USE OF A DIFFERENTIAL DIAGNOSIS TEMPLATE TO PROMOTE CLINICAL DECISION-MAKING SKILLS IN BASIC SCIENCE
Sarah Joslin, Kristina Colbenson, Erin Goranson, Joseph Grande*, Leslie King-Schultz, Natalie Rigelman-Hedberg & Kathryn Thompson
Mayo Clinic College of Medicine
Rochester MN 55905
USA
PURPOSE
Although many organ-based curricula promote integration of basic and clinical sciences, students frequently have difficulty in developing a differential diagnosis for patients with multisystem diseases. We have developed a series of autopsy cases as a platform to illustrate basic science principles and to develop clinical reasoning skills in a general pathology course.
METHODS
Groups of 4 first-year students are assigned a case consisting of gross and light microscopic images obtained from autopsy cases that highlight basic science principles. The students are provided with a standard differential diagnosis template (vascular, inflammatory, traumatic, autoimmune, metabolic, idiopathic, neoplastic, congenital, degenerative, environmental) and a brief (1-2 sentence) clinical history and are required to complete the differential diagnosis template online for comments by the course instructor. One day later, the group of 4 students presents the case to the class, emphasizing basic science aspects of the case and clinical manifestations of disease processes. Student presentations are peer-evaluated using an electronic assessment tool.
RESULTS
In previous years, case presentations were regarded as a valuable part of the basic pathology course. However, evaluations indicated that students who did not prepare the cases often did not actively participate. Having the students prepare a differential diagnosis prior to the case presentation has increased participation in the discussion, both live and online.
CONCLUSIONS
We propose that having students work through a differential diagnosis template in a basic pathology course will foster integration of basic and clinical sciences and promote the development of clinical reasoning.
EDUCATORâS PREDICTIONS FOR THE FUTURE OF MEDICAL EDUCATION
Elizabeth Kachur, Ronald Harden*, Patricia Lilley & David Solomon
Medical Education Development
New York NY 10010
USA
PURPOSE
Strategic planning requires thoughtful considerations of what the future may bring. The goal of this study was to gain a global perspective on potential future developments. We elicited predictions of the speed and the direction of changes from experienced medical educators who had a variety of academic backgrounds and came from around the world.
METHODS
This investigation used brainstorming and silent voting exercises from four conference sessions to predict the state of medical education in 20 to 25 years. The programs were: 1) a workshop at the 2002 AMEE conference (Europe), 2) a symposium at the 2005 AMEE conference (Europe), 3) an interactive poster at the 2008 Ozzawa conference (Australia), and 4) a workshop at the 2009 Generalists in Medical Education conference (USA). All sessions included an international audience with a wide range of administrative and academic backgrounds and responsibilities.
RESULTS
For each of 12 topic areas (e.g., Basic Science, Clinical Science, Doctors, Patients) we could ascertain the Top 5 predictions medical educators could envision. For example, it was predicted that âAssessment in 2025â is more likely to use utilize open computer exams, is likely to become more diverse (i.e., multiple forms of assessment), more focused on growth (i.e., formative), more continuous (e.g., use of portfolios), and more aligned with the curriculum. Predictions about the general speed of change varied significantly.
CONCLUSION
In order to make effective decisions for the present we need to keep the future in mind. Of course there are âWild Cardsâ (e.g., disasters) or âDisruptive Innovationsâ (e.g., new technologies) that can change the field radically. However, the potential trends identified through this investigation are worth considering when engaging in educational and resource planning.
CREATING A LEARNING ENVIRONMENT THAT FOSTERS INTEGRATION OF HISTOLOGY, PHYSIOLOGY, AND BIOCHEMISTRY
Frances Kennedy, Robert Stephenson & John Wang
Michigan State University
East Lansing MI 48824
USA
PURPOSE
New medical students struggle to assemble content from various basic science courses into a coherent conceptual framework. As basic science faculty we felt it unfair to expect students to grasp the connections between basic science disciplines unless we led by example.
