MSE Articles

ABSTRACT

This study posed the following questions: (1) do women and men differ in their overall medical school performance? (2) are there significant differences in the preadmission academic qualifications of female and male medical students? (3) are gender differences in preadmission qualifications a factor in medical school performance? The study included 705 students in four successive classes at the New York College of Osteopathic Medicine (NYCOM). There was no gender difference in undergraduate GPAs, while the mean total MCAT scores of men in all classes were higher than those for women. There was also no significant gender difference between women and men in their cumulative GPAs for the first two years of medical school. Men had higher mean scores on the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, given after the first two years of medical school, but when total MCATs were controlled, there was no gender difference in COMLEX Level 1 performance. MCATs were shown to be correlated with COMLEX Level 1 performance. Clinical performance was determined by scores on clinical subject examinations and the clinically-based COMLEX Level 2 examination. No significant gender differences were seen in these two clinical performance measures. Women outperformed men in evaluations of clinical clerkship performance.

ABSTRACT

Significant forces are converging to reshape the basic science medical curriculum including advances in educational theory, advances in computer technology, and increased understanding of human disease processes. The explosion of information in the medical field and financial pressure on academic medical centers is stimulating significant change in the way that the basic science curriculum is delivered. This study was undertaken to incorporate these advances into the medical microscopic anatomy curriculum by transition from paper and pencil to computerized assessments of student learning. The goals included: modernization of the mode of student assessment on high stakes examinations, maintenance of high academic standards, maintenance of student performance, acquisition of student experience in computerized testing, and reduction in student and faculty time required for assessment. Design, implementation and evaluation of the transition was documented and analyzed. Freshmen medical students were given either written or computer assessments. Student performance was compared on identical items. There was no performance difference in the overall course or for most of the experimental items. The written format provided an advantage on 3% of the items that were likely cued by proximal items. Student evaluation of the transition was positive. They felt better prepared for future computerized examinations. Student satisfaction with instant scoring of the examination was rated quite high. There was recovery of significant student and faculty time in the assessment process. There was student suspicion of the accuracy of item scoring by the computer. The concern was investigated and student satisfaction was obtained with addition of a minor modification to the programming. Overall, the transition to computerized assessments was successful and productive for both students and faculty.

ABSTRACT

Frequent testing, enhanced by computer delivery, provides a valuable means of formative assessment through timely review of course material, prompt feedback and image display. We introduced weekly computer-based quizzes in a medical school General Pathology course. Quizzes were released for several days following each of five weekly modules and represented, in total, 10% of the final grade. We hoped to further enhance the value of frequent computer quizzes by introducing two new features. First, we offered independent, open-access scheduling with the ability for the student to take the quizzes independently at any site with Internet access. By doing so we conserved in-class hours for instruction and eliminated the need for a designated testing site and faculty supervision. Secondly, we permitted an open-book format to encourage directed course review and decrease stress. Data were generated on specific questions from the quiz and on the entire quiz by individual student and class. Prompt analysis of results permitted timely remediation of problematic topics and identified students at academic risk. In the three years of study, student feedback has been highly favorable, particularly with regard to reinforcing understanding of topics for study, including both those formally presented in class and those assigned as independent learning, and for the impetus to “keep up” with course material. Performance on the final examination showed a statistically significant improvement after introduction of the quizzes. Weekly quizzes, enhanced by self-scheduled computer delivery and open-book format, are a valuable teaching tool for formative assessment.

