Medical teacher
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In 1995 Dundee medical school introduced an integrated, systems-based spiral curriculum with a number of innovative features. The medical school has now had eight years' experience of the curriculum. ⋯ Evidence from internal and external reviews and student examination data are used to identify the lessons learned from implementing the curriculum. The Dundee experience, the approaches to the curriculum described and the conclusions reached are relevant to all with an interest in medical education.
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Many medical students wish to begin developing clinical teaching skills before residency. Faculty at the University of California, Irvine developed a 60-hour, longitudinal 'service elective' in teaching skills, which 50 third-year and fourth-year students have completed since 2001. ⋯ Participating students gave the elective a mean rating of 5.24 on a seven-point Likert-type scale, which fell between 'very good' (5) and 'excellent' (6). Narrative comments showed that students believed the elective--and in particular the OSTE training--prepared them well for teaching as residents.
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Guideline
AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician.
Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. ⋯ It is likely to be some form of written test, a performance test such as an OSCE in which the student's competence can be tested in a simulated situation, and a test of the student's behaviour over time in clinical practice, based on tutors' reports and students' portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.
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Comparative Study
Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis.
The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process--identification of relevant information, interpretation or hypothesis generation--at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. ⋯ Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.