METHODS
To promote such integration, we created a 7-credit, 24-week course blending content traditionally found in separate histology, physiology and biochemistry courses. Three departments collaborate in our course, which integrates structure and function âfrom molecules to manâ. A faculty leader from each department monitors course content and directs participating faculty. These 13 faculty also teach in other courses, which fosters cross-course integration. Our hybrid course includes 89 lectures, 18 faculty-proctored histology labs, abundant self-study material (print and online), graded formative assessments (online), and 10 major examinations. Course features fostering integration include: (1) Lectures blend histology/physiology/biochemistry; (2) Histology labs coordinate with lectures; (3) All lecturers participate in histology lab; (4) All lab faculty lecture; (5) Faculty integrate lecture and lab material in self-study exercises, practice exams, online assessments, and exams.
RESULTS
Over nine years, this course has garnered increasingly enthusiastic reactions from students, faculty, and administrators. Students provide formal evaluations, and face-to-face feedback during histology labs and focus groups. Key to our success is the culture of cross-departmental collegiality and the faculty’s passion for teaching.
CONCLUSION/ FUTURE DIRECTIONS
We must accommodate our medical collegesâ expansions from one to four campuses while continuing to foster a learning environment where students grasp the links between structure and function, from molecules to man.
ARTICULATION FROM SCIENCE TO MEDICINE TO SPECIALIST TRAINING AT THE UNIVERSITY OF NEW SOUTH WALES
Rakesh K. Kumar*, Richard L. Henry, Philip D. Jones, Terence J. Campbell & Peter J. Smith
Faculty of Medicine
University of New South Wales
Sydney
Australia 2052
PURPOSE
The six-year undergraduate Medicine program at UNSW offers considerable flexibility in terms of sequencing and availability of electives. Taking advantage of this, we have developed a graduate entry stream from our Bachelor of Medical Science program, as well as an advanced standing pathway for specialist training based on electives that articulate with educational activities after graduation.
METHODS
For the graduate entry stream, high-performing students in the BMedSc program are provisionally selected into Medicine after completing core courses in year 2. They subsequently complete year 3 and a research Honours year, then enter the Medicine program after a bridging course, at the equivalent of year 4. The advanced standing pathway for specialist training has initially been implemented in Pathology. Students complete a research project in a relevant area, then undertake an elective focusing on the use of investigations in clinical diagnosis. Together with face-to-face and on-line educational activities during internship, plus an introductory Pathology term in the following year, this will allow graduates to gain one year of advanced standing in the Pathology specialist training program.
RESULTS
Introduction of the graduate entry stream has increased enrolment demand for the BMedSc, with a progressive rise in entry cutoff scores. Increasing numbers of students have registered interest in the advanced standing pathway in Pathology. Further evaluation is ongoing, as these initiatives are still at a pilot stage.
CONCLUSIONS
Opportunities for articulation will help to recruit research-oriented science students, and to promote specialisation in areas with strong foundations in the medical sciences.
CLINICAL PRACTICE GUIDELINES AS AN INTEGRAL PART OF MEDICAL EDUCATION
Radim Licenik*
Centre for Clinical Practice Guidelines
Department of Social Medicine and Health Policy
Palacky University
Olomouc
Czech Republic
PURPOSE
The Centre for Clinical Practice Guidelines of Palacky University Faculty of Medicine and Dentistry (CCPG), one of the working groups at the Department of Social Medicine and Health Policy, was established in 2007 to be concerned with development, implementation and evaluation of clinical practice guidelines (CPGs). Members of the CCPG are medical doctors of various specialties, nurses, medical educators as well as sociologists, a psychologist, a librarian, a lawyer and others. Our broad aim is to develop, teach and disseminate methods for development, adaptation, implementation and evaluation of CPGs and to provide support and resources to anyone who wants to make use of clinical practice guidelines.
METHODS
Development of new undergraduate and postgraduate medical educational programmes focused on CPGs. Implementation of the educational programmes into the Palacky University curricula and the Ostrava University curricula. Dissemination of educational programmes in co-operation with other universities, teaching and district hospitals.
