Inadequate numbers of physicians skilled at providing specialized care of the elderly, has initiated inquiry as to how medical schools will ensure tomorrow’s physicians are capable of providing the most appropriate care for Canada’s growing population of aging seniors. The Canadian Geriatrics Society has responded to such concerns with the establishment of recommended geriatric learning objectives. This thesis examined the geriatric content of the undergraduate curriculum of Canada’s newest medical school, the Northern Ontario School of Medicine, and compared these findings to the Canadian Geriatrics Society’s recommended ‘Core Competencies in the Care of Older Persons for Canadian Medical Students’. While there was a respectful compliance with the recommendations, findings reveal that five of the twenty recommended competencies were absent in the curriculum objectives. Further, present competencies were found to be unequally distributed across the curriculum in relation to both the year and the teaching setting. The results suggest areas for improvement as recommended competencies are intended as a minimum standard for performance in caring for the elderly.

Thesis (M.A.)--University of Hawaii at Manoa, 2007 / Pacific Islands Studies

acase@tulane.edu

This study analysed the learning environment of undergraduate medical and health sciences students of the School of Medicine University of Zambia who were studying at the Ridgeway Campus. Premised on the theory that learner’s perception of the learning environment determines approach to learning and learning outcome, the study utilized a descriptive, quantitative, and non-experimental design to articulate the issues that characterise the learning environment of the programmes. The aim was to provide framework based on these, and use it to propose a strategy for improving the learning environment of the School. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was administered to 448 participants from year 2 to year 7 classes of medicine, pharmacy, and physiotherapy programmes. Total DREEM, subscale, and individual items’ scores were analysed statistically and compared by analysis of variance among the programmes. The issues determined formed the framework for strategy development, and strategic options were proposed based on evidence obtained from literature. With a global DREEM score of 119.3 ± 21.24 (59.7 %), the students perceived their learning environment as “more positive than negative.” One sample binomial test of hypothesis for categorical variables returned a p value <0.05, with a verdict to ‘reject the null hypothesis,’ thereby confirming a more positive than negative perception. Subscale scores also showed ‘more positive’ perception. There were no significant differences between scores from the different programmes when compared by Games Howell test, P> 0.05, thereby upholding the second hypothesis. Analysis of individual items revealed problems in six items, which were summarised into four strategic ssues: inadequate social support for stressed students, substandard teaching and mentoring, unpleasant accommodation, and inadequate physical facilities. The implications of the findings for theory and practice were discussed and strategic options proposed to address the issues. The study concludes that analysis of the learning environment of medical schools provides more insight for strategic planning and management. / Health Studies / D.Litt. et Phil. (Health Studies)

This study explores problem-based learning (PBL) as a form of pedagogy, and its interrelationships with the students, staff members and institution of the Medical Faculty at the University of KwaZulu-Natal. Little has been written previously about the interaction of student diversity and resource-constrained circumstances with PBL. I investigate perceptions and experiences of PBL as a pedagogic strategy, using Bernstein's theories of classification and framing as an organising framework. I draw also on his writings on discourses and knowledge structures and the pedagogic device. Within an interpretive methodology, I use three methods to generate data. I analyse numerically the test marks of a cohort of 202 students over three years for demographic influences on pedagogic engagement. I explore in semi-structured interviews the perceptions and experiences of PBL of 19 students and 6 staff members, and relate these to Faculty documents; I analyse these sources thematically in order to describe the roles of student, teacher and institution. These perceptions and experiences I then examine according to the eight elements of Bernstein's classification and framing. A number of contradictions emerge: between PBL theory, echoed by Faculty documents on one hand, and staff/student perceptions and experiences on the other; between staff members and students at some points but not at others; between high-achieving and low-achieving students; between different respondents' under-standings of "integration". Some demographic characteristics prove on analysis to be highly significant influences while others, counter-intuitively, are not. Bernstein's theories about knowledge structures are pertinent to the tensions revealed. Medicine has thought of itself as akin to the pure sciences – implying a hierarchical structure in which all knowledge aggregates towards a point of abstraction. However, the structure and function revealed by respondents suggests a horizontal knowledge structure, in which disciplinary knowledge is kept distinct. Students and teachers thus struggle to integrate areas of knowledge that are inherently discrete. In terms of Bernstein's "pedagogic device", some students are able to discern PBL's implicit rules of engagement, while others are not. Consensus on medicine‟s knowledge structure might settle ambiguities and help PBL achieve its potential as a complex pedagogy in a complex field. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

