Medical Science Educator Volume 17: No. 1

For the past 90 and more years the Flexnerian model has dominated medical education. The single greatest influence Flexner had was to call for the integration of science to the study and practice of medicine. This model has served society well. We have seen a better perception by society of our health care practitioners, great improvements in the quality of our health care providers and significant advances in our understanding and treatment/management of health and disease.

Today, in medical education we are faced with great pressures to add more information and skill training to our curriculum. The expectations for us, as educators, and our students have increased as we have amassed greater understanding and knowledge of biomedical sciences. In addition to the ‘hard science’ knowledge, we also need to recognize and incorporate the behavioral, social and business aspects that are required for a complete medical education.

The end result is a very full and demanding curriculum of study. Holding to the traditional model of two years pre-clinical and two years of clinical study has led to a state of near exhaustion for our students. Over the decades since Flexner’s report we have revised and enhanced the clinical experiences and reformed ad nauseam the pre-clinical years. We have spent most of our efforts on the pre-clinical years with the greatest changes involving scheduling and use of various instructional strategies.

The roots of IAMSE are in the basic sciences and their relation to medical education. As medical educators we are closest to and the ones who can make a difference in the content and structure of the sciences in the medical education curriculum. IAMSE is embarking on a project to define what sciences should constitute the sciences basic to medical education and practice, the added value of the sciences in the medical education process and where and how best to provide instruction and learning of these sciences.

Obviously, this project cannot be completed without collaboration of our colleagues in the clinical sphere. To determine what sciences are needed as foundational requisites for clinical medicine, we must first define the scope and requirements for our students as they enter their clinical experiences.

To this end, IAMSE in collaboration with the Alliance for Clinical Education (ACE) and the Generalists in Medical Education will be conducting a series of meetings and workshops to address these topics. IAMSE will also be recruiting and collaborating with other professional medical education groups and associations to accomplish this project. It is our intent to present a comprehensive report at the 2010 IAMSE meeting, tentatively planned for Louisville, Kentucky, the professional home of Abraham Flexner on the 100th anniversary of his landmark report.

With the strength of IAMSE, its members, and their collective wisdom regarding the foundational sciences in medical education, we can and should take the lead in this issue. I would ask all to begin a dialogue and conduct research to address these issues. We should not limit ourselves to the role of the sciences simply in the pre-clinical years, but look to the pre-medical curriculum as well as integration in the clinical undergraduate and even the graduate clinical years. The Journal, JIAMSE, would then be the ideal place to publish your research on this topic. This July, at the annual IAMSE meeting in Cleveland, we will have a focus session workshop to begin a discussion on these issues.

As you peruse the agenda for this year’s Annual Meeting (http://www.iamse.org/conf/conf11/index.htm), you will find some very useful sessions addressing everything from instructional strategies, to assessment techniques and even a debate on the topic of medicine as a science. The session topics and posters are interesting and intriguing. This meeting is looking to be an exciting adventure with the opportunity to meet and talk with friends and colleagues from throughout the world.

With regard to other IAMSE business; after a number of years of faithful service, Regia Kreisle, Tom Schmidt and Deb Vaughn will be retiring from their IAMSE Board positions. We thank them for their contributions. Replacing them on the Board are Frazier Stevenson, John Szarek and Mark A.W. Andrews. Congratulations to these newest additions to the IAMSE Board who will assume their duties in July.

If you have not registered for the 2007 meeting in Cleveland, it is not too late. Neither is planning for the 2008 meeting in Salt Lake City. Have a relaxing summer and looking forward to seeing you all in Cleveland in July.

It is most gratifying to note the increased numbers and quality of contributions by the membership, both of articles, as well as Innovations and Monographs. The launching of the first Supplement was a success. The response to the call for reviewers has also yielded many new and capable professionals for the future review of all contributions. We hope to hear positive news from listing services this year. In sum, things are going very well with the journal and the editorial team is working hard.

That said, if we hope to reach the first tier of medical education publications, which is a very reachable goal, we require cooperation from the membership. We need for all of you to consider JIAMSE first when you submit papers for review. We need even more and the highest level submissions. Secondly, we need to reference the work published in JIAMSE far more. We were reviewed recently by Current Contents and their view was “While JIAMSE has left a favorable impression with the evaluators, the group notes that the journal is not demonstrating adequate levels of citation activity.” The only way in which this can be improved is if the authors who publish in our Journal also reference papers previously published in the JIAMSE. We have the volumes archived on the web and it shouldn’t be hard to peruse them to determine if any articles there are relevant to your work sent in for consideration. If we all work together, good things will happen for the Journal.

If you have educational research that needs publishing, look to the JIAMSE. You will be in good company. I look forward to hearing from you. All best,

Uldis N. Streips, Ph.D.
Editor-in-Chief, JIAMSE

It is my guess that the teaching materials and tools prepared by the faculty of some research universities are seldom or minimally recognized for their instructional value and quality and that the faculty that produce them are even less often credited or rewarded for the effort and time spent producing them. That, however, may be changing for faculty working in the field of medical education.

In a seminar given in April of 2006 at the Northeastern Ohio Universities Colleges of Medicine and Pharmacy and captured by the school on video, Robby Reynolds spoke about the Association of American Medical Colleges (AAMC) initiative that is intended to elevate the standing of outstanding teaching materials in the promotions process.* The website, called MedEdPORTAL, publishes peer-reviewed teaching materials for world-wide distribution. In the video, Reynolds, explains that the materials are accepted for publication only after being subjected to a review process that is similar to the one used by Academic Medicine in the publication of journal articles. Thus, instructors are afforded the opportunity to receive publication credit for their endeavors, and according to MedEdPORTAL, the publication of the materials by the website “should be considered a compelling scholarly contribution suitable to support promotion and tenure decisions.”