RESULTS
We offer 6 workshops and 1 seminar. The first one has been developed for undergraduate medical students with no or low experience with CPGs use in clinical practice; the others are for experienced medical or nursing students, health care professionals and CPGs developers:
Introduction to CPGs development, adaptation, implementation and evaluation;
Introduction to methodology of CPGs development and adaptation;
Guidelines for guidelines;
CPGs adaptation;
Implementation of CPGs;
Critical appraisal of CPGs;
Legal aspects of CPGs.
CONCLUSION
CCPG innovates undergraduate and postgraduate medical education and disseminates the CPGs methodology knowledge as well as the principles of evidence-based health care.
VISUALIZATIONS OF SHARED KNOWLEDGE OF SPECIALISTS
Sylvia Vink
ICLON
Leiden 2333 AL
The Netherlands
PURPOSE
Schemes like concept maps are valuable for making knowledge structures explicit. This study investigates what are the common characteristics of schemes that are made by multi disciplinary teams about clinical problems, and whether these schemes are useful for medical education.
METHODS
Seven groups of three specialists from different disciplinary backgrounds created a scheme about a clinical problem. In a second session, the schemes were revised in order to let participants experience the dynamic nature of knowledge. Schemes were analyzed using descriptive statistics. By means of a questionnaire (statements on a 5 point Likert scale), the usefulness of the schemes in medical education was surveyed.
RESULTS
Although the instruction was, to make as much knowledge explicit as possible, the specialists limit themselves, in particular in adding basic science concepts. In the second session, most adaptations affected the relations between concepts and the hierarchical ordering. Concepts were often categorized along the lines of the phases of the clinical reasoning process. Within these categories, disciplinary clusters of concepts were distinguished. Although the schemes showed a high complexity, they were assumed to be useful in both preclinical (3.9) and clinical education (4.1). This difference is not significant. In preclinical years, there is a slight preference to use the schemes as a help for the teacher to explain clinical problems (4.1) but usage by the students is considered as possible (3.8).
CONCLUSION
Schemes cannot explicate all the knowledge related to a clinical problem. Encapsulated basis science concepts are often left out. A second session motivates participants to restructure and reconnect concepts. Further research will focus on the use of the schemes in medical curricula.
ADAPTATIONS IN ANATOMY TOWARDS A SYSTEMS-BASED INTEGRATED CURRICULUM
Award Nominee
Willie Vorster*, Linda Greyling, Ben Page
University of Stellenbosch
Tygerberg 7505
South Africa
PURPOSE
Universities should provide opportunities to learn new facts and skills in an efficient way to meet set outcomes. The new integrated medical curriculum reform programme was initiated at the Stellenbosch Faculty of Health Sciences in 1999, changing from the traditional discipline-based curriculum to a student-centred, integrated, systems-based curriculum. The aims were to promote active student involvement and developing continual clinical skills.
METHODS
A new modular curriculum replaced the old discipline-based curriculum and consisted of a 19-week linear lecture-based curriculum, with reduction of lectures and practical sessions, exposing students to anatomical structures and dissections. Recent changes included a shift from the duplex parallel study programme to a simplex model, where the basic sciences were integrated into the clinical system-based curriculum. The modules where Anatomy was involved, consisted of 107 days in the duplex model (135 days for the clinical theory), whereas the new simplex model consists of 248 days of fully integrated system-based modules.
RESULTS
These adaptations resulted in full integration of the anatomy of the old curriculum with the clinical relevance in the system-based modules. The new programme changed the learning process from a lecture-based, knowledge transfer programme to student group activities, constructed around study guidelines and applied clinical cases for achieving the set outcomes.
CONCLUSION
The active and eager participation of the students in the practical group activities, with the improved ability to integrate and apply their anatomical knowledge, indicates that the new approach is justified. Continual renewal of innovative adaptations will ensure a viable new curriculum.
A METHOD FOR INTEGRATING GROSS ANATOMY WITH PATHOLOGY IN THE BASIC SCIENCE CURRICULUM
Kristina Colbenson*, Erin Goranson, Joseph Grande, Sarah Joslin, Justin Juskewitch, Leslie King-Schultz, Wojciech Pawlina, Natalie Rigelman-Hedberg, Kathryn Thompson
Mayo Clinic College of Medicine
Rochester MN 55905
USA
PURPOSE
This pilot study tests the use of histologic sections prepared from student-dissected cadavers as a platform for integrating anatomy with pathology.
