Medical Course (medical + course)

Distribution by Scientific Domains


Selected Abstracts


ALTERNATIVE CURRICULAR OPTIONS IN RURAL NETWORKS (ACORNS): IMPACT OF EARLY RURAL CLINICAL EXPOSURE IN THE UNIVERSITY OF WEST AUSTRALIA MEDICAL COURSE

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2000
June Talbot
The aim of this study was to assess the impact of a 4-day rural placement in Western Australia on the interest of fourth year medical students in a career in rural general practice. Students undertaking their Alternative Curricular Options in Rural Networks attachment (ACORNS) completed pre- and post-questionnaires examining their expectations, experiences of, and attitudes to rural general practice. Of the 103 students who participated, 81% expressed an interest in a rural career after the placement, whereas prior to this experience only 48% had been interested. The students also recorded a wide range of learning experiences, both clinical and procedural, and expressed positive attitudes to the variety of experiences and the role of the rural GP. The study concluded that early exposure to rural general practice enhances students' interest in a potential rural practice career and provides them with a broad range of experiences. The role of rural practitioners as role models for students needs to be acknowledged and reinforced. [source]


Qualitative Analysis of Medicare Claims in the Last 3 Years of Life: A Pilot Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005
Amber E. Barnato MD
Objectives: To study end-of-life care of a representative sample of older people using qualitative interpretation of administrative claims by clinicians and to explore whether this method yields insights into patient care, including continuity, errors, and cause of death. Design: Random, stratified sampling of decedents and all their Medicare-covered healthcare claims in the 3 years before death from a 5% sample of elderly fee-for-service beneficiaries, condensation of all claims into a chronological clinical summary, and abstraction by two independent clinicians using a standardized form. Setting: United States. Participants: One hundred Medicare fee-for-service older people without disability or end-stage renal disease entitlement who died in 1996 to 1999 and had at least 36 months of continuous Part A and Part B enrollment before death. Measurements: Qualitative narrative of the patient's medical course; clinician assessment of care continuity and apparent medical errors; cause, trajectory, and place of death. Results: The qualitative narratives developed by the independent abstracters were highly concordant. Clinicians felt that 75% of cases lacked continuity of care that could have improved the quality of life and the way the person died, and 13% of cases had a medical error identified by both abstracters. Abstracters disagreed about assignment of a single cause of death in 28% of cases, and abstracters and the computer algorithm disagreed in 43% of cases. Conclusion: Qualitative claims analysis illuminated many problems in the care of chronically ill older people at the end of life and suggested that traditional vital statistics assignation of a single cause of death may distort policy priorities. This novel approach to claims review is feasible and deserves further study. [source]


Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course

MEDICAL EDUCATION, Issue 12 2004
Subhashis Basu
Background, Professional bodies have expressed concerns that medical students lack appropriate knowledge in musculoskeletal medicine despite its high prevalence of use within the community. Changes in curriculum and teaching strategies may be contributing factors to this. There is little evidence to evaluate the degree to which these concerns are justified. Objectives, To design and evaluate an assessment procedure that tests the progress of medical students in achieving a core level of knowledge in musculoskeletal medicine during the course. Participants and Setting, A stratified sample of 136 volunteer students from all 5 years of the medical course at Sheffield University. Methods, The progress test concept was adapted to provide a cross-sectional view of student knowledge gain during each year of the course. A test was devised which aimed to provide an assessment of competence set at the standard required of the newly qualified doctor in understanding basic and clinical sciences relevant to musculoskeletal medicine. The test was blueprinted against internal and external guidelines. It comprised 40 multiple-choice and extended matching questions administered by computer. Six musculoskeletal practitioners set the standard using a modified Angoff procedure. Results, Test reliability was 0.6 (Cronbach's ,). Mean scores of students increased from 41% in Year 1 to 84% by the final year. Data suggest that, from a baseline score in Year 1, there is a disparate experience of learning in Year 2 that evens out in Year 3, with knowledge progression becoming more consistent thereafter. All final year participants scored above the standard predicted by the Angoff procedure. Conclusions, This short computer-based test was a feasible method of estimating student knowledge acquisition in musculoskeletal medicine across the undergraduate curriculum. Tested students appear to have acquired a satisfactory knowledge base by the end of the course. Knowledge gain seemed relatively independent of specialty-specific clinical training. Proposals from specialty bodies to include long periods of disciplinary teaching may be unnecessary. [source]


Comparison of academic, application form and social factors in predicting early performance on the medical course

