To observe or not to observe peers when learning physical examination skills; That is the question

Background: Learning physical examination skills is an essential element of medical education. Teaching strategies include practicing the skills either alone or in-group. It is unclear whether students benefit more from training these skills individually or in a group, as the latter allows them to observing their peers. The present study, conducted in a naturalistic setting, investigated the effects of peer observation on mastering psychomotor skills necessary for physical examination. Methods. The study included 185 2§ssup§nd§esup§-year medical students, participating in a regular head-to-toe physical examination learning activity. Students were assigned either to a single-student condition (n = 65), in which participants practiced alone with a patient instructor, or to a multiple-student condition (n = 120), in which participants practiced in triads under patient instructor supervision. The students subsequently carried out a complete examination that was videotaped and subsequently evaluated. Student's performance was used as a measure of learning. Results: Students in the multiple-student condition learned more than those who practiced alone (8

The effect of providing a USB syllabus on resident reading of landmark articles

Background: The acquisition of new knowledge is a primary goal of residency training. Retrieving and retaining influential primary and secondary medical literature can be challenging for house officers. We set out to investigate the effect of a Universal Serial Bus (USB) drive loaded with landmark scientific articles on housestaff education in a pilot study. Methods: We created a USB syllabus that contains 187 primary scientific research articles. The electronic syllabus had links to the full-text articles and was organized using an html webpage with a table of contents according to medical subspecialties. We performed a prospective cohort study of 53 house officers in the internal medicine residency program who received the USB syllabus. We evaluated the impact of the USB syllabus on resident education with surveys at the beginning and conclusion of the nine-month study period. Results: All 50 respondents (100%) reported to have used the USB syllabus. The self-reported number of original articles read each month was higher at the end of the nine-month study period compared to baseline. Housestaff rated original articles as being a more valuable educational resource after the intervention. Conclusions: An electronic syllabus with landmark scientific articles placed on a USB drive was widely utilized by housestaff, increased the self-reported reading of original scientific articles and seemed to have positively influenced residents’ attitude toward original medical literature

Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships

Background: Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students' expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships. Aims: To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships. Methods: Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships. Results: Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation. Conclusions: Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning

Dealing with substantial heterogeneity in Cochrane reviews. Cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Dealing with heterogeneity in meta-analyses is often tricky, and there is only limited advice for authors on what to do. We investigated how authors addressed different degrees of heterogeneity, in particular whether they used a fixed effect model, which assumes that all the included studies are estimating the same true effect, or a random effects model where this is not assumed.</p> <p>Methods</p> <p>We sampled randomly 60 Cochrane reviews from 2008, which presented a result in its first meta-analysis with substantial heterogeneity (I²greater than 50%, i.e. more than 50% of the variation is due to heterogeneity rather than chance). We extracted information on choice of statistical model, how the authors had handled the heterogeneity, and assessed the methodological quality of the reviews in relation to this.</p> <p>Results</p> <p>The distribution of heterogeneity was rather uniform in the whole I²interval, 50-100%. A fixed effect model was used in 33 reviews (55%), but there was no correlation between I²and choice of model (P = 0.79). We considered that 20 reviews (33%), 16 of which had used a fixed effect model, had major problems. The most common problems were: use of a fixed effect model and lack of rationale for choice of that model, lack of comment on even severe heterogeneity and of reservations and explanations of its likely causes. The problematic reviews had significantly fewer included trials than other reviews (4.3 vs. 8.0, P = 0.024). The problems became less pronounced with time, as those reviews that were most recently updated more often used a random effects model.</p> <p>Conclusion</p> <p>One-third of Cochrane reviews with substantial heterogeneity had major problems in relation to their handling of heterogeneity. More attention is needed to this issue, as the problems we identified can be essential for the conclusions of the reviews.</p

Interpretation of evidence in data by untrained medical students: a scenario-based study

<p>Abstract</p> <p>Background</p> <p>To determine which approach to assessment of evidence in data - statistical tests or likelihood ratios - comes closest to the interpretation of evidence by untrained medical students.</p> <p>Methods</p> <p>Empirical study of medical students (N = 842), untrained in statistical inference or in the interpretation of diagnostic tests. They were asked to interpret a hypothetical diagnostic test, presented in four versions that differed in the distributions of test scores in diseased and non-diseased populations. Each student received only one version. The intuitive application of the statistical test approach would lead to rejecting the null hypothesis of no disease in version A, and to accepting the null in version B. Application of the likelihood ratio approach led to opposite conclusions - against the disease in A, and in favour of disease in B. Version C tested the importance of the p-value (A: 0.04 versus C: 0.08) and version D the importance of the likelihood ratio (C: 1/4 versus D: 1/8).</p> <p>Results</p> <p>In version A, 7.5% concluded that the result was in favour of disease (compatible with p value), 43.6% ruled against the disease (compatible with likelihood ratio), and 48.9% were undecided. In version B, 69.0% were in favour of disease (compatible with likelihood ratio), 4.5% against (compatible with p value), and 26.5% undecided. Increasing the p value from 0.04 to 0.08 did not change the results. The change in the likelihood ratio from 1/4 to 1/8 increased the proportion of non-committed responses.</p> <p>Conclusions</p> <p>Most untrained medical students appear to interpret evidence from data in a manner that is compatible with the use of likelihood ratios.</p

Is the use of videotape recording superior to verbal feedback alone in the teaching of clinical skills?

