Overview of Diagnostic Reasoning: Hypothetical-Deductive Strategy; Problem Representation; Semantic Qualifiers; Illness Scripts; Pattern Recognition and Prototypes

Context: This current paper is a non-systematic review of diagnostic reasoning exclusive of the Bayesian model which we considered a decision-making stratagem. The paper reviews primarily the literature on hypothetical-deductive reasoning and pattern recognition; the two archetypes of analytical and non-analytical reasoning; respectively. Though a lot of work has been reported in this field internationally our medical training in Zambia does not overtly tackle diagnostic reasoning and expectedly not many clinicians in Zambia are acquainted with the subject matter. Nevertheless; our clinicians pass on to future generations; by apprenticeship; their diagnostic reasoning processes; but to be effective educators clinicians must understand diagnostic reasoning well. Purpose: The purpose of the current paper is threefold: 1) to share the generally accepted concepts in diagnostic reasoning in order to help clinicians become more effective educators in the clinical settings; 2) provoke clinicians and students alike to critically consider the subject of diagnostic reasoning and 3) also to inform readers about prospective research initiatives at the University which intend to investigate diagnostic reasoning practices of Zambian-educated medical graduates. Conclusions: Generally; there are three accepted diagnostic reasoning models; i.e.; hypothetical-deductive reasoning; pattern recognition; and pathognomonic recognition of signs and symptoms. These are categorised as analytical methods (principally the hypothetical-deductive strategy) and non-analytical methods (pattern recognition and pathognomonic approaches). The Diagnostic Reasoning Research - Zambia Project (DRR-Z) will be the first in Zambia to study diagnostic reasoning processes of graduates from University of Zambia School of Medicine. Clinicians who are well informed about the diagnostic reasoning process can teach it more effectively

Characterisation and Quantification of Anatomy Concepts in a Standard Clinical Methods Textbook: a Content Analysis Approach

"Aim: To analyse the nature and quantity of anatomy concepts intrinsic in a standard clinical methods textbook; used for teaching medical students clinical methods; in order to identify anatomy concepts to be taught to medical students in preparation. Methods: Five categories of anatomy indicators developed in consultation with and accepted by an international panel of anatomists were used to content analyse the 19th Edition of Hutchinson's Clinical Methods. The five categories were subdivided into two classes designated ""General Anatomy Terms"" and ""Technical Anatomy Terms"". The inter-rater reliability of coding instructions was 0.76 (P value = 0.0005). Results: A total of 17; 223 recording units were coded of which 10;162 were anatomy indicators and 6;980 were technical anatomy terms. The average total anatomy indicators ratio (TAIR = total anatomy indicators/total recording units) was 0.55 and the technical anatomy terms ratio (TATR = technical anatomy terms/total anatomy terms) was 0.68 respectively. There was variability in requirement for technical anatomical terms between the 17 different chapters in the textbook. Sixty-five anatomy themes emerged from the 17 chapters. Conclusions: These results suggest that a student cannot benefit sufficiently from Hutchinson's Clinical Methods without substantial knowledge of anatomy. The implications for medical educationists are that 1) educators must be wary of teaching methods that consider anatomy learning in a superficial and simplistic manner; and 2) educators must ensure that students attain adequate depth and scope of anatomy knowledge before or concurrently to learning clinical methods."

Teaching and Teacher Education for Health Professionals: Perspectives on Quality and Outlook of Health Professionals Education in Zambia

