An experiment in medical education: a critical analysis using traditional criteria

Article Abstract:

To evaluate an alternative approach to the basic science component of medical education (the first two years) at Rush Medical College in Chicago (the alternative curriculum; AC), a study was conducted to compare the performance of AC students with that of students enrolled in the traditional curriculum (TC). The AC curriculum allows students to meet twice each week in small groups to discuss clinical problems; groups are led by a facilitator who uses the Socratic approach. Students are required to pass the National Board of Medical Examiners (NBME), part I, and to take the NBME, Part II. Students who entered medical school in 1985 and 1987 also underwent oral examinations consisting of three case histories and were asked questions on which they were graded on a 1 to 9 scale (9 was highest). Students who matriculated between 1984 and 1988 made up the study group: each year, 18 positions in an entering class of 120 were allocated for the AC. No differences were found between AC and TC students for scores on either part of the NBME, although subset scores (on particular topics, such as anatomy) for TC students tended to be higher. These differences were most pronounced for the first two classes. TC and AC students performed similarly well (most in the ''adequate'' or ''good'' ranges) on the oral examination, with AC students from the class that matriculated in 1987 scoring higher than TC students. Curriculum revision in medical schools is a topic currently receiving attention, and the merits of problem-based curricula such as the AC are by no means widely acknowledged. The results demonstrate the value of traditional examinations for evaluating program effectiveness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Education

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The long shadow of Flexner: a prolonged polemic in assessing outcomes in medical education

Article Abstract:

The process of evaluating medical education is undergoing a transition. The importance of this review process is stressed in a recent statement on accrediting agencies by the US Secretary of Education. The statement outlines a policy of basing accreditation decisions on the systematic acquisition of substantial and accurate information on the effectiveness of the educational process. This is done by assessing the educational achievement of the students with respect to licensing examinations, employer evaluations and placement rates. In other words, assessment of outcome focuses on the final product of the teaching institution, the student. Schools most frequently rely upon National Residency Matching Programs, future practice location and student attitudes and interpersonal skills. Although these factors are not equally important, this type of grading and appraisal should be encouraged by the schools. Accrediting committees since the beginning of this century have collected information about a school's resources and curricula in order to judge its medical educational system. The results of personal surveys carried out at the school by members of the accrediting committee have been important. The site visit team often tried to obtain information regarding residency programs, licensing results, the residency director's reports and other measures of outcomes. To improve this process, more information on the development of the careers of medical graduates should be included. Such outcome measurements could be used to help adjust the busy medical curriculum of medical school, adjudge the effect of student/faculty ratio and better assess the educational success of different medical schools and residencies.

editorial

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Putting more prevention into medical training

Article Abstract:

Medical students and residents receive inadequate training in preventive medicine. In evaluating the disease prevention content of medical school curriculum, investigators found that only clinical prevention was covered. Other areas such as quantitative methods, health service organizations and community dimensions were neglected. Preventive medicine should be integrated into the curriculum, but currently there is no structure set up for that purpose. Lack of time and staff are also factors that contribute to inadequate preventive medicine training. Solutions proposed at an annual preventive medicine meeting in New Orleans, LA, included the use of a chart detailing counseling, immunization and screening standards and methods to assess health risk factors.

Management, Study and teaching, Health promotion, Preventive medicine, Medicine, Preventive

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