that non converters after repeated BCG vaccinations are able to have clinical training in the tuberculosis ward as long as their BCG vaccinations are correctly administered and any immunological deficiencies are ruled out.

Adolescent↗
PubMed2004

Tutorial dynamics and participation in small groups: a student perspective in a multicultural setting.

AIM: This study investigated the language and cultural backgrounds of medical students, and explored their perspectives of the influences on student participation in small-group tutorial settings. METHOD: A task group of students and staff from a variety of cultural backgrounds designed a cross-sectional survey using an anonymous questionnaire. The survey was conducted at the Christchurch School of Medicine and Health Sciences (a campus of the University of Otago). Students attending a 4th-year and a 5th-year lecture were invited to participate. RESULTS: Seventy-five percent of students enrolled in the medical course responded to the survey. Half of the sample self-identified as New Zealand European or Maori. Sixty-four percent of students identified English as their first language. Ninety-one percent of students stated a preference for small-group tutorials rather than lectures. Most students reported that there was a 'lack of prior preparation' by students in these tutorials (no statistically significant difference between students with English as first or second language). Two thirds of students (66%) students felt there was a lack of full participation in small-group teaching. Personality, cultural, and language differences were perceived as contributing factors to the lack of participation. CONCLUSIONS: Lack of participation should not be assumed to be due to language difficulties. Barriers to participation are perceived differently by students from a variety of language and cultural backgrounds. Moreover, interactions between students who dominate and under-participate may influence student participation. Further research is needed to determine whether language and cultural backgrounds affect students' participation in small group teaching.

Asian People↗
PubMed2006

[Childhood sexual abuses among 1307 adult students and analysis on results of Symptom Checklist-90 test].

OBJECTIVE: To survey the occurrence of childhood sexual abuses (CSA) among adult students and analyze the correlation between the sexual abuses and the results of Symptom Check-List-90 (SCL-90) test. METHODS: Questionnaire survey of 1307 adult students (701 female students, 606 male students) in a college about their personal experience on childhood sexual abuses. The surveys were conducted anonymously. And SCL-90 test was carried out at the same time. RESULTS: A total of 1307 students were surveyed. 18.67% of them (female students, 155, 22.11%; male students, 89, 14.69%) experienced non-physical contact sexual abuses and/or physical contact sexual abuses before the age of 18 years, among whom 124 students (female students, 81, 11.55%; male students, 44, 7.26%) experienced physical contact sexual abuses, including 35 (26 female; 9 male) who suffered attempted genital or anal sexual intercourse and 11 (8 female and 3 male) were forced for genital or anal sexual intercourse; 13.70% (female 15.66%; male 11.44%) said they experienced sexual abuses before the age of 16 years. Of the boys, experienced sexual abuse 54.7% from age 12 to age 16 years. And among the girls sexual abuses tended to increase with their growth (results of tendency test: chi(2) = 33.5, P < 0.001). The abusers were mostly males; only a small percentage of them used violence; for most female students who experienced non-physical contact sexual abuses, the abusers were strangers (78.7%), while 71.3% of physical contact abuses were from acquaintances, 12.5% of them were teachers, 17.5% were neighbors and 21.3% were relatives. Of the male victims, 89.9% said they knew the abusers before the abuses happened, 14.6% (13 out of 89) of them were teachers, and neighbors constituted another 21.3% (19 out of 89). Students who experienced childhood sexual abuses got higher scores than the students who didn't have such experience in the nine basic symptom factors of SCL-90 and higher than normal model of national young group notably. CONCLUSION: Childhood sexual abuse among students is not rare. The female students' incidence was obviously higher than that among the male students (chi(2) = 11.8, P = 0.001). About half of the abusers were the victims' close relatives, neighbors and teachers who live or study together with them. Personal experience of childhood sexual abuses may be one of the important factors influencing the victims' results of SCL-90 test.

Adolescent↗
PubMedDate not supplied

[Smoking among medical students in Tunisia: trends in behavior and attitudes].

We report a cross sectional survey to analyze the effects of medical training on the smoking habits of Tunisian medical students, and their attitudes and knowledge about smoking. Two groups of medical students were studied. One group was 257 first year students at the Medical Faculties of Tunis and Sfax, in 1987, the other 211 final year students at the same Faculties in 1994 and who had been in the first year in 1987. A questionnaire bases on that of the WHO and International Union against Lung Disease for health professionals was administered. It was completed by 95% of the students. Fifty-four % were men and 46% women, and 70.2% lived in an urban area before attending university (table 1). Nonsmokers were defined as those who had never smoked. Exsmokers were those who had formerly smoked but no longer did so. Smokers were divided into those who smoked occasionally and those who smoked daily. The prevalence of smoking was higher among the final year students than the first year students. Combined daily and occasional smoking was 24.1% among first year students and 37.1% among final year students (table 2). The rates among men for daily smoking were 19.2% in the first year and 38.9% in the final year, whereas for women the corresponding rates were 1.8% and 2% (table 3). The prevalence of occasional smoking among men was 17.8% for the first year and 17.7% in the final year. Among women, this behavior increased from 5.5% to 16.8%. Men exsmokers increased from 6.2% to 16.8% and women from 4.6% to 13.4% from the first to the final year. The proportion of first year smokers who reported a serious attempt to stop was 64.8% and that of final year students was 50%. Protected personal health was the most common reason (table 4). In the final year, 94.1% of te students agreed strongly with the view that smoking is harmful to health (table 5). However, there was substantial underestimation of the contribution of tobacco to causing serious diseases including bladder cancer, coronary artery disease, peripheral vascular disease, emphysema and neonatal morality (table 6). The study evidences insufficient awareness of medical students about their responsibility for health education and prevention. There was little interest in preventive action for patients. Only 4.5% of the final year students felt that they were equipped to advise patients about smoking. Similarly, 65.7% would not advise patients to stop smoking if they had no smoking-related symptoms and did not raise the question themselves (table 7). There were major deficiences in knowledge of preventive measures. Only 45.5% of final year students considered that they had adequate knowledge to advise patients about smoking (table 8) and 72.5% thought that they should have received more specific training about counseling (table 9). This work shows that, like in Africa, Asia and Europe, Tunisian medical students have an unsatisfactory knowledge of tobacco and its effects. There were no substantial changes in the students' knowledge of, or attitude to, smoking between the first and final year of training. Simply stimulating the interest of these future doctors in the problem of smoking is insufficient.

Cross-Sectional Studies↗