Trevor Gibbs

Using team-based learning to prepare medical students for future problem-based learning

Background: The original concept of problem-based learning (PBL) was built upon an acceptance that its participants would be of a more mature age, and with personal and potential qualities that would equip them for problem solving as part of their learning process. However, despite global acceptance for the use of PBL in medical and health sciences education, and knowledge of the diverse background of students about to embark upon PBL, structured programs preparing medical students for such an educational activity are not common. Aim: The primary aim of this study is to describe the experience in adopting and adapting an educational approach analogous to PBL, team-based learning (TBL), in preparing medical students to later study in a PBL environment and secondarily, to measure the students’ reaction to this experience. Methods: At the University of Sharjah, 363 students were enrolled over four semesters in the ‘Introduction to Medical Sciences Education (IMSE)’ course. They were divided into groups of 25–27 students per class, where their learning was facilitated through a TBL approach. The course was evaluated both quantitatively and qualitatively and appropriate statistical analysis was applied to their responses. Results: Out of 363 students, 304 (84%) responded to a 28-item closed-ended questionnaire. Their mean scores and consensus measurements indicated a high degree of students’ satisfaction. Eighty-two students (65%) responded to the open-ended questions providing 139 comments. Content analysis of the responses supported the quantitative results. Conclusion: This study demonstrated a high degree of students’ satisfaction from the course in acquiring skills preparing them for future PBL. Although this represents an evaluation of the TBL effects upon the early exposures to PBL, TBL was considered to be a feasible, efficient and cost-effective educational approach in preparing the students for their new educational experience.

Factors Associated With Antihypertensive Drug Discontinuation Among Chinese Patients: A Cohort Study

BACKGROUNDnAntihypertensive drug discontinuation imposes a substantial health services burden but few studies have addressed the factors associated with their discontinuation in Chinese patients. This study evaluated the association between age, gender, and drug classes with antihypertensive discontinuation.nnnMETHODSnFrom clinical databases, we included all adult patients prescribed an antihypertensive medication during January 2004 to June 2007 in one large territory of Hong Kong. We studied the factors associated with drug discontinuation within 180 days after the first prescription date by multivariable regression analysis.nnnRESULTSnFrom 93,286 eligible patients, 13.2% discontinued their antihypertensive prescriptions. Younger (<50 years; adjusted odds ratio (aOR) = 0.63 for patients aged 50-59 years; 0.52 for patients aged 60-69 years; 0.70 for those aged >or=70 years; all P < 0.001) and male patients (aOR = 1.05, P = 0.027) were more likely to have drug discontinuation. When compared with thiazide diuretics, patients prescribed beta-blockers were more likely (aOR = 1.67, P < 0.001) and patients prescribed calcium channel blocker (CCB) (aOR = 0.76, P < 0.001) and combination therapy (aOR = 0.73, P < 0.001) were less likely to have drug discontinuation. Stratified analyses in different age and gender groups reported similar results; except that only elderly male patients (aOR = 1.12, P = 0.002) and younger patients (aOR = 2.43 for patients aged <50 years, P < 0.001) prescribed beta-blocker were more likely to have drug discontinuation.nnnCONCLUSIONSnDiscontinuation of antihypertensive drug treatment in ethnic Chinese is more likely to occur in younger, male patients, or those prescribed beta-blockers. These data suggest that more meticulous monitoring of patient adherence is required in patients with these characteristics.

Medical education in Japan: A challenge to the healthcare system

In response to a change in health and societal need, the system of medical education in Japan has undergone major reform within the last two decades. Although the general health status of Japanese citizens ranks amongst the highest in the world, a rapidly increasingly elderly population, a social insurance system in crisis and a decrease in the number of practicing physicians is severely affecting this enviable position. To compensate, the Government has reversed its previous decision to reduce the number of doctors. Concomitantly, public opinion is changing to that of support and sympathy for the practicing physician. In order to produce a new breed of future doctors, Japanese medical education has undergone major reform: problem-based learning and clinical skills development has been instituted in most medical schools, more rigid assessment methods, ensuring competency and fitness to practice have been introduced, and there has been an increase in purposeful clinical attachments with a hands-on approach rather than a traditional observation model. A new postgraduate residency programme, introduced in 2004, hopes to improve general competency levels, while medical schools throughout the country are paying attention to modern medical education and faculty development.