<p>Abstract</p> <p>Background</p> <p>In recent times, medical schools have committed to developing good communication and history taking skills in students. However, there remains an unresolved question as to which constitutes the best educational method. Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self-assessment on history taking and communication skills.</p> <p>Methods</p> <p>A randomized controlled trial was designed. The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students. All students' performances of communication and history taking skills were assessed twice. Between these assessments, the study group had received both verbal and visual feedback by watching their video recordings on patient interview; the control group received only verbal feedback from the teacher.</p> <p>Results</p> <p>Although the self-assessment of the students did not change significantly, assessors' ratings increased significantly for videotaped interviews at the second time.</p> <p>Conclusions</p> <p>Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors.</p

Evaluation of a communication skills program for first-year medical students at the University of Toronto

Abstract Background Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills. Methods Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater. Results Only the external rater, using an instrument designed to assess the students' empathy based on their written responses, showed a time × group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students' communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities. Conclusion The lack of strong findings may be partly due to the study's small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students' communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, their management of the doctor-patient relationship, and their ability to give and receive feedback

Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study

OBJECTIVE: We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period. METHODS: A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group. PRINCIPAL FINDINGS: AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p<0.001 by day 14. The AMA group were more likely to be readmitted within 14 days with a related diagnosis than the non-AMA group (Adjusted Odds Ratio 12.0; 95% Confidence Interval [CI]: 3.7-38.9). Patients who left AMA were more likely to be readmitted multiple times at one year compared to the non-AMA group (adjusted frequency ratio 1.6; 95% CI: 1.3-2.0). There was also higher all-cause in-hospital mortality during the 12-month follow-up in the AMA group compared to non-AMA group (6.7% vs. 2.4%, p = 0.01). CONCLUSIONS: Patients discharged AMA were more likely to be homeless and have multiple co-morbid conditions. At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality. Interventions to reduce discharges AMA in high-risk groups need to be developed and tested

How to improve medical education website design

<p>Abstract</p> <p>Background</p> <p>The Internet provides a means of disseminating medical education curricula, allowing institutions to share educational resources. Much of what is published online is poorly planned, does not meet learners' needs, or is out of date.</p> <p>Discussion</p> <p>Applying principles of curriculum development, adult learning theory and educational website design may result in improved online educational resources. Key steps in developing and implementing an education website include: 1) Follow established principles of curriculum development; 2) Perform a needs assessment and repeat the needs assessment regularly after curriculum implementation; 3) Include in the needs assessment targeted learners, educators, institutions, and society; 4) Use principles of adult learning and behavioral theory when developing content and website function; 5) Design the website and curriculum to demonstrate educational effectiveness at an individual and programmatic level; 6) Include a mechanism for sustaining website operations and updating content over a long period of time.</p> <p>Summary</p> <p>Interactive, online education programs are effective for medical training, but require planning, implementation, and maintenance that follow established principles of curriculum development, adult learning, and behavioral theory.</p

An overview of the statistical methods reported by studies using the Canadian community health survey

BACKGROUND: The Canadian Community Health Survey (CCHS) is a cross-sectional survey that has collected information on health determinants, health status and the utilization of the health system in Canada since 2001. Several hundred articles have been written utilizing the CCHS dataset. Previous analyses of statistical methods utilized in the literature have focused on a particular journal or set of journals to understand the statistical literacy required for understanding the published research. In this study, we describe the statistical methods referenced in the published literature utilizing the CCHS dataset(s). METHODS: A descriptive study was undertaken of references published in Medline, Embase, Web of Knowledge and Scopus associated with the CCHS. These references were imported into a Java application utilizing the searchable Apache Lucene text database and screened based upon pre-defined inclusion and exclusion criteria. Full-text PDF articles that met the inclusion criteria were then used for the identification of descriptive, elementary and regression statistical methods referenced in these articles. The identification of statistical methods occurred through an automated search of key words on the full-text articles utilizing the Java application. RESULTS: We identified 4811 references from the 4 bibliographical databases for possible inclusion. After exclusions, 663 references were used for the analysis. Descriptive statistics such as means or proportions were presented in a majority of the articles (97.7%). Elementary-level statistics such as t-tests were less frequently referenced (29.7%) than descriptive statistics. Regression methods were frequently referenced in the articles: 79.8% of articles contained reference to regression in general with logistic regression appearing most frequently in 67.1% of the articles. CONCLUSIONS: Our study shows a diverse set of analysis methods being referenced in the CCHS literature, however, the literature heavily relies on only a subset of all possible statistical tools. This information can be used in identifying gaps in statistical methods that could be applied to future analysis of public health surveys, insight into training and educational programs, and also identifies the level of statistical literacy needed to understand the published literature