Using a workshop to determine the effectiveness of a text on the problem-oriented medical record.
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The article describes the efforts of the faculty members in the Department of Community Medicine at the Rockford School of Medicine to improve their clinical teaching skills in the Primary Care Experience (formerly the Basic Ambulatory Experience). Faculty members opted for an instructional development program under the direction of an educational consultant as a result of their problems with clinical teaching in a new medical school. Each faculty member's teaching was videotaped and analyzed by the consultant, who met with the instructor to discuss the videotape, From this initial discussion problem areas were defined to be discussed at large group meetings. Faculty members will be videotaped in the present academic year to ascertain improvement in their clinical teaching.
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BACKGROUND: As medical schools implement curriculum changes to address the relevancy of medical education to today's health care needs, examining schools' grading systems and their valuing of curriculum hours has become a priority. METHOD: In 1991-92 all 126 U.S. medical schools were surveyed regarding various issues related to the schools' grading systems and valuing of curriculum time, including the ways in which the schools achieved a balance between lectures and self-directed learning activities. RESULTS: A total of 122 schools responded. Forty-eight schools calculated grade-point averages and used them to compute and publish class ranks; 72 published grade-point averages. Fifty schools reported curriculum revisions that decreased lecture hours, incorporated small-group discussion, or used problem-based learning and/or assessments using standardized patients. These 50 schools fell into four categories: had a system to balance lecture time and self-directed learning (11 schools); were moving toward such a system (27 schools); had tried but failed to balance lecture time and self-directed learning (one school); and had no policy to achieve a balance (11 schools). CONCLUSION: The survey results indicate that most schools have not established systems for the valuing of curriculum time that include balancing values for lecture time and values for self-directed learning. If needed curriculum reforms are to be implemented effectively, they must be valued meaningfully.
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Efforts to redesign education in ambulatory settings are hampered by a lack of rigorous and coherent research on the learning process in these settings and the desired outcomes of the educational experiences. The authors present 13 priority research topics and 51 important research questions concerning education in ambulatory settings that were defined by a distinguished group of medical educators, clinicians, and policymakers who attended an invitational conference on education in ambulatory settings in 1996. The need to establish valid and reliable measures of quality and outcomes of educational programs and instructional interventions stood out as the major prerequisite for conducting research on education in ambulatory settings. Issues of theory building, research priorities, and research design are discussed, and policy recommendations are made for the development of valid measures of educational outcomes. The creation of a "Medical Education Outcomes Commission" is proposed to act as a repository for measures and instruments, and to provide the field with mechanism to validate instruments and uniform recommendations to conduct studies of quality. The authors urge funding agencies with missions that support medical education to invest in basic research on the outcomes of education in ambulatory settings.
Responsibility for teaching communication skills often falls to a multidisciplinary group of faculty who lack both a common model for teaching and prior experience teaching communication in small groups. This article describes East Tennessee State University's multifaceted faculty development program in teaching communication skills. The program was developed and implemented in three phases. First, a two-step Delphi approach helped identify core communication skills. Phase two gave faculty the opportunity to practice identifying communication teaching issues and effective strategies for working with small groups. The third phase involved the videotaping of faculty teaching small groups of students. These tapes were reviewed both individually and in faculty groups. The tapes were also reviewed by students, who provided realtime, moment-to-moment feedback to the faculty. Implementation and review of the program has helped to identify new strategies for effectively facilitating small-group teaching of communication skills.
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PURPOSE: One of the many challenges clinicians face is applying growing medical knowledge to specific patients; however, there is an information gap between information needs and delivery. Digital information resources could potentially bridge this gap. Because most medical students are exposed to personal computers throughout their education, this study postulated that students may be more comfortable using computer-based information resources within clinical interactions. METHOD: In 2001, the authors monitored second-year medical students' use of a unique digital textbook, UpToDate, as they transitioned from preclinical to clinical years at the University of Iowa Roy J. and Lucille A. Carver College of Medicine. In 2002, at the end of their third year, students were surveyed about their preferred clinical information resources. RESULTS: Medical students rapidly adopted UpToDate as a clinical resource during their clinical clerkship as evidenced by a rapid growth in the electronic textbook's use. One hundred sixteen of a possible 154 students (75%) responded to the survey. More than 85% of respondents identified electronic sources as their primary resource (UpToDate 53%, MDConsult 33%; p <.001 when compared to paper resources). They also reported using the information resources on a daily basis and requiring less than 15 minutes to answer most of their clinical questions. CONCLUSIONS: This study clearly demonstrates that medical students embrace and use electronic information resources much more than has been reported among practicing clinicians. The current generation of students may be the leaders in a medical culture shift from paper to electronic resources.
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