Accrediting bodies for medical schools require that medical students be provided with formative assessment in all clerkship courses. The literature describes many strategies for formative assessment in clerkship settings, but qualitative studies of clerk and supervisor experiences with formative assessment are lacking. In this thesis, I describe a study that explores clerk and supervisor experiences with formative assessment in one internal medicine clerkship course. First, the literature was reviewed to determine current conceptions of formative assessment and learning in medical education. Then, novice and experienced clerks were recruited to participate. Prior to starting their Core Internal Medicine course, each clerk participated in an interview to understand his or her concepts of learning and assessment. During the six-week course, they replied to an electronic weekly questionnaire to describe and reflect on learning experiences. Finally, they participated in a focus group at the end of the course, to explore their experiences with formative assessment. Supervisors, (residents and attending physicians), who supervised clerks were recruited to participate in one interview to explore their approach to supervision and assessment of clerks, and to understand factors that influenced their ability to do this. All relevant artifacts (forms, policies, procedures) were collected for subsequent analyses. Four experienced clerks and eleven novice clerks participated, along with eight attending physicians and five residents. Participants identified four key themes as playing a significant role in assessment and learning: (a) the developing role of doctor, (b) the role of the team, (c) working and learning environments, and (d) educational strategies. Data analysis revealed the participants had unclear formal concepts of formative assessment, even though they could all describe the key concepts about how assessment affects learning, and were quite clear about what factors supported learning, and which ones were barriers to learning. The study contributes to our understanding of clerks’ and supervisors’ experiences with assessment and learning in a workplace-based learning setting. Finally, the study led to recommendations about how to better support formative assessment in the Core Internal Medicine course, and for further research. / Thesis (Master, Education) -- Queen's University, 2012-12-24 07:06:24.439

UA Open Access Publishing Fund / Study objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises. Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions. Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00). Conclusion: At our institution, we successfully integrated ultrasound and critical problemsolving instruction, as part of a 1-day workshop for undergraduate medical education

Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.

Abstract The formation of a physician's professional identity and conception of him/herself as a doctor is often taken for granted and considered a by-product of learning. During professional socialization, medical students internalize knowledge, skills, attitudes, behavioral models as well as ethical and moral values of medicine. However, certain critical experiences may trigger an active construction of professional identity. The aim of this research was to explore the process of constructing professional identity during medical education in the framework of cultural-historical activity theory. Multiple methods (questionnaires, videotapes of medical students' reflection group sessions, and interviews of the supervisors) were used in data collection and analysis. Medical students were found to have differing orientations towards learning and practising medicine. Some of the students, more commonly females, expressed a need for more support for their professional development. Reflection groups offered medical students a possibility to share their experiences of critical situations. The topics of discussion dealt with career choice, medical education (teaching, patient encounters, communication), working experiences and career opportunities. Medical students' narratives of their experiences in university hospital learning situations revealed the way in which various interaction situations laid the basis for the development of professional identity. In constructing a physician's professional identity, medical students had to solve dilemmas encountered in three different activity systems: Personal life, Medical education and Work. Encountering critical situations is part of the daily practice in medical schools. These situations may induce reflection on action and conscious development of professional identity. Medical students should be provided with more possibilities to elaborate on especially dilemmas concerning professionalism, communication skills, encountering death, and biomedical versus psychosocial aspects of medicine during their medical education.

The purpose of this study was to investigate the relationship between the utilization of student support services and overall satisfaction in medical school. Utilization of services, and overall satisfaction were analyzed by gender, race/ethnicity, and medical specialty choice. In addition, the study identified the most utilized support service, and explored whether utilization of services and overall satisfaction were correlated with academic performance. Two medical schools in the state of Florida were used for the study, University of South Florida Morsani College of Medicine (USF MCOM), and Florida State University College of Medicine (FSU CoM). Separate anonymous, three-part, on-line surveys were created and administered to fourth-year students. Data were collected on the utilization of the specific academic and psychological support services available at each school. Data were analyzed by medical school (n = 87; n = 71), and as a combined set (N = 158). Results of a multiple regression analysis, using each support service as predictors, indicated that the utilization of the primary service for academic counseling at both medical schools was inversely related to overall satisfaction. Results also revealed that no significant differences existed for utilization of support services and overall satisfaction by gender, race/ethnicity, and medical specialty choice. The most utilized service at USF MCOM was the Office of Student Affairs. At FSU CoM, the Office of Student Counseling Services was the most utilized. The findings indicated that utilization of USF MCOM services increased as academic performance decreased; however, there was no significant relationship between academic performance and utilization of services at FSU CoM. A significant relationship existed between academic performance and overall satisfaction; as students’ experience of academic difficulties increased, their overall satisfaction with medical school decreased. The implications from this study can help facilitate an initiative, at both medical schools, to broaden the scope and utilization of the academic and psychological support services to possibly increase their influence on student resiliency, and the overall medical school experience.