METHODS
Gross anatomy is taught as a team-based experience, with groups of 4 students responsible for completing a cadaver dissection. The final week of the course, a pathologist came to the anatomy lab, assisted students with identifying abnormal tissues in each of their cadavers, and obtained tissue specimens which were then histologically prepared and digitally photographed. The images were made available to students during their general pathology course two months later. Students were expected to analyze the histologic sections and correlate their microscopic findings with their previously-completed summary of gross findings. Groups with specimens demonstrating interesting educational pathology were asked to present their findings to the class.
Analysis: Qualitative interviews were conducted addressing studentsâ perceptions of the educational benefit of the exercise as it pertains to integration of anatomy with pathology. After the course, students will complete a feedback form that addresses these same issues from a quantitative standpoint. Responses will be compared against feedback from students who took the course prior to this integrated component.
RESULTS
Students reported that the opportunity to analyze specimens obtained from âtheirâ cadavers helped them to better understand the pathology underlying their gross anatomical findings. They also felt it established continuity of learning between the two courses.
CONCLUSIONS
We propose that analysis of histologic sections obtained during dissection in gross anatomy facilitates the integration of gross anatomy with microscopic anatomy and pathology.
WHAT DO STUDENTS EXPECT FROM PRE-CLINICAL PATIENT CONTACTS AND HOW EFFECTIVE ARE THEY?
Zuzana de Jong, Anne de Boer, Debbie Melchers & Sylvia Vink
LUMC
Leiden 2300 RC
The Netherlands
PURPOSE
Early contacts with patients help medical students to learn and to develop appropriate attitudes towards their studies and future practice. In the third year Leiden undergraduate medical curriculum, patients with rheumatoid arthritis and with low back pain of diverse origin participate in small group sessions implemented as a part of the block Musculoskeletal Problems. The purpose of these sessions is to give students an opportunity to train history taking and physical examination with ârealâ patients. This study investigates the expectations students have of these sessions and the effectiveness of this intervention.
METHODS
To evaluate the studentsâ opinions on the sessions, participating students were invited to take part in a focus group. Ten students agreed. The focus group discussed the studentsâ expectations (focus group 1) and their satisfaction with the sessions afterwards (focus group 2) extensively. The data thus collected, were converted into survey and emailed (before and after the sessions) to all students who participated in the sessions. Educational effectiveness was measured by comparing the participantsâ results on the end-of-block test with the non-participants.
RESULTS
Survey 1 was completed by 80 out of 179 participants (80/179; 44.7%). The most frequently mentioned expectations, selected from a list of statements, were: âstimulation of memory processesâ (71.3%), âimprovement of physical examination skillsâ (67.5%) and âcontextualization of theoryâ (68.8%). Survey 2 was completed by 72 participants (72/179; 40.2%). The most important benefits experienced by the participants were: âcontextualization of theoryâ (93.1%), âstimulation of memory processesâ (91.7%) and âunderstanding of the impact of illnessâ (91.7%). Most students (81%) were (very) satisfied with the sessions and would sign up again (1 00%).Participants scored significantly higher at the end-of-block test than non-participants, even after correction for confounders (p=0,019).
CONCLUSIONS
The pre-clinical patient contacts have positive effects on studentsâ learning and should be implemented throughout the preclinical curriculum.
IMPLEMENTATION OF PRE-CLINICAL CONTACTS IN LEIDEN UNDERGRADUATE CURRICULUM
Zuzana de Jong, Rani van Exel, Esther Helms & Sylvia Vink
Friedo LUMC
Leiden 2300 RC
The Netherlands
PURPOSE
Early small scale contacts with patients have positive effect on studentsâ learning and are a permanent part of the 3rd year block Musculoskeletal Problems of the Leiden undergraduate medical curriculum. Historically, the block uses trained patients with rheumatoid arthritis to lecture students in small groups how to approach patients with joint diseases and to demonstrate their joint pathology. No structured feedback on studentâs professional attitude was provided. No additional information, either lab or X-rays, is available and no time for self-reflection is reserved. The purpose of this study was to implement studentsâ opinions on experienced benefits of the sessions to improve its design.