MEDICAL EDUCATION, Issue 9 2004
Andrew B Lumb
Objectives, To compare the relative importance of social, academic and application form factors at admission in predicting performance in the first 3 years of a medicine course. Design, Retrospective cohort study. Setting, A single UK medical school. Participants, A total of 738 students who entered medical school between 1994 and 1997. Main outcome measure, Performance in Year 3 objective structured clinical examination (OSCE). Results, School-leaving grades were significant predictors of success in the OSCE. Non-academic activities as assessed from the application form were associated with poorer performance. Mature students performed extremely well, and male and ethnic minority students performed less well. Socioeconomic status and type of school attended were not found to affect performance on the course. Conclusions, The relatively poor performance of male and ethnic minority students urgently needs further investigation. Our results carry no suggestion that, other things being equal, widening access to medical school for mature students and those from less affluent backgrounds would result in poorer performance. [source]


Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post?

MEDICAL EDUCATION, Issue 12 2003
A qualitative study of the views of pre-registration house officers using critical incidents
Introduction, In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as ,critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. Method, We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. Results, We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. Conclusions, Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO. [source]


The influence of admissions variables on first year medical school performance: a study from Newcastle University, Australia

MEDICAL EDUCATION, Issue 2 2002
Frances Kay-Lambkin
Aims This study examined the relationship between the performance of first year medical students at the University of Newcastle, Australia, and admission variables: previous educational experience, and entry classification (standard , academic or composite, Aboriginal and Torres Strait Islander, or overseas), age and gender. Methods Admission and demographic information was obtained for students who entered first year medicine at Newcastle between the years 1994 and 1997 inclusive. Academic performance was measured according to results of first assessment (`satisfactory' vs. `not satisfactory') and the final assessment of the first year (`satisfactory' vs. `not satisfactory'). Logistic regression was used to examine the relationship between predictor variables and outcomes. Results Assessment and admissions information was obtained for 278 students, 98% of all students who entered the medical course between 1994 and 1997. Regression analysis of first assessment indicated that Aboriginal and Torres Strait Islander and overseas students were significantly more likely to be `not satisfactory' than all other students (RR=3·1,95% CI: 1·4. , 6 7 and RR=1·5, 95% CI: 1·2,1·8, respectively). Analysis of final assessment indicated these two student groups were also significantly more likely to be `not satisfactory' than all other students (RR=4·5, 95% CI: 1·4,13·5 and RR=3·5, 95% CI: 1·2,10·8, respectively). At first assessment, students entering via the standard academic pathway and older students were less likely to be `not satisfactory' (RR=0·6, 95% CI: 0·5,0·7 and RR=0·8, 95% CI: 0·7,0·9, respectively). However both these differences were not evident at final assessment. There were no significant relationships between performance in first year and the remaining variables. Conclusions Aboriginal and Torres Strait Islander, and overseas medical students had academic difficulties in the first year of the course, suggesting the need for extra course support. The result may reflect the educational and other obstacles these students must overcome in order to enter and progress through their medical degree. More research is warranted to explore the extent to which these differences persist throughout the medical degree. [source]


Comparison of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course

MEDICAL EDUCATION, Issue 3 2000
Article first published online: 25 DEC 200
Objective The experiences of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course were compared. Method Eighty percent (28) of the rural and 70% (114) of the non-rural students completed a post-placement questionnaire. Result The two groups did not differ on their overall rating of the placement, whether they felt welcome, adequacy of the time with doctors or their rating of the accommodation provided. However, 46% (13) of the rural students reported the placement had changed their feelings towards rural practice to the maximum/almost maximum extent compared with only 24% (27) of the non-rural students. [source]


Influences on medical students' decisions to study at a rural clinical school

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2008
Ryan J. Spencer
Abstract Objective:,To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Design:,Third-year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year-long placement at a RCS. Results:,Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. Conclusion:,The most important positive influence on Monash third-year medical students' decision to study at an RCS is the perception of high-quality clinical experiences and education. This perception arises from rural exposure during pre-clinical years. [source]


