Comparison of Basic Science Knowledge Between DO and MD Students.

CONTEXT: With the coming single accreditation system for graduate medical education, medical educators may wonder whether knowledge in basic sciences is equivalent for osteopathic and allopathic medical students. OBJECTIVE: To examine whether medical students' basic science knowledge is the same among osteopathic and allopathic medical students. METHODS: A dataset of the Touro University College of Osteopathic Medicine-CA student records from the classes of 2013, 2014, and 2015 and the national cohort of National Board of Medical Examiners Comprehensive Basic Science Examination (NBME-CBSE) parameters for MD students were used. Models of the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores were fit using linear and logistic regression. The models included variables used in both osteopathic and allopathic medical professions to predict COMLEX-USA outcomes, such as Medical College Admission Test biology scores, preclinical grade point average, number of undergraduate science units, and scores on the NBME-CBSE. Regression statistics were studied to compare the effectiveness of models that included or excluded NBME-CBSE scores at predicting COMLEX-USA Level 1 scores. Variance inflation factor was used to investigate multicollinearity. Receiver operating characteristic curves were used to show the effectiveness of NBME-CBSE scores at predicting COMLEX-USA Level 1 pass/fail outcomes. A t test at 99% level was used to compare mean NBME-CBSE scores with the national cohort. RESULTS: A total of 390 student records were analyzed. Scores on the NBME-CBSE were found to be an effective predictor of COMLEX-USA Level 1 scores (P<.001). The pass/fail outcome on COMLEX-USA Level 1 was also well predicted by NBME-CBSE scores (P<.001). No significant difference was found in performance on the NBME-CBSE between osteopathic and allopathic medical students (P=.322). CONCLUSION: As an examination constructed to assess the basic science knowledge of allopathic medical students, the NBME-CBSE is effective at predicting performance on COMLEX-USA Level 1. In addition, osteopathic medical students performed the same as allopathic medical students on the NBME-CBSE. The results imply that the same basic science knowledge is expected for DO and MD students.

Investigación sobre plantas medicinales realizada por estudiantes de medicina en Perú / Investigação sobre plantas medicinais realizada por estudantes de medicina no Peru / Medicinal plant research conducted by medical students in Peru

Con el objetivo de determinar la contribución a la investigación sobre plantas medicinales por estudiantes de medicina en Perú se realizó un estudio bibliométrico, utilizando como fuente de análisis los libros de resúmenes de los Congresos Científicos Nacionales de estudiantes de Medicina realizados en Perú durante los años 2005 al 2011. Se seleccionaron las investigaciones en ciencias básicas que tuvieron como objeto las propiedades medicinales de las plantas. El 17,4% (95/546) de las investigaciones fueren sobre plantas medicinales, el modelo de experimentación en e173,7% era in vivo; en su mayoría el tipo de extracto usado fue el acuoso (29,5%), el alcohólico y/o hidroalcohólico (20,0%) y el aceite esencial (12,6%);se reportaron 21 posibles utilidades medicinales; e1 15,8% de las investigaciones fue pubflcada en alguna revista científica. Concluimos que existe interés hacia el estudio de plantas medicinales desde el pregrado médico, siendo necesario el apoyo de 103 centros educativos para su desarrollo y la comunicación de resultados a través de la publicación (AU)

Como objectivo de determinar a contribuiçao para a investigaçao de plantas medicinais realizada por estudantes de medicina no Peru foi feito um estudo bibliometrico, utilizando como fonte de anélise os livros de resumes dos Congressos Nacionais Cientificos de estudantes de medicina realizados no Peru durante os anos de 2005 a 2011. Foram selecionadas as investigaçoes em ciencias básicas que tiveram como objectivo as propriedades medicinais das plantas. Verificou-se que 17,4% (95/546) das investigaçoes foram sobre plantas medicinais, o modelo experimental em 73,7% foi in vivo; na sua maioria o tipo de extracto utilizado foi o aquoso (29,5%), o alcoólico e/ou hidroalcoólico (20,0%) e o oleo essencial (12,6%); reportaram-se 21 possiveis utilizaçoes medicinais; 15,8% das investigagoes foram publicadas em alguma revista científica. Concluiu-se que ha interesse no estudo de plantas medicinais desde a formaçao medica, sendo necessário o apoio dos centros educativos para o seu desenvolvimento e a comunicaçao de resultados atraves de publicaçoes (AU)

In order to determine the contribution in medicinal plant research conducted by medical students in Peru a bibliometric study was conducted, using as source of analysis the abstract books of the National Scientific Congress of medical students conducted in Peru during the years 2005 to 2011. Research in basic sciences which were aimed at the medicinal properties of plants were selected. As results, 17.4% (95/546) of the investigations were about medicinal plants, experimental model in vivo was 73.7%; mostly type used was the aqueous extract (29.5%), the alcohol-hidroalcohol (20.0%) and essential oil (12.6%); 21 reported possible medicinal utilities; 15.8% of all the investigations was published in a scientific journal. We conclude that there is interest in research on medicinal plants. We conclude that there is interest in the study of medicinal plants in undergraduate medical students. Support of schools for their development and communication of results through the publication is required (AU)

Building bridges: qualitative assessment of a clinical faculty exchange between a naturopathic and an allopathic medical training program.

