Kaaren I. Hoffman

Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery

IN THE LATE 1990S THE Society of American Gastrointestinal Endoscopic Surgery (SAGES) formed a committee (Fundamentals of Laparoscopic Surgery or FLS) and charged it to develop educational materials covering the basic fundamentals of laparoscopic surgery. Four major principles guided the committee’s developmental process. First, comprehensive coverage of the domain of basic laparoscopy was seen as involving two components: one cognitive (declarative knowledge); and the other psychomotor (procedural skill). Second, the focus of the program was to be on the educational material considered unique to laparoscopy and not on material normally encountered during open surgical training. Third, in accordance with the idea of basic fundamentals, any content specific to a particular anatomic location or to a specific laparoscopic procedure was to be avoided. And fourth, the program was to contain mechanisms for assessment as well as for didactic instruction. The overall goal of the FLS program was to ‘‘teach a standard set of cognitive and psychomotor skills to practitioners of laparoscopic surgery’’ in the belief that knowledge and application of these fundamentals would help ‘‘ensure a minimal standard of care for all patients undergoing laparoscopic surgery.’’ The didactic learning modules are

A Comparison of Computer-Monitored Group Tests with Paper-and-Pencil Tests.

A test was administered to pharmacy students in two ways: using a computer-monitored, group-response system and using the conventional, paper-and-pencil method. Student performance on the two administrative modes was compared. Test-taking behavior for the two modes, as measured by the number and pattern of changed answers, was also compared. Three item formats (true-false, multiple-choice and matching) were analyzed separately.

A pilot experience with competency-based clinical skills assessment in a surgical clerkship

This investigation examines a competency-based clinical skills assessment program for surgical clerks using checklists and rating forms for precise measurement of physical exam (PE) skills, physician-patient interaction (PPI) skills, and patient write-up (PW) skills. Analysis of variance demonstrated improvement in PW skills across the academic year when measured by the rating instrument, but this improvement was not detected on traditional subjective rating forms (SRF). PPI skills improved between first rotations across 2 academic years with the addition of orientation to expectations (mean, 79% versus 92%, P = 0.000). Poor correlation was noted between the National Board of Medical Examiners Surgery Subtest scores and PE skills (r = .19), PW skills (r = .20), and PPI skills (r = .15). While the overall ratings given by faculty on SRF correlated with the SRF ratings of PE skills (r = .77) and PPI skills (r = .58), these same faculty ratings correlated poorly with these skills as assessed by checklist (r = .16 and r = .14, respectively). This pilot experience demonstrates that PE skills, PW skills, and PPI skills (1) improve only with orientation to expectations and feedback, (2) correlate poorly with fund of knowledge assessment, and (3) are best assessed with precise measurement (eg, checklist, direct observation), which avoids the halo effect of overall evaluation that occurs with subjective rating forms.

Integrated Cases Section: A Course Designed to Promote Clinical Reasoning in Year 2 Medical Students

Background: Medical students often have difficulty applying basic science knowledge within clinical contexts as they transition into clerkships. Description: To enhance clinical reasoning skills in 2nd-year medical students, we developed a 7-week transition course called the Integrated Cases Section. Curricular instruction incorporated analytic and nonanalytic clinical reasoning models. Practice with variable case scenarios enhanced students’ application of basic science knowledge to clinical problem solving. Evaluation: We evaluated curricular design and objectives by measuring student perceptions during the course and following completion of 2 clerkship rotations. To obtain measurement of students’ clinical reasoning ability we administered a script concordance test immediately before and after the course. Conclusions: Students reported increased confidence in their diagnostic reasoning ability during the course and after completion of 2 clerkships. Students’ clinical reasoning showed a significant gain after the Integrated Cases Section on a script concordance test. Student support has solidified Integrated Cases Section in the curriculum.

Effects of intensive clinical exposure on attitudes of medical students toward cancer-related problems

The attitudes of third‐year medical students toward cancer and patients with cancer was examined before and after a 6‐week clerkship that included contact with pediatric patients with cancer and their families. A 51‐item testing instrument was employed, which included pediatric, adult, and general oncology questions. Beginning with positive attitudes toward the importance of early diagnosis, aggressive therapy, and the complete disclosure of prognosis, the clinical exposure appeared to strengthen the rwo former attitudes and somewhat diminish the latter. Approval of aggressive cancer therapy was stronger for children than for adults; but approval of both aggressive therapy and intensive surveillance of patients in remission was increased in regard to adults as well as children after the clerkship. A comparison with responses of second‐year medical students from another institution suggests that third‐year students recognize greater personal limitations in respect to management and adopt a more “defensive” position regarding the patient. In general, during the clerkship, the students moved in the direction of attitudes that were previously designated to be appropriate for students by a muftidisciplinary committee that was distinct from the instructional staff in oncology.

Objective measure of incidental learning in oncology.

The learning experience of 150 third‐year medical students in the specific area of paediatric oncology during a 6‐week required paediatric clerkship, was assessed.

An Innovative Instructional Format for a Course in Basic Psychopathology

An innovative course in psychopathology for medical students was developed using principles derived from instructional development models. The instructional format consisted of carefully designed self-instructional workbooks and patient-centered workshops. No lectures were presented during the 32-hour course. Statistically significant learning gains were achieved between the pre- and postcourse examinations, and the students were highly enthusiastic about the innovative educational format.

Student-constructed examination items

Student‐written items were compared with teacher‐written items on an objective examination given to first year medical students. While student scores were higher on the student‐written items than on teacher‐written items, there was a positive correlation between the scores. Student items did not differ from teacher items in the course, according to student ratings of emphasis. As a by‐product of this study, correlations were found which suggest that student scores on an item often reflect the degree of teaching emphasis given the content area of the item rather than the inherent difficulty of the content. It is suggested that further research is needed to determine whether students learn through the process of writing examination items. Therefore, if the process proves to be educational, this study indicates that it will be feasible to incorporate the student‐constructed items in examinations.

Predicting Medical Student Performance in a Course in Clinical Psychopathology

Experiential and academic data of Year 2 medical students were used to predict pre- and end-of-course performance during instruction in clinical psychopathology. No relationships of practical significance were found either between experiential data and test performance or between the pre- and end-of-course test performances. These findings are discussed in light of their implications for academic preparation for medical school, the medical school curriculum, and psychiatrically related learning experiences.