METHODS
In 2008, a survey was sent to all students participating in the sessions to evaluate the benefits. The least positively answered statements were: participation in the sessions improves skills in history taking and in examination of the joints, teaches how to use translate theoretical knowledge into practice, has positive effect on studentâs professional attitude, and facilitates self-reflection on studentâs role as a doctor.
RESULTS
To facilitate a broader and deeper experience the sessions have been re-designed. Forty untrained patients with arthritis of diverse origin were recruited from the outpatient clinic of the rheumatology department to participate. Before the sessions, students were obliged to see an Internet-based video on history taking and joint examination of patients with arthritis. The sessions were supervised by a rheumatologist and structured to train students in history taking, joint examination, problem-solving and presentation skills. Patientsâ lab results and X-rays were directly available on line. Patients were instructed to give a structured feedback to the students about their professional attitude and time was reserved for self-reflection.
CONCLUSIONS
Studentsâ opinions on the experienced benefits of an educational module were taken into account when improving a design of a module. A protocol describing how to set up sessions will be made available on line to coordinators of all pre-clinical blocks to assist them in organizing pre-clinical contacts.
INTRODUCTION OF AN ELECTRONIC CURRICULUM: IMPLEMENTATION AND EVALUATION AFTER THREE YEARS
Award Nominee
e-Demo
Robert M Klein*, Giulia A Bonaminio, Heidi Chumley, Glendon G Cox, James L. Fishback, Michael Karr & Anthony Paolo
University of Kansas Medical Center
Kansas City KS 66160
USA
PURPOSE
Technology allows enhancements in medical education including self-directed learning, student collaboration, and improved access to materials. When the University of Kansas, School of Medicine (KUSOM) introduced a new basic science curriculum in 2006, we used technology in multiple ways.
METHODS
The technology components included a required tablet PC for students, lecture podcasts, web-based access to curriculum materials, virtual microscopy, electronic faculty and course evaluation, and electronic examination. The tablet PC is the centerpiece of the curriculum and is used to integrate technology components and provide 24/7 access to all curricular material, including lecture podcasts. We reduced lectures by 40% and replaced material with small group sessions and web-based learning.
RESULTS
The implementation curriculum was successful. We encountered few technical problems, and student and faculty satisfaction has been high. Podcasting was extensively used both instead of and in addition to attending lectures. Virtual microscopy has been a welcome change from microscopes, though creating an active learning laboratory environment has been a challenge. E-textbooks were not used effectively by students or faculty. We found that a technology-intensive curriculum requires extensive time and resources. Some NBME Subject Exam scores have improved while others have declined. Initial results on Step I of the USMLE are no different than the previous year.
CONCLUSION/ FUTURE DIRECTION
Ultimately, we hope to improve studentsâ knowledge, problem solving abilities, clinical skills, and USMLE Step One scores. Our electronic curriculum was implemented successfully. Refinements of the curriculum continue as it evolves to include fewer lectures and more interactive learning experiences.
A TRAINING AND EDUCATION CONTINUUM FOR DENTISTRY AND MEDICINE â A BOLOGNA ORIENTED CONCEPT
Jerome Rotgans*
Aachen University
Aachen
Germany
PURPOSE
1999 the EU member states decided in their Bologna Declaration to overcome permanent problems with recognition, crediting, quality, mobility and internationalization until 2010. One of the recommendations was to introduce a life-long training concept based on three cycles: bachelor, master and doctorate.
METHODS
Though a lot of countries already implemented a variety of curricula in medicine reserve is observed. If implemented, faculties reshaped their curricula simply by announcing the preclinical phase bachelor phase and the clinical one master phase. As traditional basic medical training and education is per definitionem at the undergraduate level these curricula not only violate the recommendations but are explicitly contra-productive to the goals of the Bologna initiative. Beyond this the question arises whether a (basic) doctor and dentist must be a master. RWTH University Aachen Medical Faculty developed a concept (i) to simply reorganize the actual 12 semester structured medical curriculum (2 x 14 weeks) in trimester (3 x 14 weeks); as for the 10 semester structured dental curriculum without any loss of quality, and (ii) to allow restricted licensure according to the Medical resp. Dental Treatment Act for an additional two-year national interim cycle towards full licensure to fulfill the EU-regulation of at least 6 resp. 5 year training and education.
