A comparison of changes in dental students' and medical students' approaches to learning during professional training.

The purposes of this study were 1) to compare the learning approaches of dental students (DS) and medical students (MS) for the Class of 1998 at a single institution at admission and graduation and 2) to determine if their learning approaches changed over the course of their studies. An Approaches to Studying Inventory (ASI) was administered to DS and MS at two times: their first month in school and their last month in school. Means and standard deviations were calculated for three ASI orientations to studying: 'Meaning', 'Reproducing', and 'Achieving'. An additional domain referred to as 'Styles and Pathologies' identified learning problems. In comparison, DS and MS demonstrated a different pattern of learning approaches at matriculation; however, at graduation these differences were less apparent. Over time, DS reported a decreased use, and MS reported an increased use of the Reproducing orientation bringing them closer together. MS also demonstrated an increased use of the Achieving orientation. The Meaning orientation, which indicates a deep approach to learning, was equivalently used by both groups at entry and remained unaltered.

Widening the lens on standardized patient assessment: what the encounter can reveal about the development of clinical competence.

The standardized patient (SP) examination is used in a majority of medical schools to test clinical skills. This examination usually yields both numerical ratings of clinical skill and narrative comments by patients or observers, yet most empirical studies of SP assessment focus on the numerical ratings only. This quantitative focus can lead to a narrow conceptualization of the nature and development of clinical competence. The authors suggest that in addition to utilizing SP numerical ratings, medical educators also use the rich qualitative material produced in the SP examination (e.g., patient comments, videotapes of the examination) to explore students' development of clinical competence, which involves the purposive integration of basic science, technical skill, empathy, communication, professional role, and personal history.

Changes in nutrition knowledge among first- and second-year medical students following implementation of an integrated nutrition curriculum.

Existing studies suggest that many of the objectives called for by the National Academy of Sciences in its 1985 report are not being addressed in medical student education. Members of the Nutrition Curriculum Working Group at the UCLA School of Medicine prepared a list of proficiencies in nutrition and developed a coordinated, vertically integrated, two-year nutrition education curriculum to address those objectives. To assess the impact of the curriculum on students' knowledge, the authors tested a cohort of students at repeated intervals over a two-year period using a Nutrition Progress Survey drawn from the Nutrition Test-Item Bank developed at the University of Alabama. There was a significant increase in knowledge over the three administrations of the Progress Survey as measured by total score. This was largely accounted for by an increase in the number of correct responses, which rose from 39% at pre-test to 62% at delayed follow-up. In spite of a significant increase in nutrition knowledge, the low percentage correct indicates that nutritional content should be threaded throughout the core clerkship curriculum as well.

Exercise-induced asthma.

Exercise-induced asthma is the phenomenon of transient airflow obstruction, typically 5 to 15 minutes after physical exertion. The increased airway resistance produces a 15% or greater decrease in the forced expiratory volume in 1 second, or in peak expiratory flow rate. Exercise-induced asthma occurs in 90% of individuals with asthma, representing 12% to 15% of the population world-wide. The prevalence of exercise-induced asthma among athletes ranges between 3% and 11%. Several theories of the etiology exist: respiratory heat or water loss (or both), hyperventilation causing discharge of bronchospastic chemical mediators or rebound rewarming of the blood in airway tissues. Treatment is either by pharmacologic or nonpharmacologic means, but medication continues to be the cornerstone of therapy for exercise-induced asthma. beta 2-Specific agonists remain the drugs of choice. Cromolyn sodium and nedocromil sodium are alternatives to the beta 2-agonists, and the combined use of the two classes of agents can provide additive benefits.

Strategies for improving teaching practices: a comprehensive approach to faculty development.

