Academic medicine : journal of the Association of American Medical Colleges
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Comparative Study
Use of an objective structured clinical examination to determine clinical competence.
To describe the performance of second-year internal medicine residents on an objective structured clinical examination (OSCE) and to analyze the role of the OSCE in the evaluation of clinical competence. ⋯ The OSCE's moderate correlation with the ITE and CRS suggests that the OSCE, which consists largely of physical diagnosis stations, may test a component of clinical skills not evaluated by the other measures. Thus, the OSCE is an important addition to the assessment of clinical competence.
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To use issues identified by students in order to establish an experience- and evidence-based approach to medical ethics education. ⋯ The differences between the responses of the sophomores and seniors tend to support other research suggesting a retardation of moral sensitivity in the course of medical education. It may be that clinical teaching and faculty behavior model values at odds with what is taught in the classroom. Ethics education should focus on issues relevant to students' experience.
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The author describes in detail the successful education initiatives on domestic violence, especially violence against adult women, that have been implemented for family medicine residents at the St. Paul-Ramsey Medical Center in St. Paul, Minnesota, and for medical students at each of the three Minnesota medical schools. ⋯ The author describes some important types of resistance to having instruction about domestic violence in the medical curriculum. To move forward, faculty must overcome their discomfort with the topic yet acknowledge that teaching about it is difficult and requires personal stamina and empathy with colleagues. Faculty must also agree to collaborate with those who have sensitivity and expertise in the area, and must make a long-term commitment to prepare physicians to recognize problems of domestic violence and work effectively with its victims and perpetrators.
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The most effective way to integrate philosophy into medical education uses ethical, social, and conceptual problems arising in medical practice such as those about informed consent, confidentiality, competency, resource allocation, the doctor-patient relationship, and death and dying. Medical students become better physicians by learning salient views on these matters and by developing philosophical skills and attitudes to (1) examine key assumptions; (2) broaden their perspectives and gain self-knowledge; (3) develop critical thinking skills about the kind of judgments they make, how bias affects their views, and the scope and limits of their knowledge claims; (4) generate tolerance, openness, and skepticism about dogma; and (5) cultivate empathy. Learning these skills and dispositions using moral, conceptual, and social issues facing them will enable students to recognize these issues when they arise in their medical practices and learn how to respond to them in justifiable ways. It will also strengthen the health care profession and institutions overall by fostering the openness, the questioning mind, and the critical thinking essential to the practice of good medicine.