Halil İbrahim Durak

Use of case-based exams as an instructional teaching tool to teach clinical reasoning

Background: It is a very well-known fact that examinations drive learning to a great extent. The examination program is actually the ‘hidden curriculum’ for the students. In order to improve teaching and learning one option is to strategically use of exams. Aims: This report of the strategic use of an innovative assessment tool in clinical problem solving domain, presents the design, format, content, students’ results and evaluation of one year test results of instructive case-based exams for 6th year medical students. Method: Using a hybrid form of the OSCE, PMP and KFE formats, we developed a case-based stationary exam. Students were treated as advanced beginners in medical career and forced to an inquiry to use their clinical knowledge in the cases. Case discussions and question-answer sessions followed the exams. Six exams were held in 2000–2001 and 382 students participated in the study. One or two problems were used for each exam and the mean duration was 27 minutes for 7–11 stations. 17–19 observers contributed to each exam. Exams were evaluated by questionnaire based feedbacks of the students and oral feedbacks of the staff members. Results: The exams were well received and rated ‘fair’ by the students and the format was found highly ‘relevant for learning’ while the content was ‘instructive’ and ‘not difficult’. The total non-satisfactory performance rate was 2.36%. Students asked to take a similar test weekly. Although it was labor intensive, staff members appreciated the collaborative working process. Conclusions: Instructive case-based exams and the following case discussions seemed a high potential and motivating teaching tool in the clinical problem solving domain for 6th year students.

An early patient contact programme combining simulation and real settings.

Context and setting We present the format and the first year’s evaluation results of our Early Patient Contact Programme (EPCP) in the Year 2 curriculum. We implemented the EPCP during the 13-week Introduction to Clinical and Pathological Sciences block. We used a portfolio-driven, multisetting-based, experiential learning approach to teach patient interviewing skills to students. Why the idea was necessary Although early student)patient contact is generally seen as an educationally sound approach, the hospital setting seems not to be optimal. Previously, there was no structured patient contact programme in our curriculum. Teaching took place on an ad hoc basis during the clinical years and there was neither content nor method consensus among teachers. What was done In the preparation phase, an educational collaboration contract was signed with 20 primary health care centres (PHCCs). A computerised standardised patient laboratory was established. Using guidelines drawn from the Calgary-Cambridge Observation Guide to the Consultation and MAASGlobal (an instrument designed to rate the communication and clinical skills of doctors in consultations), a conceptual framework and a set of patient interview guidelines were developed. A total of 284 Year 2 students were divided into 3 main rotating groups and then into 32 subgroups, each consisting of 3 students. Teaching teams were formed, each composed of 1 clinical teacher and 1 general practitioner (GP) teacher and each in charge of 3–6 subgroups. Nine teacher training and programme development workshops were organised for GPs and faculty members. A student learning and assessment portfolio was developed. In the implementation phase, the programme included 8 hours of preparatory lectures, 3 half-day work sessions at PHCCs and hospital clinics, 9 SP encounters (in 3 doctor and 6 observational roles) and 3 group feedback sessions. In each session, teachers worked with 3–6 students and used the experiential learning cycle. Students were given feedback on the SP contacts by their peers and the SPs following the SP contact and from their GP teachers through the records. Evaluation of results and impact The EPCP was evaluated by: • student achievement: assessed with a portfolio (40%) and an SP-based performance examination (60%); • a student feedback questionnaire; • a student programme evaluation meeting, and • teachers’ SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.

A multicenter study: how do medical students perceive clinical learning climate?

Background The relationship between students and instructors is of crucial importance for the development of a positive learning climate. Learning climate is a multifaceted concept, and its measurement is a complicated process. The aim of this cross-sectional study was to determine medical students’ perceptions about the clinical learning climate and to investigate differences in their perceptions in terms of various variables. Methods Medical students studying at six medical schools in Turkey were recruited for the study. All students who completed clinical rotations, which lasted for 3 or more weeks, were included in the study (n=3,097). Data were collected using the Clinical Learning Climate Scale (CLCS). The CLCS (36 items) includes three subscales: clinical environment, emotion, and motivation. Each item is scored using a 5-point Likert scale (1: strongly disagree to 5: strongly agree). Results The response rate for the trainees was 69.67% (n=1,519), and for the interns it was 51.47% (n=917). The mean total CLCS score was 117.20±17.19. The rotation during which the clinical learning climate was perceived most favorably was the Physical Therapy and Rehabilitation rotation (mean score: 137.77). The most negatively perceived rotation was the General Internal Medicine rotation (mean score: 104.31). There were significant differences between mean total scores in terms of trainee/intern characteristics, internal medicine/surgical medicine rotations, and perception of success. Conclusion The results of this study drew attention to certain aspects of the clinical learning climate in medical schools. Clinical teacher/instructor/supervisor, clinical training programs, students’ interactions in clinical settings, self-realization, mood, students’ intrinsic motivation, and institutional commitment are important components of the clinical learning climate. For this reason, the aforementioned components should be taken into consideration in studies aiming to improve clinical learning climate.

Factors Influencing the Choice of Pediatric Surgery as a Medical Career Among Turkish Pediatric Surgeons and Residents

ABS TRACT Ob jec ti ve: Each me di cal spe ci alty has its own re a sons to be se lec ted as a ca re er by me di cal doc tors. The aim of this study was to iden tify the ma in re a sons to se lect pe di at ric sur gery as a me di cal ca re er among Tur kish pe di at ric sur ge ons and re si dents. Ma te ri al and Met hods: Da ta of this cross-sec ti o nal sur vey we re col lec ted from pe di at ric sur ge ons and re si dents, ba sed on a self-ad mi nis tra ted qu es ti on na i re du ring 23rd Na ti o nal Con gress of Pe di at ric Sur gery in Sep tem ber 2005. The qu es ti on na i re inc lu ded de mog rap hic va ri ab les (sex, gen der, aca de mic af fi li a ti on) and 13 pos sib le inf lu en ce fac tors which were mar ked on a 7 po int se man tic dif fe ren ti a ti on sca le (3= strong ne ga ti ve inf lu en ce, 0= no inf lu en ce, +3= strong po si ti ve inf lu en ce). Re sults: Eigthy-se ven pe di at ric surge ons and re si dents par ti ci pa ted in the sur vey. Thre e strong po si ti ve re a sons (op por tu nity to per form sur gery, wor king with chil dren, and ex pec ted emo ti o nal sa tis fac ti on), one mo de ra te re a son (abi lity to ap pra i sal of own skills and ap ti tu de), and two mi nor po si ti ve re a sons (ex pec ted aca de mic op por tu ni ti es and a te ac her as a ro le mo del) we re iden ti fi ed to se lect pe di at ric sur gery as a me di cal care er. Conc lu si on: Our fin dings may be used for the early iden ti fi ca ti on and sup port of doc tors who will be co me pe di at ric sur ge ons in Tur key.