RESEARCH QUESTION: What are the perceived benefits of a clinical exchange experience designed as part of a program to promote acceptance and use of evidence-based medicine (EBM) in naturopathic clinical practice? METHODS: Nine faculty members participated in a focus group (n = 6) or a structured interview (n = 3) to assess experience in the program. Investigators independently analyzed transcribed notes for common experience themes. ANALYSIS AND INTERPRETATION: Six major themes emerged: integrating EBM into naturopathic clinical teaching, strengthening of professional relationships, exposure to clinical experiences outside the usual naturopathic scope, reaffirmation of naturopathic training and profession, observation of clinical and administrative resources and practices, and recommendations for future clinical exchanges. MAIN RESULTS: A clinical exchange experience was viewed as a favorable way to promote EBM appreciation within the complementary and alternative medicine educational community and to foster improved clinical experiences for faculty and their students and patients.

The transformation of osteopathic medical education.

Osteopathic medical schools and hospital-based postgraduate programs have long constituted small but important sources of physicians and surgeons, particularly for traditionally underserved areas of the United States. Though frequently marginalized in or even left out of standard histories and studies of U.S. medical education, these institutions have become much more difficult to ignore, given the rapid expansion of the number of osteopathic medical students in new and existing colleges and the size of their classes. By 2019, upwards of 25% of all U.S. medical school graduates produced annually will be doctors of osteopathic medicine. The author examines the process through which osteopathy was transformed into osteopathic medicine, how osteopathic medical schools achieved their present status as a significant source of U.S. graduates for residency training, and what challenges osteopathic medical education now faces.

Accreditation standards of osteopathic and allopathic medical schools: could they affect educational quality?

Accreditation of medical schools in the United States is the province of the Liaison Committee on Medical Education (LCME) for MD-granting schools, and the Commission on Osteopathic College Accreditation (COCA) for DO-granting schools. One of the functions of accreditation is to provide medical schools an opportunity for critical self-analysis, which leads to improvement in quality. In some quarters, there are perceptions that the quality of osteopathic education, and therefore the graduates of DO medical schools, are of a lower quality than is the case with MD schools. To examine that assertion, the authors delved into certain aspects of accreditation across the two professions, particularly the structure of the two accrediting bodies, as well as a comparative analysis of certain select accreditation standards, to determine whether these elements demonstrate any differences that could lead to educational quality dissimilarities.The basic structures of the two accrediting bodies are functionally similar except in the way the members are chosen. Also, the LCME has student representation and COCA does not. However, the authors did not think these differences have significant quality implications. In the areas of governance, the major difference is that a for-profit osteopathic school has now been approved, while the relevant LCME standard states that a medical school should be not-for-profit unless there are extraordinary and justifiable circumstances that preclude full compliance with the standard.Relative to academic environment, LCME standards are more expansive, possibly leading to environments where that may enhance student learning. Comparative analysis of several other standards demonstrates some variation, but not enough to conclude that accreditation is a factor in any quality issues across the two professions.

Knowing--in medicine.

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains - the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.

Implementation of the European educational programme "Learning to live with cancer": how participants evaluate the seminars "Education of educators".

PURPOSE: To assess the need and willing for education of oncology experts for the implementation of the European Educational Programme (EEP) "Learning to live with cancer", and to analyze how participants evaluated the first 3 seminars "Education of educators". MATERIALS AND METHODS: In March, April and May 2003, three 3-day seminars entitled "Education of educators" for implementing the EEP "Learning to live with cancer" were organized by a certified educator team of the Institute for Oncology and Radiology of Serbia, Belgrade. The attendees (n=70) answered a questionnaire specially constructed in order to assess their previous knowledge about the topics of the seminar, their satisfaction with the content of the seminar, their attitude towards implementation of what they learned in daily routine practice, and their willingness to continue such an education in the future. RESULTS: Education of patients and their families was not a part of daily routine practice of 79% of the attendees, and 88.6% of them thought that their patients would benefit from the implementation of the EEP. The knowledge acquired during the seminars was completely or partially new for 76% of the participants, and 96% of them thought that similar seminars should be organized on a regular basis--once a year. Readiness to participate actively in future seminars expressed 64% of the attendees, and all of them suggested topics they thought most interesting for their practice. CONCLUSION: The content of the three seminars satisfied the great majority of the attendees. Their positive attitude and willingness to implement what they have learned in their practice confirmed the need to apply the EEP in the holistic treatment of cancer patients.

Development of a tool to support holistic generic assessment of clinical procedure skills.