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京都大学 / 新制・論文博士 / 博士(医学) / 乙第13461号 / 論医博第2248号 / 新制||医||1055(附属図書館) / (主査)教授 古川 壽亮, 教授 松村 由美, 教授 永井 洋士 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Indiana University-Purdue University Indianapolis (IUPUI) / Background. Despite widespread criticism of physician-performed evaluations of medical students’ clinical skills, clinical clerkship evaluations (CCEs) remain the foremost means by which to assess trainees’ clinical prowess. Efforts undertaken to improve the quality of feedback students receive have ostensibly led to higher assessment demands on physician faculty; the consequences of which remain unknown. Accordingly, this study investigated the extent to which physicians’ evaluative responsibilities influenced the quality of CCEs and qualitatively explored physicians’ perceptions of these evaluations. Methods. A questionnaire was delivered to physicians (n = 93) at Indiana University School of Medicine to gauge their perceived evaluative responsibilities. Evaluation records of each participant were obtained and were used to calculate one’s measurable quantity of CCEs, the timeliness of CCE submissions, and the quality of the Likert-scale and written feedback data included in each evaluation. A path analysis estimated the extent to which one’s evaluative responsibilities affected the timeliness of CCE submissions and CCE quality. Semi-structured interviews with a subset of participants (n = 8) gathered perceptions of the evaluations and the evaluative process. Results. One’s measurable quantity of evaluations did not influence one’s perceptions of the evaluative task, but did directly influence the quality of the Likert-scale items. Moreover, one’s perceptions of the evaluative task directly influenced the timeliness of CCE submissions and indirectly influenced the quality of the closed-ended CCE items. Tardiness in the submission of CCEs had a positive effect on the amount of score differentiation among the Likert-scale data. Neither evaluative responsibilities nor the timeliness of CCE submissions influenced the quality of written feedback. Qualitative analysis revealed mixed opinions on the utility of CCEs and highlighted the temporal burden and practical limitations of completing CCEs. Conclusions. These findings suggest physicians’ perceptions of CCEs are independent of their assigned evaluative quantity, yet influence both the timeliness of evaluation submissions and evaluative quality. Further elucidation of the mechanisms underlying the positive influence of evaluation quantity and timely CCE submissions on CCE quality are needed to fully rationalize these findings and improve the evaluative process. Continued research is needed to pinpoint which factors influence the quality of written feedback.

Patient-care skills in medicine have become more important over time to promote the health and well-being of patients. It has become critical to research how medical schools can best teach students patient-care skills. This is a mixed-method study on the experiences of first and second-year Boston University School of Medicine students and faculty about the relationship between their medical school curriculum and patient-centered care skills including communication, empathy, and the cultural context of care. Patient-centered care and its accompanying skills (empathy, communication, and cultural context of care) are supported and developed at the Boston University school of Medicine. These skills are promoted through curricular adaptation influenced by changing concerns within biomedicine. As well as Doctoring 1 and 2 courses, their patient-actor events, and the development of students’ professional physician identity. Methods will include participant observation and review of curriculum and program documents. This study also includes surveying first and second-year students and in-depth interviews with students and faculty. The conclusion of this study is the importance of evaluating medical school curriculum as it relates to patient-centered care skills, and particularly how those skills are utilized in the clinical world.