Purpos: To measure students' perspectives on the teaching quality of the school of medicine at University of Zambia and concurrently measure health professionals educators perspectives on the need for teaching courses for health professionals educators (educational skills training). The results are discussed as indications for educational skills training for educators in health professionals' education. Method: 250 medical students from the MB ChB programme were surveyed; in an evaluation exercise; to rate the teaching contribution of all the full-time and honorary lecturers (n=88). The students were requested to rate each lecturer out of 10 on eight scales: a) attendance; b) punctuality; c) clarity; d) interest in the subject; e) supportiveness to students; f) ability as a lecturer; g) appropriate use of audiovisual aids; and h) amount of workload done in the academic year. Additionally; a multi-site study surveyed 426 health professionals educators; defined as persons who considered themselves as continually participating in teaching students in a training institutions for health professions in the Country on the necessity for and their willingness to enroll into a teaching programme for health educators. Results: Two hundred students of the eligible 250 completed the evaluation giving a response rate of 80. The scores for teaching quality ranged from 8/ 40 to 40/40. The mean score was 32.2. The results showed that about 27.2(n=24) did not meet the merit standard which was set at 30/40 as the quality assurance benchmark by the School. This result suggests that a large proportion of teaching staff could benefit from teacher education. Four hundred and four questionnaires were completed and returned out of the 426 that had been distributed; yielding a response rate of 94.8. The Cronbach's alpha for reliability test was 0.62 - 0.70 on the teaching skills sub-scale and 0.76 - 0.78 on the Educational skills sub-scale. The majority; over 85; acknowledged they lacked expertise in educational skills and that they would enrol in a programme to improve their educational skills. There was overwhelming (90) agreement in topics to be covered. Limitations: Quality of teaching contributions only measured at school of medicine; Large proportion of educators' survey were not full-time teaching staff. Implications: The belief that professional qualifications are sufficient for preparation for teaching health professionals is now being confronted. Formal systems of teacher education in the health professions have emerged worldwide and are now also available in Zambia

A Review of Outcome of Postgraduate Medical Training in Zambia

The University of Zambia School of Medicine was opened in 1966. Since inception; over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery. The postgraduate Master of Medicine (M.Med)programme was started in 19822 with the intention of providing district specialists in the rural and semi urban communities of Zambia. Additional hope was to stem the brain drain to other countries. This is a study to describe the deployment of graduates of the M.Med training programs at the University of Zambia School Of Medicine in relation to the objectives defined by the University of Zambia senate in 1981. It was found that the School of Medicine has produced 118 Master of Medicine graduates in 5 clinical programs over a period of 22 years. The average graduation rate is 5 students per annum. The largest specialist group has been in General surgery with 34 (29) of all graduates. The ratio of men to women was 3 to 1. The ratio of Zambian to Non Zambian ratio was 10:1. Of all students who have graduated over this period 13 (11) have gone abroad and 7(6) have died.; Eighty-eight (75) of the graduates are working along the line of rail in the 5 most urbanized towns in the country. Twenty-five ( 21) are doing non clinical jobs which involve health programs administration and 12 (10) are working in private practice. We concluded that external migration is not a major problem and; overall; the creation of a local postgraduate training program has reduced brain drain. The key challenge is internal brain drain

Student Evaluation of Teaching: A Case Study from School of Medicine (UNZA)

Purpose: This paper presents a case study of an academic department's experience with evaluation. The purpose is to review the impact of student evaluation of teaching. The paper also introduces a new evaluation scoring method: the University of Zambia Staff Appraisal System (UNZASAS) method. Method: Anonymous 5-point Likert scale evaluation rating forms were administered to 134 third-year medical students in two consecutive years to measure students' perceptions of teaching quality of four faculty members in an academic department at School of Medicine. The rating forms were scored using the UNZASAS method. Results: The response rate averaged 83. The group average lecturer rating improved from 120 to 141.5. Individual performance of three lecturers improved while that of one declined. The UNZASAS method was effective in summarizing data to identify the areas of weakness and strength in the faculty members. The specificity and sensitivity of this method were fundamental to its success as a diagnostic tool for formative evaluation of teaching quality. Conclusions et Implications: The quality of teaching in the academic department improved after evaluation of teaching was introduced. The UNZASAS method proved to be an effective tool for scoring evaluation data and for providing faculty with useful and specific formative feedback. Health professionals training institutions can consider using the UNZASAS method for their evaluation of teaching contribution by educators