ABSTRACT

The goal of the study was three-fold: to investigate medical student behaviors (e.g., changing answers) while taking high-stakes multiple-choice exams; to determine if specific behaviors were associated with performance on the exam; and to determine if there are associations of learning style, as measured by Kolb’s Learning Style Inventory (LSI), with test-taking activities. We developed high-stakes, on-line exam applications that included server event logs, which provided a time sequence of entries/activities that students made while taking their exam. This new paradigm allows collection of detailed test taking behaviors that can be used to test a variety of hypotheses. Test taking activities were extracted from the event logs for a mid-term anatomy exam given to freshman medical students. Although student exam-taking activities showed considerable variability, one notable finding was that when students changed answers, they were 3 times more likely (on average) to change their answer from incorrect-to-correct than they were to change it from correct-to-incorrect. Correlation of test-taking behaviors with performance on the exam revealed that there were significant negative correlations with the number of times answers were changed, and the number of times answers were changed from correct-to-incorrect. There were also significant associations of learning styles with exam-taking behaviors. The most consistent differences between students who did the best on the exam (Assimilators) and those who did the worst (Accommodators), concerned the frequencies with which answers were changed. Differences between Accommodators and Convergers, who received the next highest average score, involved behaviors related to variables other than changing answers (e.g., time spent reviewing the exam and number of questions marked for review). In summary, the use of objective computer entry logs allowed a better understanding of the associations of test-taking behaviors with academic performances and with learning styles. Based on these findings, learning strategies might be designed to help students cope with courses that rely heavily on multiple-choice exams for assessing student achievement.

ABSTRACT

At Vanderbilt University, an interactive, Web-based histology atlas was transformed into a dynamic database-driven tool through utilization of a MySQL^® database and the PHP scripting language. The advantages of this transformation were substantial. For the faculty, data associated with the histological images were manipulated quickly and easily to affect the entire website without the involvement of a technology expert. Features such as practice exams, keyword searches, slide lists, and site usage analysis took minutes to develop after the conversion to a database-driven atlas. For the medical students, the database-driven interactive atlas could quickly adapt to meet their educational needs. The implementation of a database-driven histology atlas was well-received by students and faculty due to the ease of data entry, the increased functionality, and the unlimited potential to adapt to meet the pedagogical demands of students.

ABSTRACT

The basic sciences in Nepal are taught during the first four semesters of the undergraduate medical course. The objectives of this study were to obtain information on the attitudes towards and perception of the basic sciences among second and fourth semester students and note the association, if any, of the attitude with the respondent personal characteristics. The study was carried out among second and fourth semester medical students at the Manipal College of Medical Sciences, Pokhara, Nepal during March 2005. The student attitudes towards the basic sciences were assessed by noting their degree of agreement with a set of nine statements using a modified Likert-type scale. The median scores for the different statements were compared among the various subgroups of respondents. Sixty-two of the 75 second semester (82.7%) and 73 of the 75 fourth semester (97.3%) students successfully completed the questionnaire. Female students were more in agreement with the statement ‘Faculty members excite students’ curiosity through the teaching of the basic sciences’ compared to male students (p=0.034). The female students had a more positive opinion regarding the ‘perceived effectiveness of medical education’ compared to males (p=0.003). Significant differences in the median scores of some statements were seen between the second and fourth semester students. Greater emphasis should be placed on the psychological aspects of medical treatment and on teaching about applying basic sciences to clinical medicine. Similar studies in other medical schools would add to this data. The students overall had a positive opinion towards the basic sciences.

ABSTRACT

Course directors often note that medical science classes struggle with beginning medical courses when the material introduces novel concepts and terminology or requires recall of previously learned material. Pre-class quizzes induce students to review past courses and pre-read before the class is initiated, fostering easier entry into the subject matter

I will be assuming the daunting position of Editor-in-Chief starting with the December issue of JIAMSE. Our current Editor-in-Chief, Douglas Gould has already done the yeoman work of putting our journal on strong footing with International recognition and a steady stream of high quality peer-reviewed papers on subjects most important to the International medical education community. He and our superb Editorial Board deserve all praise for what JIAMSE is today.

My first IAMSE meeting was in Chicago and I have been a steady contributor to the Basic Science Educator (predecessor of JIAMSE) and to JIAMSE over the years. Currently, I am a Professor of Microbiology and Immunology at the University of Louisville, School of Medicine, and I felt I was at a time in my career where I could take on this important job and devote the time and energy necessary to accomplish what I hope to achieve. When the call came out that Doug was stepping down from his position and IAMSE was looking for a successor, I never thought that I would get the job; I was shocked but pleased when it was offered. I accepted the offer with great enthusiasm, excitement, and strong intentions of building on what has been so ably started.