CONTEXT: The challenges of maintaining comprehensive banks of valid checklists make context-specific checklists for assessment of clinical procedural skills problematic. OBJECTIVES: This paper reports the development of a tool which supports generic holistic assessment of clinical procedural skills. METHODS: We carried out a literature review, focus groups and non-participant observation of assessments with interview of participants, participant evaluation of a pilot objective structured clinical examination (OSCE), a national modified Delphi study with prior definitions of consensus and an OSCE. Participants were volunteers from a large acute teaching trust, a teaching primary care trust and a national sample of National Health Service staff. Results In total, 86 students, trainees and staff took part in the focus groups, observation of assessments and pilot OSCE, 252 in the Delphi study and 46 candidates and 50 assessors in the final OSCE. We developed a prototype tool with 5 broad categories amongst which were distributed 38 component competencies. There was > 70% agreement (our prior definition of consensus) at the first round of the Delphi study for inclusion of all categories and themes and no consensus for inclusion of additional categories or themes. Generalisability was 0.76. An OSCE based on the instrument has a predicted reliability of 0.79 with 12 stations and 1 assessor per station or 10 stations and 2 assessors per station. CONCLUSIONS: This clinical procedural skills assessment tool enables reliable assessment and has content and face validity for the assessment of clinical procedural skills. We have designated it the Leicester Clinical Procedure Assessment Tool (LCAT).

Case notes and clinicians: Galen's "Commentary" on the Hippocratic "Epidemics" in the Arabic tradition.

Galen's "Commentaries" on the Hippocratic "Epidemics" constitute one of the most detailed studies of Hippocratic medicine from antiquity. The Arabic translation of the "Commentaries" by Hunayn ibn Ishaq (d. c. 873) is of crucial importance because it preserves large sections now lost in Greek, and because it helped to establish an Arabic clinical literature. The present contribution investigate the translation of this seminal work into Syriac and Arabic. It provides a first survey of the manuscript tradition, and explores how physicians in the medieval Muslim world drew on it both to teach medicine to students, and to develop a framework for their own clinical research.

Response to a proposal for an integrative medicine curriculum.

BACKGROUND: A paper entitled "Core Competencies in Integrative Medicine for Medical School Curricula: A proposal," published in Academic Medicine, stimulated a broad discussion among complementary and alternative medicine (CAM) educators. This discussion led to a formal process for responding to the issues raised by the paper. METHODS: Representatives from the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) and the Oregon Collaborative for Complementary and Integrative Medicine (OCCIM) formed the ACCAHC/OCCIM Task Force to participate in a Delphi process of consultation and deliberation. This process led to a broad, cross-discipline agreement on important points to include in a response to the integrative medicine (IM) curriculum proposal. RESULTS: Five key areas of concern emerged: (1) the definition of IM as presented in the paper; (2) lack of clarity about the goals of the proposed IM curriculum; (3) lack of recognition of the breadth of whole systems of health care; (4) omission of competencies related to collaboration between MDs and CAM professionals in patient care; and (5) omission of potential areas of partnership in IM education. CONCLUSIONS: A major overall theme emerging from the Delphi process was a desire for closer collaboration between conventional medical schools and CAM academic institutions in developing IM curricula. Several cross-disciplinary venues for addressing the Delphi Task Force themes include the National Center for Complementary and Alternative Medicine's R-25 Initiatives, and the National Education Dialogue. OCCIM is presented as an example of a successful lateral integration approach.

An innovative model for teaching complex clinical procedures: integration of standardised patients into ward round training for final year students.

OBJECTIVES: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. However, although the need for ward round training is emphasized in the published literature, there are currently no reports of ward round training in a simulated setting with standardized patients. METHODS: 45 final year students participated in a ward round training session lasting two hours with three standardized patient scenarios and role-plays. Final year students assumed the role of either doctor, nurse or final year student with role-specific instructions and provided each other with peer-feedback during the training session. Training was assessed using final year student focus groups and semi-structured interviews of standardized patients. Written protocols of the focus group as well as the interviews of standardized patients were content analysed. RESULTS: In the course of five focus groups, 204 individual statements were gathered from participating final year students. Ward round training proved to be a feasible tool, well accepted by final year students. It was seen to offer a valuable opportunity for reflection on the processes of ward rounds, important relevant feedback from standardized patients, peer group and tutors. Semi-structured standardized patient interviews yielded 17 central comments indicating that ward rounds are a novel and exciting experience for standardized patients. CONCLUSION: Ward round training with standardized patients is greatly appreciated by final year students and is viewed as an important part of their education, easing the transition from observing ward rounds to conducting them on their own.

The yin and yang of integrative clinical care, education, and research.

Communication between mainstream clinician scientists and complementary therapists is often problematic, in part because of different perspectives, assumptions, and values. However, a simple conceptual model can help conventional scientists and less conventional practitioners find common ground and appreciate their unique approaches toward achieving the same goals. The model described in this article has grown out of my experience in integrating complementary therapies and approaches into clinical care, education, and research. It uses the familiar yin-yang symbol from Chinese medicine to build bridges between mainstream Western clinician-scientists and complementary therapists from other traditions. Over the past seven years, I have developed and used this model in caring for patients, teaching medical students and residents, and conducting research in conjunction with complementary clinicians. This paper describes the yin-yang model as a way to integrate and enhance the understanding of different cultures of healthcare.