The spiral curriculum: implications for online learning.

BackgroundThere is an apparent disjuncture between the requirements of the medical spiral curriculum and the practice of replacing previous online material in undergraduate courses. This paper investigates the extent to which students revisit previous online material for the purposes of building the educational spiral, and the implications for the implementation of a Facultys Learning Management System implementation.MethodsAt the University of Cape Town, medical students last date of access to 16 previous online courses was determined. Students completed a survey to determine their reasons for revisiting this material and the perceived benefits of this availability.Results70% of the students revisited their previous online courses. The major reasons were to review lecture presentations, lectures notes, and quizzes. The perceived benefits were for understanding new material, preparation for assessments, and convenience.Although student comments were not always in line with the concept of the spiral curriculum, most referred to processes of building on previous work, and some mentioned the spiral curriculum specifically.ConclusionThis study suggests that the practice of replacing previous online courses may hinder rather than support student learning. Although students visit previous material for ranges of reasons, a large number are aware of the spiral curriculum, and use the online environment to build upon previous material. Any practice, which entails replacing material and redesigning curricula content may be detrimental to the students future learning needs, and such activities may need revision.

Developing health science students into integrated health professionals: a practical tool for learning

BackgroundAn integrated sense of professionalism enables health professionals to draw on relevant knowledge in context and to apply a set of professional responsibilities and ethical principles in the midst of changing work environments [1, 2]. Inculcating professionalism is therefore a critical goal of health professional education. Two multi-professional courses for first year Health Science students at the University of Cape Town, South Africa aim to lay the foundation for becoming an integrated health professional [3]. In these courses a diagram depicting the domains of the integrated health professional is used to focus the content of small group experiential exercises towards an appreciation of professionalism. The diagram serves as an organising framework for conceptualising an emerging professional identity and for directing learning towards the domains of self as professional [4, 5].ObjectiveThis paper describes how a diagrammatic representation of the core elements of an integrated health professional is used as a template for framing course content and for organising student learning. Based on the assumption that all health care professionals should be knowledgeable, empathic and reflective, the diagram provides students and educators with a visual tool for investigating the subjective and objective dimensions of professionalism. The use of the diagram as an integrating point of reference for individual and small group learning is described and substantiated with relevant literature.ConclusionThe authors have applied the diagram with positive impact for the past six years with students and educators reporting that it just makes sense. The article includes plans for formal evaluation. Evaluation to date is based on preliminary, informal feedback on the value of the diagram as a tool for capturing the domains of professionalism at an early stage in the undergraduate education of health professional students.

Twelve tips for developing and sustaining a programme of student selected components

Background: Student selected components (SSCs) represent a significant component of medical curricula in the UK and a new approach in medical education. Despite the prominence given to SSCs by the General Medical Council in each of its seminal papers regarding undergraduate medical education, there remains a diverse view of the purpose, outcomes, structure and assessment of SSCs. Many Schools have adopted their own perspective of SSCs and created different but often innovative courses. Aims: This article brings together the Scottish Medical Schools and their experience in organising SSCs, highlights some of the challenges and offers possible solutions to some of the difficulties encountered. Method: The SSC Director from each of the Scottish medical schools each contributed their own ‘12 Tips’. From these a consensus was achieved. Results: Even though the Scottish medical schools have a wide range of curriculum and timetable formats, there was a great deal of agreement in the challenges and problems encountered in their SSC programmes, as expressed through these 12 Tips. Conclusion: There is much diversity in SSC programmes at different medical schools, although there is also much commonality in the challenges that arise. We hope that this paper will promote thought and discussion amongst those involved, and be useful to those involved in curriculum and programme development and also to those new to medical education.

