M D Carlo

A comparison of faculty-led small group learning in combination with computer-based instruction versus computer-based instruction alone on identifying simulated pulmonary sounds.

Background: Computer-based learning has gained widespread acceptance in medical curricula, but can it replace faculty-led teaching. Purpose: To investigate the effectiveness of independent computer-based learning of pulmonary auscultation alone and in combination with faculty-led teaching. Methods: The first method involved independent computer-based instruction (CBI; Group 1) of 113 second-year medical students. The second method involved a combination of faculty-led instruction and independent CBI (Group 2) of 79 second-year medical students. A pretest-posttest method of assessment was used. Results: The pretest showed recognition rates of 48% for Group 1 and 46% for Group 2, whereas the posttest showed recognition rates of 81% for Group 1 and 88% for Group 2. The posttest clinical correlation scores were identical with both groups scoring 93 percent. Conclusions: The study demonstrates that student learning of pulmonary auscultation is similar whether a computer-based independent instructional approach is used alone or in combination with faculty-led sessions.

Effect of curriculum reform on students' preparedness for clinical clerkships: a comparison of three curricular approaches in one school.

As medical schools revise preclinical curricula to emphasize active learning, clinical relevance of the basic sciences, and early clinical experiences, critical evaluation of the results of the changes is important. Such changes in preclinical curricula are expected to help students develop better skills in communication, interpersonal relationships, critical thinking, and other areas essential to the practice of medicine, resulting in better preparation to begin clinical clerkships. How does changing foundational aspects of preclinical curricula affect students’ preparedness for clinical work? How can that be assessed? Performance on the USMLE Step 1 is certainly the most visible outcome of preclinical education. Although the Step 1 is commonly taken just before clinical clerkships are undertaken, its scores are not likely to reflect effects of all curricular changes. Changes such as adopting small-group, problem-based learning (PBL) or early clinical experiences might be expected to impact noncognitive aspects of students’ performances beyond the cognitive outcomes measured by Step 1 scores. Scores on knowledge-based examinations are not likely to be useful measures of students’ preparedness for noncognitive elements of clinical clerkships, such as cross-disciplinary teamwork or patient communication, in which procedural knowledge must be applied in clinical tasks. Might students’ preclinical course performances predict their readiness for clinical clerkships? Studies of preclinical course performances as predictors of clerkship performance, such as those by Baciewicz et al. and Roop and Pangaro, tend to demonstrate a relationship between those measures and students’ clinical course examination scores or grades. We felt, however, that preclinical course grades had not been shown to be a sensitive measure of readiness for the noncognitive demands of clinical training. While students are frequently asked to evaluate course objectives, instructional delivery, and other curriculum features, they are not often asked how well their curriculum has prepared them to undertake the next training level. Fincher, Lewis, and Kuske used interns’ self-assessments to examine their preparedness in competencies required to begin the intern year, including history and physical examination, patient diagnosis and management, and interpersonal skills. We adopted a similar approach to study important noncognitive outcomes of preclinical curriculum change. Over the past seven years, the University of Texas Medical Branch (UTMB) implemented stepwise preclinical curricular reform. In 1995, a problem-based learning (PBL) track featuring selfdirected learning in small groups and early clinical experiences opened to 24 students chosen by lottery from approximately twice that number of volunteer students per class, running parallel to the traditional didactic curriculum (TC). The PBL track’s student assessment procedures relied heavily on essay tests, standardized-patient (SP) examinations, and evaluation of small-group work; the TC assessments relied predominantly on multiple-choice questions (MCQs), with less use of SP examinations. In 1998, the TC was replaced with the Integrated Medical Curriculum (IMC), a hybrid curriculum combining the problem-based, small-group, self-directed aspects of the PBL track with some didactic teaching. The hybrid IMC retained the TC’s heavy reliance on MCQs for cognitive assessment with some SP-based examinations but added the PBL track’s small-group assessment. The PBL track, meanwhile, remained essentially unchanged. All three tracks featured early clinical experiences, but the PBL track’s emphasis was heavier than that of the TC or IMC. The curriculum labels used in this study (‘‘PBL,’’ ‘‘traditional,’’ ‘‘hybrid IMC’’) may unintentionally call attention to each curriculum’s instructional characteristics more than the curriculum features more relevant to this study. Our use of these labels references all features of each curriculum, including amount of early clinical experience and array of assessment methods. UTMB’s curriculum evolution process provided an uncommon opportunity to examine the effects of three distinct preclinical curricula within a single institution on students’ perceptions of their preparedness for clinical training. To that end, we developed a clinical-preparedness survey and administered it to students as they finished their preclinical curriculum. We hypothesized that if differences were found between students’ self-assessments of preparedness for clinical training those differences would correspond to the differing emphases in the three preclinical curricula.

Implementation of colorectal cancer screening guidelines by residents in training is poor-need for an educational intervention

Implementation of colorectal cancer screening guidelines by residents in training is poor-need for an educational intervention