Diagnostic image use by nonradiologist lecturers in an introductory clinical medicine course.

RATIONALE AND OBJECTIVES: A curriculum-tracking study was designed to determine the type and amount of diagnostic imaging used by nonradiologists teaching an Introduction to Clinical Medicine (ICM) course to second-year medical students. METHODS: Two second-year medical students independently recorded the type and number of images shown, the length of the lecture, the departmental affiliation of the lecturer, and the amount of time devoted to either didactic radiology or radiologic images during each of 288 lectures in the 1990 ICM course. RESULTS: A total of 35.2% of the lectures presented some type of diagnostic image, and 7.0% of all lecture time was devoted to radiology. No mammography or diagnostic nonangiographic interventional images were shown. CONCLUSIONS: The results suggest that a more consistent and uniform presentation of diagnostic images across disciplines is required, emphasizing the need for more coordination of radiology instruction through consultation with the Department of Radiology.

The validity of lecturer ratings by students and trained observers.

This study sought to determine to what degree student ratings of specific lecturer characteristics relate to trained observer ratings of such characteristics and to identify the distinguishing delivery characteristics of highly rated lecturers. The 15 lowest-rated lecturers and the 15 highest-rated lecturers, based on the mean ratings of students from two consecutive years (1982 and 1983) in a large multi-instructor course, served as the target group. Blinded non-student raters observed the lectures in 1984 (two per lecture) and completed quantitative and qualitative forms. For all six subscores from the quantitative form, statistically significant differences between the lecturers given the highest and lowest ratings were obtained. It is concluded that the students' ratings were stable across the three years; the independent observers discriminated between the lecturers the students rated the highest and the lowest; voice presentation characteristics discriminated the most effectively; and nonmedical non-student observers are potentially a useful source of information regarding faculty teaching skills.

Teaching a screening musculoskeletal examination: a randomized, controlled trial of different instructional methods.

PURPOSE: To develop and test a program to teach a rapid screening musculoskeletal examination. METHOD: In 1995, 191 medical and physician assistant students were randomized to four intervention groups: written materials only (n = 47), written materials and videotape (n = 46), written materials and small-group sessions facilitated by fourth-year medical students (n = 55), and all three methods (n = 43). Assessments, in the form of a written test and standardized patient examinations, were conducted before the interventions (n = 40 randomly selected students), seven to ten days and again three months after the interventions (n = all 191 students), and 16 months after the interventions (n = 103 students). RESULTS: While the four intervention groups' written test scores were approximately equal, their scores on the standardized patient examination differed significantly. The students taught in small groups demonstrated significantly superior examination skills compared with the students taught with written material or videotape at seven to ten days and retained this relative superiority after three and 16 months (p < .0001). CONCLUSION: Small-group instruction with hands-on supervised practice is superior to more passive instructional methods for teaching musculoskeletal examination skills and can be successfully delivered by trained senior medical student facilitators with minimal direct expenditure of faculty time.

Teaching physical examination of the adult liver with use of real-time sonography.

RATIONALE AND OBJECTIVES: The authors developed and evaluated an approach to teaching examination of the liver that incorporates real-time ultrasound (US) imaging as immediate feedback to improve diagnostic accuracy. MATERIALS AND METHODS: Second-year medical students participating in a course in physical examination were assigned to receive instruction in measuring liver span without (group 1) or with (group 2) real-time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practice session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students then made three measurements each of the liver span of a healthy practice patient and a single healthy test patient without US. The vertical liver span reference standard was determined by one of the authors. RESULTS: Students in group 2 showed greater accuracy in measuring liver span during both the practice and the test sessions than did students in group 1. The differences were significant for the third practice measurement and all three test measurements (P < .05). CONCLUSION: The use of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.

Medical student evaluation of self-selected learning modules.

BACKGROUND: The purposes of this study were to determine the self-directed learning needs of second-year medical students, the resources they selected to address their learning needs, and the effectiveness of those resources. METHODS: Students in an Introduction to Clinical Medicine course were required to devote 24 hours to the study of self-directed learning activities. Although options were provided, students could create their own study modules. Students evaluated each module used. RESULTS: Major needs identified were history and physical examination skills, diagnosis, emergency procedures, psychosocial issues in medicine, and issues concerning physicians as people. The most selected module types were videotapes (52%), computer-aided instruction, labs, and seminars. Overall ratings (5 = high) indicated four clusters of modules: self-directed learning, 4.3; labs, 4.0; seminars, slide-tapes, and computers, 3.65; and videotapes and books, 3.25. Videotapes, the most frequently used module, received low overall ratings. CONCLUSIONS: Self-directed learning allowed students to use a great array of educational opportunities. Students appeared to recognize needs, identify resources, and use those resources to address their learning needs.

Student attitudes toward same-gender versus mixed-gender partnering in practicing physical examination skills.

Students were surveyed to assess perceptions with regard to the use of same-gender and mixed-gender partnering in practicing physical examinations. There was support for this arrangement, with students reporting that the practice provided an important learning experience with reasonable levels of comfort and no loss of thoroughness and rigor. Students did express some concerns. Females tended to have lower comfort levels, particularly when they were in the role of patient. Many of the concerns expressed could be addressed with procedural changes during the assignment of partners, and the benefits of continuing this practice seem to outweigh any negative aspects.

Blood and body fluid exposures during clinical training: relation to knowledge of universal precautions.

To investigate the relation between knowledge of universal precautions and rates of exposure to blood and body fluid during clinical training, a cohort of 155 students was surveyed following training in universal precautions and 18 months later. A total of 127 students (82%) participated; 58 (46%) experienced at least one exposure during the first clinical training year. Knowledge of universal precautions was inversely associated with the frequency of mucous membrane exposures (p .001); an apparent "dose-response" effect was evident (one-way analysis of variance; F = 5.2, p - 0.007). Students are frequently exposed to blood and body fluid during clinical training. Higher levels of retained knowledge about universal precautions are associated with a decreased risk of mucous membrane exposure.

Universal precautions training of preclinical students: impact on knowledge, attitudes, and compliance.

BACKGROUND: Little information exists regarding the impact of universal precautions training programs on preclinical students' knowledge, attitudes, and behavior. METHODS: We developed, implemented, and assessed an educational program in universal precautions for 2nd-year medical and preclinical physician assistant students. Students (n = 170) completed pre- and post-training questionnaires to assess universal precautions knowledge and to evaluate attitudes about their perceived risk for bloodborne pathogen infection, the importance of universal precautions procedures, and their willingness to provide care for human immunodeficiency virus (HIV)-positive or acquired immune deficiency syndrome (AIDS) patients. Phlebotomy, intravenous catheter insertion, and arterial blood gas sampling techniques were demonstrated, practiced, and evaluated during practical training sessions. Outcome measures included changes in pre- and posttraining knowledge scores and attitudes, as well as observed compliance with universal precautions during practical training. RESULTS: Universal precautions knowledge scores increased significantly after training (P < 0.0001). Personal assessments of the risk of developing HIV due to patient care significantly decreased (P < 0.0001) and willingness to provide care for AIDS patients increased (P = 0.004) following training. Importantly, students reported that high expected rates of contact with HIV-positive and other patient groups would not significantly affect their specialty choice. Observed compliance with universal precautions procedures during practical training ranged from 95 to 99% for glove use, 76 to 77% for direct sharps disposal without needle recapping, and 56 to 78% for handwashing after glove removal during phlebotomy and intravenous catheter insertion. CONCLUSIONS: This program is effective in increasing students' knowledge of universal precautions. Training favorably affects students' willingness to care for HIV-positive patients and their assessed risk of developing occupational bloodborne infection.