Giovanni Filippo Ingrassia: A five-hundred year-long lesson

CLINICAL ANATOMY, Issue 7 2010
Francesco Cappello
Abstract Giovanni Filippo Ingrassia was born five centuries ago in Regalbuto, a small town in the center of Sicily. After his medical course in Padua, under the guidance of Vesalius and Fallopius, he gained international fame as a physician and was recruited as a Professor of human anatomy in Naples and later in Palermo. He is remembered as "the new Galen" or "the Sicilian Hippocrates." He contributed to the knowledge of human anatomy through the description of single bones rather than the whole skeleton. In particular, he was the first to describe the "stapes," the "lesser wings of the sphenoid" and various other structures in the head (probably the pharyngotympanic tube) as well as in the reproductive system (corpora cavernosa and seminal vesicles). He was also a pioneer in the study of forensic medicine, hygiene, surgical pathology, and teratology. As Protomedicus of Sicily, he developed the scientific culture in this country. During those years, he faced the spread of malaria and plague with competence and authoritativeness. Indeed, he was one of the first physicians to suppose that certain diseases could be transmitted between individuals, therefore, introducing revolutionary measures of prevention. He is remembered for his intellectual authority and honesty. Five-hundred years after his birth, his teaching is still alive. In this article, we survey the life and contribution of this pioneer of early anatomical study. Clin. Anat. 23:743,749, 2010. © 2010 Wiley-Liss, Inc. [source]


Do medical courses adequately prepare interns for safe and effective prescribing in New South Wales public hospitals?

INTERNAL MEDICINE JOURNAL, Issue 7 2009
S. N. Hilmer
Abstract Aims: To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. Methods: A cross-sectional study was performed on all interns (n= 191) who attended intern orientation programmes at four NSW hospitals in January 2008. A clinical case scenario that tested prescribing ability and a survey investigating impressions of clinical pharmacology training in medical school were administered to the interns in exam format. Outcome measures were: (i) ability to prescribe medications safely and appropriately for the clinical case scenario and (ii) interns' impressions of their training in clinical pharmacology at medical school. Results: No intern completed all prescribing tasks correctly. No intern charted the patient's usual medications on admission completely correctly, only six wrote an accurate discharge medication list, and none wrote both an accurate discharge medication list and a legal Schedule 8 discharge script. None of the respondents strongly agreed that they felt adequately trained to prescribe medications in their intern year and 84% would have liked to have more training in pharmacology as medical students. Conclusions: Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school. [source]


Models for the development of graduate entry medical courses: two case studies

MEDICAL EDUCATION, Issue 11 2004
David Prideaux
Introduction, The introduction of graduate entry medical courses requires attention to models of decision-making and change. Much of the educational literature describes change as either centralised or decentralised with the latter claimed to be more effective. Recently Fullan has argued for the importance of an ongoing culture of change. This paper examines the change culture of two medical schools adopting graduate entry courses; Flinders University in South Australia and St George's Hospital Medical School, London. Method, Comparative case study was used. Key informants were interviewed and documents and records analysed. Data were cross-checked and categorised to generate models of change. Results, There were four components of the change culture at Flinders but they were not sufficient on their own to generate change. The process was triggered by a significant external event. The nature of the change was also important. The descriptive model developed suggested a complex interplay of factors rather than attributing the success of the change to the change mechanisms adopted alone. The model was tested for explanatory potential at St George's. The culture there was described as both ,macro-innovative' and ,micro-conservative'. External events were also important but they exerted a positive force. A more centralised approach was adopted. Discussion, The models developed represent change as ,dynamic, complex and open' rather than a simple centralised or decentralised dichotomy. While some of the elements of a change culture were evident at both schools there were longer term questions of sustainability. This has implications for development of all programmes but particularly for graduate entry schools. [source]


Review of anatomy education in Australian and New Zealand medical schools

ANZ JOURNAL OF SURGERY, Issue 4 2010
Steven Craig
Abstract Anatomy instruction at Australian and New Zealand medical schools has been the subject of considerable debate recently. Many commentators have lamented the gradual devaluation of anatomy as core knowledge in medical courses. To date, much of this debate has been speculative or anecdotal and lacking reliable supporting data. To provide a basis for better understanding and more informed discussion, this study analyses how anatomy is currently taught and assessed in Australian and New Zealand medical schools. A mailed questionnaire survey was sent to each of the 19 Australian and 2 New Zealand medical schools, examining the time allocation, content, delivery and assessment of anatomy for the 2008 academic year. Nineteen of the 21 (90.5%) universities invited to participate completed the survey. There was considerable variability in the time allocation, content, delivery and assessment of anatomy in Australasian medical schools. The average total hours of anatomy teaching for all courses was 171 h (SD ± 116.7, range 56/560). Historical data indicate a major decline in anatomy teaching hours within medical courses in Australia and New Zealand. Our results reveal that as there is no national curriculum for anatomy instruction, the curriculum content, instruction methodology and assessment is highly variable between individual institutions. Such variability in anatomy teaching and assessment raises an important question: is there also variable depth of understanding of anatomy between graduates of different medical courses? [source]