Medical school faculty members are being asked to assume new academic duties for which they have received no formal training. These include time-efficient ambulatory care teaching, case-based tutorials, and new computer-based instructional programs. In order to succeed at these new teaching tasks, faculty development is essential. It is a tool for improving the educational vitality of academic institutions through attention to the competencies needed by individual teachers, and to the institutional policies required to promote academic excellence. Over the past three decades, strategies to improve teaching have been influenced by the prevailing theories of learning and research on instruction, which are described. Research on these strategies suggests that workshops and students' ratings of instruction, coupled with consultation and intensive fellowships, are effective strategies for changing teachers' actions. A comprehensive faculty development program should be built upon (1) professional development (new faculty members should be oriented to the university and to their various faculty roles); (2) instructional development (all faculty members should have access to teaching-improvement workshops, peer coaching, mentoring, and/or consultations); (3) leadership development (academic programs depend upon effective leaders and well-designed curricula; these leaders should develop the skills of scholarship to effectively evaluate and advance medical education); (4) organizational development (empowering faculty members to excel in their roles as educators requires organizational policies and procedures that encourage and reward teaching and continual learning). Comprehensive faculty development, which is more important today than ever before, empowers faculty members to excel as educators and to create vibrant academic communities that value teaching and learning.

Generation of physician-scientists manpower: a follow-up study of the first 294 graduates of the Harvard-MIT Program of Health Sciences and Technology.

BACKGROUND: The MD program of the Harvard-MIT Division of Health Sciences and Technology was founded in 1970. One of its goals was the application of the academic resources of the two universities to the education of leaders in academic medicine and biomedical sciences. METHODS: The first MD class was admitted in 1971. Prerequisites for admission are a strong background in quantitative sciences and demonstrated interest in research. Research and a thesis are obligatory. Enrollment in a PhD program is elective. Questionnaires were sent to 293 alumni who graduated from the MD program between 1975 and 1988, followed up by letters and telephone calls. RESULTS: By 1988, 296 students had graduated, 207 with an MD only, 89 with MD-PhD degrees. Follow-up by questionnaires of 293 living graduates (92%), plus indirect data on 11 others, revealed that 212 (75%) held faculty appointments in 64 medical schools. Overall, 73.5% of respondents were engaged in research: 68% of MDs and 86% of MD-PhDs. One hundred and four (38%) respondents spent more than 50% of their time on research: 54 (29%) of MDs and 50 (60%) of MD-PhDs. Seventy-five percent of respondents were active in teaching. CONCLUSION: Our experience indicates that both an MD-PhD program and a research-oriented MD program are effective in producing physician-scientists and leaders in academic medicine.

Martial arts injuries.

In the United States, approximately 1.5 million to 2 million persons practice the martial arts. It is the general belief that martial arts are safe, with little thought given to the physical forces involved. Some enthusiasts gravitate to the martial arts to learn self-defense, whereas others participate to improve cardiovascular fitness, flexibility, and self-esteem. Some join for the structured exercise programs, whereas others desire the artistic expression or have a need to compete. Injuries involve the head and neck region, trunk, and extremities. Soft tissue trauma, hematomas, and lacerations are some of the most common injuries. Occasionally fractures occur, most often involving the hands and digits. The neurosurgical literature indicates that wearing headgear increases the shearing injury to nerve fibers and neurons in the brain in proportion to the degree of acceleration to the head. Three case presentations illustrate death resulting from anterior chest trauma.

Health care reform as perceived by first year medical students.

Our study objective was to evaluate the attitudes of first year medical students toward the health care system using a self administered questionnaire to all first year medical students at the medical schools in the University of California system. Of 631 students surveyed, 94% completed the instrument. Students were asked about their attitudes toward and familiarity with concepts in health services, access to care, and managed care. Our findings indicated that most students were unfamiliar with concepts related to health services. Students were concerned about access to care; sixty-six percent of students favor a national health insurance plan. A majority of students supported allowing patients access to the current health care system regardless of the cost or utility of a medical test or procedure. Thirty-nine percent felt that rationing health care in any form (transplants, access to the intensive care unit, etc.) is contrary to the way medicine should be practiced. 72% felt that practicing physicians had a major responsibility to help reduce health care costs. When asked about specific changes intended to control health costs, students identified reform of medical malpractice system (63%) and increased spending on preventive health (60%) as the two proposals most likely to be effective. Students generally held negative attitudes toward managed care organizations; only 10% would chose to receive their care in HMOs. We conclude that first year medical students generally have little understanding of the health care system. Despite this, they hold strong opinions about access to care, managed care organizations and strategies intended to reduce health care spending. It is up to medical educators to find creative methods of introducing these content areas into an already bulging curriculum.