Reynolds continues by saying that MedEdPORTAL will consider any topic dealing with medical education, and that there are no restrictions on the form of the material submitted. For example, case studies, animated artwork, atlases and PowerPoint presentations are published on the website. He explains that the materials need not be web-based and that the site has not as of yet matured into a repository for the materials. As it is currently constituted, the web-based resources are linked to the servers that host them while the authors of the non web-based materials, e.g., paper cases and CD-ROMs must provide the materials to interested parties at no charge (except perhaps for duplication and shipping costs) upon request.

More information on how to publish teaching materials through MedEdPORTAL can be obtained by visiting the website or linking to the streaming online video seminar. **

Google Scholar and Wikipedia, which are also reviewed in this issue of The Medical Educator’s Resource Guide (MERG), remind us that users of the Internet are looking for speed and convenience when using websites as sources of educational information, and that they want to know that the information is reasonably complete and accurate. This is the reason the MERG is so useful. In each instance, the sites have been tested in the classroom or office, and have satisfied the needs of faculty and students that use them in their work and studies. If you have experience with a website that offers similar benefits to teachers and students working in the medical sciences please consider sharing your experience with us. You can do so by contacting us by e-mail (jrcotter@buffalo.edu).

ABSTRACT

The purpose of this article is to heighten awareness concerning an alternative method for delivery of multimedia-rich digital classroom presentations in a manner providing significant ease of access and portability. The method targets Windows^® PC-Based presentations and employs syndication by simple internet broadcasts, currently referred to as podcasts, of large volumes of such presentations in a video-feed format for viewing on small hand-held devices. The goal is to offer students another alternative format for some of the materials currently used in the classroom or published on the internet in various formats. The methods for producing this content require: 1) special formatting of the initial digital presentation for maximum clarity on the small screen; 2) rendering and translating the video product for podcasting; and 3) production of a web page and appropriate links for the end-user to gain access to and use the materials at large.

To date, podcasting has primarily been used to feed simple text, still photos or MP3 audio. What makes this method somewhat novel is the production of the next level of podcast output: video MP4 files. Currently, video podcasts are being offered to first- and second-year students in gross anatomy and neuroscience classes at Ross University School of Veterinary Medicine to offer an alternative learning format to facilitate the needs of students with varied learning styles.

ABSTRACT

Problem-based learning (PBL) is considered by many to be an important innovation in medical education. Integral to the success of PBL is the role of the tutor, which is considered a prime determinant of how the tutorial group functions. Recently, there has been considerable debate about the role of subject expert and non-expert tutors in facilitating PBL session and who will be more effective and efficient in facilitating the learning experience. The aim of this review is to evaluate the role of expert and non-expert tutors in facilitating PBL sessions.

An electronic search of the Medline database was undertaken for the articles published on tutoring in PBL with specific reference to expert and non-expert tutors in PBL. Relevant articles were chosen for review and analysis.

Tutoring in PBL is a multifaceted process, with the issue of the tutor expertise forming only one part of this complex process. Published literature was equivocal on this issue because of the inconsistency in defining expert and non-expert tutors and the inconsistency in evaluation tools used. There is no consistent evidence to suggest that groups facilitated by expert tutors do better, in terms of student academic achievement and student perception, than those facilitated by non-expert tutors.

ABSTRACT

This formative evaluation examines the process of curricular change as a College of Osteopathic Medicine develops a competency-based curriculum. The study explores how faculty perceive the need for change, the process of change, and the results of specific changes to guide the college in the change process and improve the chances of achieving a long-lasting and well-accepted curriculum innovation. Study objectives were to determine status of faculty members regarding: a) levels of readiness for change early in the change process, including changes in perceptions after implementation; and b) specific concerns and level of use of the Competency-Based Curriculum. The evaluation is based on well-established principles that focus on change, first in individuals and then in organizations. The Concerns-Based Adoption Model describes seven levels of concern that users experience while adopting a new program or practice. The Stages of Concern (SoC) questionnaire was administered to all basic science and clinical faculty, and to related staff. The results showed an overall profile consistent with an institution beginning a change process. The profile revealed very high awareness concerns, moderately high information and personal concerns, moderate concerns in management, low concerns in impact or consequences, with rising concerns in collaboration and refocusing. The institutional profile shows the typical non-user profile except for some tailing up at Stages 6 and 7, which may indicate resistance to the innovations. Understanding the profile will help in tailoring information and training sessions. Follow-up interviews of a purposeful sample of faculty focused on the five key elements of the Competency-Based Curriculum: overall integration of national competencies; student accountability for learning outcomes; curriculum scope based on clinical relevance; innovative use of curriculum time and instructional modalities, and curriculum expansion allowing student choice. Interviews were analyzed for level of use and stage of concern, bringing to light new themes that will guide faculty development and implementation.

ABSTRACT

Medical educators are identifying how learning opportunities help further student professionalism, which requires explicit methods of assessment. This paper reports how student comments about peer professionalism may contribute to our understanding and assessment of medical student professionalism. An inductive qualitative analysis identified themes across student comments. Using comment characteristic (positive versus negative) as an independent variable and the mean score of the nine scale questions of the professionalism assessment as the dependent variable, an independent-sample test was calculated. Participants included one-hundred and eleven first-year medical students in a required problem-based learning course. A total of 12 comment themes were distinguished. Out of the total male (292) and female (212) comments, 82% and 88% were positive comments, respectively. There was a significant difference in the mean professionalism score between the students who did and did not receive negative comments, t = 2.93, df = 109, p = .002. Overall, this study provides an initial framework from which future studies may draw. This investigation will assist educators to interpret the rich and complicated data of student comments, furthering how we figure qualitative information into the overall evaluation of student professionalism.

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.