Objective: To identify the usefulness of critical-incident reports for reflective learning and for classifying the types of experiences that medical students regarded most memorable during clinical clerkship at general medical ward and clinic. Design: Descriptive qualitative study using the critical-incident technique. Setting: General medical ward and clinic of a university hospital. Participants: Fifth-year medical students that took part in the clinical care of patients during the clerkship from October 1, 1996 to September 31, 1997. Measurements and Main Results: Ninety-five reports were collected over one year and subjected to the analysis. Reports were classified for seven major themes, with a mean of 1.85 themes per narrative. As for the distribution of themes, 68 reports (72%) dealt with biomedical topics, 45 (47%) with communication with patients and families, 26 (27%) with personal feelings, 19 (20%) with the physician's role, 11 (12%) with ethics, 7 (7%) with psychosocial subjects, and 1 (1%) with recognition of alternative medicine. Reports from men and women contained a similar mean number (men 1.82; women 2.09) and distribution of themes. Conclusions: Medical students have divergent meaningful experiences on non-biomedical themes as well as biomedical issues during their general medicine rotation.
With multiple-choice questions presenting one, two, or three of five choices (types A, K or X), the expected probability of a correct answer (P) can be obtained with a five-dimensional equation for the knowledge level (q), which is the probability of discriminating correct and incorrect items. From equations for each question type, we inversely estimated the q value (the estimated knowledge level), replacing P with the raw score rate in the actual examinations for promotion. The distribution and mean value of the raw score rate of type X differed from those for types A and K. However, distributions of estimated q values for the three question types were similar. This method can be used to estimate the actual knowledge level of students without the question type affecting the raw score but cannot be used to estimate incorrect knowledge.
To examine ethical problems students may face during clinical clerkships and to help them to learn how to solve these ethical problems practically, we started a compulsory ethical case conference for medical students rotating through the department of general medicine. Actual cases were selected from among those students had encountered during their clinical clerkship. Groups of students were to analyze these cases and to discuss how to solve ethical problems. In this study, we evaluated this course on the basis of student's questionnaires and case sheets they submitted. Eighty students (92%) answered that they had encountered ethical problems. Each student encountered an average of 3.95±1.53 cases with ethical problems. Students noted 130 ethical issues (an average of 1.63±0.51 issues per case). Ethical issues included informed consent, treatment selection, refusal of treatment, medical distrust, and the doctor-patient relationship. In addition, such important subjects as economic burden, ability for self-determination, social rehabilitation, and patient-family relationships were mentioned, but only rarely. Eighty-five percent of students thought the conferences were valuable. Moreover, 87% of students thought such conferences would motivate them to think about ethical issues in the future. All students thought these compulsory ethical conferences should be continued. However, both the students' degree of participation and comprehensiveness of the conference contents could be improved.
Tokyo Women's Medical University introduced tutorial education in 1990 for 1st-through 4th-year students. To examine the effectiveness of this system in a basic-medicine course, questionnaires were given to all 2nd-year students. Many students felt that they had become accustomed to performing self-learning tasks through collecting information themselves and discussing their findings in a group; in particular, they found that tutorial education markedly improved their communication skills. A few students thought that this method helped them develop the ability of logical/critical thinking and analytic skills from multiple viewpoints. These findings suggest that an assessment system should be established by which students themselves could recognize the extent to which they have developed their abilities, which was the aim of tutorial education.
Personal interviews and group discussions were conducted with all 2nd-year students to examine how they feel about tutorial education used as the core of the basic-medicine course and how they recognize the importance of developing their abilities, which was the aim of this course. Many students showed slight anxiety about the results of their learning with tutorials, felt inadequate in their self-learning ability, and hoped the guidance by instructors would be improved. These findings suggest that students' anxiety will decreased and their willingness to learn will increase if their developed abilities are evaluated appropriately and if they receive adequate feedback. These findings also suggest that a retraining program for experienced instructors is needed to improve their guidance skills and to reinforce the importance of their role.
We gave tests to 6th year medical students before and after pregraduate lectures in neurosurgery in the 1997 and 1998 academic years and compared the scores with those of the student total evaluation at graduation (TSG). We also selected 10 students with high, middle, or low TSG scores and compared their TSG scores with those of tests before and after lectures. We found that TSG scores were more strongly correlated with the scores of the postlecture test than with the scores of prelecture tests in both 1997 and 1998. The scores of postlecture tests differed between students with high, middle, and low TSG scores (P<0.01), whereas scores of prelecture tests did not. In both 1997 and 1998, students with high TSG scores achieved higher scores on the postlecture test than on the prelecture test and students with low TSG scores achieved higher scores on the prelecture test than on the postlecture test. We conclude that the prelecture test increases the student's will to study and that the postlecture test can be used to evaluate a student's basic knowledge at the time of lectures.
We have previously reported that tutorials help medical students develop analytical ability, which is necessary for problem-solving. In this study we analyzed students' assessments of tutorials, results of term-end examinations, and posttutorial questionnaires to determine whether tutorials help students develop interests and proper attitudes for studying. The results suggest that our tutorials are not sufficient for medical students to develop interests and proper attitudes for studying.
All 11 1st-year medical trainees in 1999 participated in medical interview training in the outpatient department under the supervision of senior physicians. Interviews were to be done within 15 minutes. The training was completed when each trainee had interviewed an average of 10 patients. Approximately 70% of the chief complaints were common ones that the Japanese Society of Internal Medicine has recommended general internists master. Most trainees considered this training effective for learning to clarify the patient's reason for seeking care and for improving presentation skills. However, they considered the training ineffective for learning to judge the necessity of emergency care and for understanding the usefulness and limitations of laboratory data, electrocardiograms, and chest films.