Medical teacher
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Medical students need to learn how to recognize and manage critically ill patients; to communicate in critical situations with patients, families, and the healthcare team; and finally, to integrate technical knowledge with communication skills in caring for these patients. Meeting their needs will help prepare them to demonstrate, as physicians, the ability to synthesize information while simultaneously caring for patients, that the American Medical Association recently characterized as vital. ⋯ It is feasible to integrate the teaching of communication skills with the recognition and management of critically ill patients. The next step will be to revise the curriculum to address student deficiencies and to evaluate its effectiveness more rigorously.
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Disaster and bioterrorism preparedness is poorly integrated into the curricula of internal medicine residency programs. Given that victims may present to a variety of healthcare venues, including primary care practices, inpatient hospital wards, and intensive care units, we developed a curriculum to address this need. ⋯ In this pilot study, a disaster-preparedness curriculum including simulation-based training had a positive effect on residents' knowledge base and ability to respond to disaster. However, this effect had diminished after one year, indicating the need for reinforcement at regular intervals.
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The Cleveland Clinic Lerner College of Medicine was designed to encourage medical students to pursue careers as physician investigators. Our faculty decided that assessment should enhance learning and adopted only formative assessments to document student performance in relation to nine broad-based competencies. No grades are used to judge student performance throughout the 5-year program. Instead, assessments are competency-based, relate directly to performance standards, and are stored in e-Portfolios to track progress and document student achievement. The class size is limited to 32 students a year. ⋯ Using assessment data for formative purposes may encourage application and integration of knowledge, help students identify performance gaps, foster student development of learning plans and promote student responsibility for learning. Discussion provides applications for institutions with larger classes to consider.
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In 2004, the Japanese government reformed the monospecialty-oriented postgraduate medical education (PGME) program and introduced a new PGME program to develop the primary care skills of physicians by mandatory rotation through different clinical departments. ⋯ The new PGME program appears to have been successful at improving both the clinical experience and confidence levels of medical residents, especially at university hospitals.
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The use of an objective structured clinical examination (OSCE) has been a powerful influence on doctor training but assessments do not always drive study behaviour in predictable ways. ⋯ The expectation that an OSCE drives learning into the clinical workplace was not supported by this study. This suggests the role of clinical experience in helping students prepare for the exam may be more subliminal, or that an OSCE is more as a test of psychomotor skills than a marker of clinical experience. An unexpected benefit may be to drive more collaborative learning.