Made available in DSpace on 2015-12-06T23:05:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / O modelo biomédico prevalente no ensino médico sofre sérios questionamentos a partir da metade do século XX, havendo uma transição paradigmática rumo ao atual, de atenção integral do indivíduo. Estas mudanças, que ocorreram em todo o mundo, tiveram reflexos tardios no Brasil, e somente na década de oitenta surgiram movimentos propondo uma reflexão mais profunda sobre a formação médica, no sentido de reduzir as falhas do ensino e qualificar o profissional para a nova realidade que se apresentava. O perfil contemporâneo de formação, preconizado pelas Diretrizes Curriculares Nacionais, é de um profissional capacitado em todas as dimensões da competência profissional, avançando para além das cognitivas e técnicas e incorporando as dimensões afetivas, relacionais, dentre outras. Hoje precisamos de um profissional humanizado e multicompetente, capaz de trabalhar em equipe e ciente de seu papel transformador da sociedade.Neste contexto situa-se essa pesquisa, voltada para a necessidade de estudar o ensino atual de uma especialidade médica – a oftalmologia – para compreender de que forma a inserção do ensino de uma especialidade (em geral isolada no currículo médico) ocorre, frente à necessidade da formação geral do médico. O objetivo deste trabalho é analisar a inserção da oftalmologia em cursos de medicina com currículo disciplinar e não-disiciplinar, a partir de análise documental e de entrevistas realizadas com coordenadores de graduação e com docentes responsáveis pela oftalmologia. Foram estudadas oito escolas de medicina, localizadas no Estado do Rio de Janeiro, São Paulo e Paraná. As entrevistas foram analisadas para apreender as concepções dos sujeitos sobre o ensino, identificando suas características principais. Todos os entrevistados, tanto coordenadores de curso como docentes da especialidade, consideraram que os cursos médicos devem formar um profissional com um perfil geral, em conformidade com as Diretrizes Curriculares Nacionais para os Cursos de Graduação em Medicina, sendo este o contexto no qual a oftalmologia deve ser inserida. Em que pese a oftalmologia, tanto como serviço hospitalar quanto componente curricular, ser relacionada dentre as especialidades cirúrgicas, foi possível depreender que o ensino da mesma no âmbito da formação geral do médico deve considerar essencialmente seus aspectos clínicos. Uma possibilidade de integração da oftalmologia diz respeito à “pulverização” dos conteúdos longitudinalmente no currículo, guardando relação com competências profissionais desenvolvidas por grandes áreas da medicina (clínica, pediatria e medicina comunitária, dentre outras). Os resultados demonstraram a necessidade de reavaliação do espaço da oftalmologia dentro do currículo médico, no sentido de adequar o ensino da especialidade à formação geral do médico. O trabalho finaliza propondo princípios norteadores para a inserção da oftalmologia na graduação médica, numa perspectiva de integração e de atenção integral à saúde. / The biomedical model widely adopted in medical education has been challenged since the second half of 20th.Century. There has been a paradigmatic shift towards a model that aims at integral care of the individual. Those worldwide changes reflected lately in Brazil, and only about 1980 it has been proposed a more deep reflection about medical undergraduation, in order to reduce educational failures and improve the training of professionals towards the new reality. Nowadays, National Curricular Guidelines demand that medical courses graduate doctors with all the dimensions of professional competence, from cognitive and technical to relational and affective, among others. Doctors must be able to work in teams, in a compassionate way, and must be conscious of their social transforming role. This research aims at studying the teaching of a medical specialty – ophthalmology – in order to understand how possible it is to insert a specialty in a generalist curriculum. The objective of the research is to analyze the insertion of ophthalmology in undergraduate medical courses with disciplinary and non-disciplinary curricula, by means of document analyses and interviews with deans and medical teachers responsible for ophthalmology courses. Eight schools in Rio de Janeiro, Sao Paulo and Parana States were investigated. The conceptions of the subject about teaching were apprehended in the interviews. All subjects stated that medical courses must graduate general physicians, according to Curricular Guidelines, and that is the context in which ophthalmology should be taught. Despite being a surgical specialty, emphasis should be put on clinical aspects. Integration with other areas could be attempted by “powdering” its contents longitudinally along the course. Competencies should be developed simultaneously with main fields of medical teaching, such as Internal Medicine, Pediatrics and Community Medicine, among others. The results showed the need of reevaluating the insertion of ophthalmology in medical undergraduate curriculum. Finally the work proposes several principles in order to achieve teaching of the specialty in an integrative perspective. / BV UNIFESP: Teses e dissertações