Getting the most out of student selected components: 12 Tips for participating students

Background: Student Selected Components (SSCs) are an established feature of UK undergraduate medical curricula that offer students choice. They represent a large investment in time and resources. Although programmes vary between Schools, the major learning objectives remain broadly similar. Providing students engage fully with the activity, the final learning outcomes should also be comparable. However, engaging effectively and purposefully with such programmes may not be a clear and straightforward process for students. Aim: To present the challenges and solutions to inform students how to derive the greatest benefit from the learning activities in their SSC programmes. Methods: Synthesis of the accumulated experience over more than 10 years of developing, running and evaluating SSCs by the Directors of SSCs in five Scottish Medical Schools, combined with analysis of course evaluation and student feedback. Results: Consensus defined 12 tips aimed at improving the approach taken by students to their SSCs, and to provide a structure to maximise their final learning outcomes. Conclusion: SSC programmes provide diverse opportunities for students to develop and expand their learning. With increasing emphasis being placed upon student assessment to judge a wide range of professional skills and standards into foundation and specialist training, much greater importance is now being given to SSCs as an opportunity for personal, professional and academic developments. However, it is important that this is performed in a purposeful manner to maximise this opportunity. These 12 tips provide guidance to students on how they can maximise the opportunity presented to them by SSCs.

Medical students as family-health advocates: Arabian Gulf University experience.

Background: The Arabian Gulf University is a coeducational Islamic institution in the Kingdom of Bahrain sponsored by the Gulf Cooperative Council. The College of Medicine follows a problem-based curriculum in which science is integrated with professional skills and a community-health programme, comprising of maternal and child health, family studies, and population-health research. The family-studies programme requires all third-year students to complete a wide series of activities under family-physician supervision. Aim: The aim of the study was to assess the performance of the programme with specific regard to students’ family-health advocacy roles. Method: A trained community-health nurse administered a semistructured questionnaire based on family empowerment to 30 families. Themes included health-knowledge gains, positive changes in lifestyle and communication practices, and accessing community resources. Results: All families reported a gain in relevant health knowledge, and a number of families reported positive changes in lifestyle. Conclusions: Students proved to be valuable advocates for families in this programme. Their principal role lay in the uncovering of psychosocial distress, but they were able also to offer practical help in lifestyle behaviour changes, communication, and community-resource use. Practice points Agreement exists that using the community for real-life contextual learning is useful. Learning in the community is a reciprocal process, with the student, patient, and patients family all benefiting from the experience. Patients seem comfortable with students being involved in the management of disease. Patients often present medical material in greater detail to the student than to the attending physician, which both empowers and challenges the student. Faculty must recognise the positive effects of this learning on the students’ status and the potential harm that can occur to the unsuspecting student, and be ready to respond to this new challenge.

Early involvement in a multiprofessional course: an integrated approach to the development of personal and interpersonal skills

WHAT IS ALREADY KNOWN IN THIS AREA • Many papers describing multiprofessional educational activities relate to activities occurring late into curricula activity. • Meta-analyses demonstrate multiprofessional learning only becoming effective when students are placed in a working environment. • Scant attention is placed upon the early development of students, recognising the need to grow into professionalism and sharing the development of those skills so relevant to both unprofessional and multiprofessional life. WHAT THIS WORK ADDS • This paper describes an early-exposure activity, related to multiprofessional learning, in which students share the learning of common requirements for professional development, and evaluate their experience in a positive manner. SUGGESTIONS FOR FUTURE RESEARCH • The real benefit to multiprofessional life and real-world activity will only be truly evaluated as their individual courses develop and the newly found skills of reflection are allowed to develop.

Mentoring in general practice: a real activity or a theoretical possibility?

There are many ways of describing a mentor and their specific roles. In 1998 an enquiry into mentoring used the broad definition of: ‘the process whereby an experienced, highly regarded, empathetic individual (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development’. Essentially mentoring involves a supportive relationship between two individuals and offers guidance on issues that generally fall within three categories (see also Figure 1).