It is my goal to shepherd JIAMSE to the very top of available medical education journals. It is important to increase the paper submission totals and maintain a high level of quality, so I ask each of you to consider submitting articles to JIAMSE for review on the exciting things you do at your schools to foster better medical education. It is also critical to be indexed in Index Medicus, an initiative that has already been started. Then, we need to increase the exposure radius for this journal in the educational community.

I have requested the Editorial Board and staff to remain and I have happily heard from most of them that they will. I have increased the number of Associate Editors to expand the expertise and also to provide a wider opportunity for targeted editing. I intend to maintain the methodology and quality for review started by Doug. I am looking forward to Doug??bf?s assistance in putting together the December issue.

I will be happy to talk to any of you in Puerto Rico about JIAMSE and also about publishing your work in the journal of our association. If you have posters and oral talks, you should definitely consider submitting your work.

In closing, I am very proud and excited to be the next Editor-in-Chief of JIAMSE, and I hope all of you share my pride and the pride of our great organization in this journal which so brightly represents our association.

The five reviews in this issue of the Guide were written by medical and osteopathic students and a graduate student in anatomy. All of the reviews deal with three of the four major sub-disciplines of anatomy: histology, neuroanatomy, and gross anatomy. This may not be a coincidence. Anatomy is one of the cornerstones of medical… Read more »

ABSTRACT
Limited formal mechanisms exist for exploring basic sciences during the clinical clerkships in many medical schools. This study was designed to create a model for integrating basic and clinical sciences in a fourth year clerkship. Fifty-eight fourth year students enrolled in the Emergency Medicine clerkship participated in the study, undertaken by the clinical director of the clerkship and a basic scientist. Expert basic scientists were invited as discussants. Clinical presentations commonly encountered in the Emergency Department were selected for a case-based approach. Students researched and discussed both basic science and clinical questions that arose from the case discussion. They completed a questionnaire at the end of the session. More than 50% of the participants reported that the sessions enabled them to achieve a deeper understanding of the basic science principles relevant to clinical problems and improved their ability to evaluate and manage another comparable patient. They noted that this approach would motivate them to explore the basic sciences in the future and agreed that understanding basic science principles would contribute to better patient care. They reported that the availability of a basic science expert facilitated the integration and that they would recommend the model for other fourth year clerkships. Our results suggest that the incorporation of a structured basic science inquiry related to a patient problem in a fourth year clerkship could be an effective approach to encourage the exploration of the relevant basic science principles. Presence of a basic science expert, along with a clinician, enhanced the reported effectiveness of the integration.

ABSTRACT

Using a whole day, comprehensive test three times a semester, rather than many individual course examinations in the same time span is the hallmark of Block Examinations. This manuscript examines the effect such a curriculum change has made at two medical schools of similar size (University of Louisville with 144 students and Medical University of South Carolina with 146). The implementation of Block testing at both medical schools has been associated with a sustainable increase in pass rates as well as absolute scores in Part 1 USMLE at both schools. This testing process is well accepted by faculty and students and appears to provide time for students acquire and retain preclinical material.

ABSTRACT
Metaphors, analogies, and similes bridge the known to the unknown, and alter the conceptual system of existing knowledge by modifying and strengthening its associations. Although the use of metaphors, analogies, and similes is pervasive in our language, not much has been written about its use as a potential active teaching strategy in medical education to explain complex or abstract concepts. Metaphors, analogies, and similes were used intentionally in two consecutive years of an undergraduate pathology course for medical and dental students for two purposes: a) to communicate and understand complex concepts such as those related to acute and chronic inflammation, thrombosis, embolism and infarction; and b) to provide practice for students to become better communicators of complex medical concepts using these strategies. Students found that working with metaphors, analogies and similes enhanced and aided their learning, and challenged their communication skills. The unexpected impact of creating visual metaphors had a unique potential for improving recall of information. The discussion and negotiation of metaphors can be used in medical education as an effective teaching strategy to augment communication skills towards a better understanding of complex medical concepts. This, in turn, may aid students in becoming effective communicators with their prospective patients.