RESULTS
The intended reorganisation (i) meets the bachelor standard by delivery of an employable doctor and dentist, (ii) allows students to start specialization two years earlier as before, (iii) assures that the shorter length of study is related to the half-life of actual medical knowledge.
CONCLUSIONS
The concept meets the respective Bologna Recommendation exemplary. It is therefore expected that the concept will be Gold Standard for the MedEd-Project about accreditation and certification of the German Society of Medical Education.
THE LIFE STAGES COURSE AS A MULTIFACETED COMPONENT OF A NEW CURRICULUM
Ancuta M. Stefan, Eileen M. Moser, Michael Giuliano & Cristian Stefan
Touro University College of Medicine
Hackensack, NJ 07601
USA
PURPOSE
The Life Stages course is incorporated into the integrated curriculum of a new medical school. It extends through the last five and a half weeks at the end of the second year of study.
METHODS
The Life Stages course was designed with a three-fold purpose in mind: 1) to integrate morphological, functional and psychological changes that occur between the intrauterine and late stages of life; 2) to review previously encountered aspects of various basic sciences in the context of the development and aging processes; and 3) to provide exposure to common topics and ambulatory experiences in pediatrics and geriatrics.
RESULTS
Basic science information related to the life cycle is presented together with clinical, psychological, sociocultural, and ethical aspects specific to various age groups and reinforced by several half-day meaningful clinical experiences in pediatrics and geriatrics. These clinical experiences also strengthen the interprofessional interactions with other healthcare providers. The course content is viewed as part of the curricular continuum. It is linked to material presented in previous and concurrent courses and the clerkships to follow. A diverse array of instructional modalities is matched to individual sessions to facilitate the development of clinical reasoning abilities and the acquisition of appropriate knowledge, skills and attitudes.
CONCLUSIONS
The curricular placement and content of the Life Stages course makes it a multifaceted component of the curriculum that wraps-up, reviews and expands on knowledge, skills and attitudes introduced in the first two years and links them with the educational needs of the clinical clerkships.
INTEGRATING NEUROSCIENCE AND PSYCHIATRY/BEHAVIORAL SCIENCES AMONG COURSES IN A NEW MEDICAL SCHOOL
Cristian Stefan*, Diego Coira, Ancuta M. Stefan & Eileen M. Moser
Touro University College of Medicine
Hackensack NJ 07601-7023
USA
PURPOSE
A new medical school curriculum offers multiple possibilities and challenges for reshaping and enhancing traditional ways in which the material is structured, presented, and tested.
METHODS
In designing the new program across the first two years of the curriculum, three areas received special simultaneous attention: a) coverage and proper sequence of topics; b) balance between content and pedagogical modality for each session; and c) appropriate placement in individual courses to interconnect with other disciplines, threads and topics.
RESULTS
The design process blending Neuroscience, Psychiatry/Behavioral topics within and across individual courses required constant shifting between placing content pieces; applying conceptual aggregates derived from various disciplines; and connecting institutional, course, and session goals and objectives. In the new program, an overview of basic Neuroscience concepts is presented in the first semester of study. Specific concepts are enhanced and expanded in system-based courses. Morphological and molecular concepts are from day one linked to their functional/clinical relevance. In the eight-week Neuro-Psychiatry I course, at the beginning of the second year curriculum, the clinical Neuroscience is expanded and seamlessly linked with Neurology, Ophthalmology, and Psychiatry/Behavioral Sciences, with focus on patient centered medicine. Thematic program topics specific to the pediatrics and geriatrics are scheduled in the Life Stages course, at the end of the second year curriculum.
CONCLUSIONS
The merging of Neuroscience with Neurology, Behavioral Sciences, and Psychiatry as a unified longitudinal program offers unique opportunities for integration and reinforcement of knowledge, elimination of redundancy, and continuity with other disciplines across the curriculum.