This study investigates the use of a Web Based Learning environment to support a newly introduced Problem Based Learning curriculum at the Nelson R. Mandela School of Medicine. Questionnaires, observations and interviews form the basis of this qualitative study amongst first and second year students. Attempts are made to interrogate the way in which staff members use the system to support a constructivist learning environment. In addition similar prior research at this institution is taken into account and reported in the literature review. While not disputing the findings of earlier research the qualitative methodology used here shows some discrepancies with previous research. In particular, although learners are able to, and do, make use of the system it is predominantly used for the dissemination and retrieval of information. The basic premises of construction of knowledge are not facilitated by the Medical School's use of the Web Based Learning environment and of great concern was the small number of staff members who saw it as an integral part of the new curriculum and learning process. / Thesis (M.A.)-University of KwaZulu-Natal, 2006.

Indiana University-Purdue University Indianapolis (IUPUI) / Although interprofessional education (IPE) opportunities can help prepare students for future practice and patient-centered care, many health professions students in the country are not educated in an environment with opportunities to learn with, from, or about students from other health professions. With upcoming curricular changes at the Indiana University School of Medicine (IUSM) and the Indiana University School of Nursing (IUSN), IPE remains at the forefront of these changes in both schools. To date, few studies have explored student, faculty, and administrators’ conceptualizations of IPE prior to formal implementation. Additionally, previous studies have not compared IPE conceptualizations across these groups. This multiple-case study explores and compares how groups of stakeholders from the IUSM (Indianapolis) and the IUSN (Indianapolis) conceptualize IPE. Data collection included the examination of discipline-specific public documents and one-on-one interviews (N=25) with pre-licensure students, clinical faculty, and administrators from each school. Coding and extraction of themes transpired through within-case and cross-case analysis and data supported the following findings: the ‘business of medicine’ may prevent IPE from becoming a priority in education; stakeholders’ conceptualizations of IPE are shaped through powerful experiences in education and practice; students desire more IPE opportunities at the institution; stakeholders at the IUSN have a long-standing investment in IPE; and the institution requires a ‘culture shift’ in order to sustain IPE efforts. The findings suggest that IPE belongs in all education sectors and IPE efforts deserve reward and reimbursement. The findings also insinuate that leadership, roles, and team training education belong in IPE and IPE culture requires all individuals’ (e.g., student, faculty, administrators, patients) commitment. Importantly, the institution must continue IPE development, research, and dissemination. These findings can help shape curricula as time progresses, increase the likelihood of developing a successful new curriculum, and prompt ongoing reflection about IPE. This information can influence how institutions approach IPE and may lead to a more successful and informed IPE curriculum in the first years of implementation. And, hopefully what is learned through IPE will be translated into healthcare practice environments.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. Traditionally, departmental appointment type (basic science or clinical) and/or degree earned (PhD, MD, or MD-PhD) have served as proxies for how we conceptualize clinical and basic science faculty. However, the landscape in which faculty work has considerably changed and now challenges the meaning of these cohorts. Within this context I introduce a behavior-based role variable that is defined by how faculty spend their time in four academic activities: teaching, research, patient care, and administrative duties. Methods. Two approaches to role were compared to department type and degree earned in terms of their effects on how faculty report their perceptions and experiences of faculty vitality and its related constructs. One approach included the percent of time faculty spent engaged in each of the four academic activities. The second approach included role groups described by a time allocation rubric. This study included faculty from four U.S. medical schools (N = 1,497) and data from the 2011 Indiana University School of Medicine Faculty Vitality Survey. Observed variable path analysis evaluated models that included traditional demographic variables, the role variable, and faculty vitality constructs (e.g., productivity, professional engagement, and career satisfaction). Results. Role group effects on faculty vitality constructs were much stronger than those of percent time variables, suggesting that patterns of how faculty distribute their time are more important than exactly how much time they allocate to single activities. Role group effects were generally similar to, and sometimes stronger than, those of department type and degree earned. Further, the number of activities that faculty participate in is as important a predictor of how faculty experience vitality constructs as their role groups. Conclusions. How faculty spend their time is a valuable and significant addition to vitality models and offers several advantages over traditional cohort variables. Insights into faculty behavior can also show how institutional missions are (or are not) being served. These data can inform hiring practices, development of academic tracks, and faculty development interventions. As institutions continue to unbundle faculty roles and faculty become increasingly differentiated, the role variable can offer a simple way to study faculty, especially across multiple institutions.