Students' perception of the 'educational climate' at the Faculty of Medical Sciences, the University of the West Indies, Jamaica / Percepción de los estudiantes sobre el "clima educacional" en la Facultad de Ciencias Médicas, de la Universidad de West Indies, Jamaica

BACKGROUND: In 2001, the Faculty of Medical Sciences at the Mona Campus of The University of the West Indies (UWI) introduced a restructured curriculum in keeping with advances in the philosophy of medical education. OBJECTIVES: To explore the quality of the educational environment in the Undergraduate Medical Programme at the Mona campus of the UWI to identify areas for improvement and examine for any differences in student perception in a transitional medical curriculum. METHODS: The Dundee Ready Education Environment Measure (DREEM) was self-administered and completed anonymously during April 2004 by 278 (70%) undergraduate medical students (cohorts 2004-2007) registered in the Faculty of Medical Sciences, Mona Campus, Jamaica. RESULTS: The overall mean DREEM score was 102.80 ± 21.88 (maximum score 200; the higher the score, the more favourable the perception) and there was no significant difference by year of study. Teacher knowledge was highly rated by students but this was overshadowed by concerns about attitudes and behaviour toward students. The quality of the learning atmosphere was poorly rated with general concerns of an overcrowded curriculum, time-table issues and lack of adequate support systems to deal with student stress. CONCLUSIONS: Curriculum managers must identify strategies to improve the student-centredness and student-friendliness of the school's educational environment.

ANTECEDENTES: En el año 2001, la Facultad de Ciencias Médicas en el Campus de Mona de La Universidad de West Indies (UWI) introdujo un currículo reestructurado siguiendo los adelantos en filosofía de la educación médica. OBJETIVOS: Explorar la calidad del ambiente educacional en el Programa de Medicina de Pregrado en el Campus Mona de UWI a fin de identificar las áreas a mejorar, y detectar diferencias en la percepción del estudiante en el plan de transición para los estudios de medicina. MÉTODOS: Una encuesta Dundee para la medición del ambiente educacional (DREEM) fue autoadministrada y llenada anónimamente durante abril de 2004 por 278 (70%) estudiantes de pregrado de medicina (cohortes 2004 - 2007) matriculados en la Facultad de Ciencias Médicas, Campus de Mona, Jamaica. RESULTADOS: El promedio general de la puntuación en DREEM fue 102.80 ± 21.88 (la puntuación máxima fue 200; mientras más alta fue la puntuación, más favorable fue la percepción) y no hubo diferencia significativa por año de estudio. El conocimiento del maestro recibió una alta puntuación por parte de los estudiantes, pero fue eclipsado por la aún mayor puntuación cuando se trataba de las preocupaciones sobre las actitudes y comportamiento hacia los estudiantes. La calidad de la atmósfera del aprendizaje recibió una puntuación pobre, acompañada de preocupaciones generales por un currículo atiborrado, problemas de horarios, y falta de sistemas de apoyo adecuados para tratar con el estrés estudiantil. CONCLUSIONES: Los administradores del currículo tienen que identificar estrategias para mejorar el ambiente educacional de la escuela, en el sentido de lograr que sea más amigable y más centrado en el estudiante.

Student self-assessment in a paediatric objective structured clinical examination / Autoevaluación del Estudiante en un Examen Clínico Objetivo Estructurado de Pediatría

OBJECTIVE: The objective structured clinical examination (OSCE) has been recognized not only as a useful assessment tool but also as a valuable method of promoting student learning. Student self-assessment is also seen as a means of helping students recognize their strengths and weaknesses, understand the relevance of core learning objectives and to take more responsibility for each stage of their work The authors sought to evaluate the accuracy of medical student self-assessment of their performance in the paediatric clerkship OSCE and thus obtain preliminary data for use in programme strengthening. DESIGN AND METHODS: A self-administered questionnaire was completed by successive groups of students immediately after the OSCE at the end of each clerkship rotation. Students assessed their performance at each station, using a performance rating scale. Performance data were summarized using descriptive and non-parametric tests. Basic statistical analysis of the Likert items was conducted by calculatingfrequencies, means and standard deviations. Regression analysis was used to correlate self-reported rating and actual performance in each station. A p value of < 0.05 was considered significant. Eighty-one students (92) completed the questionnaire. RESULTS: Fifty-eight (72) of the students achieved greater than minimum competence in their overall scores. Significant positive correlation (p < 0.05) between student self-rating and actual score was noted- among the following stations: technical skills, cardiovascular examination, assessment of dysmorphism, dermatology, communication and photographic interpretation stations. Students overestimated their performance in the gastrointestinal examination, radiological and arterial blood gas interpretation. Students underestimated their performance in the following: respiratory system, examination of the head, developmental and nutritional assessment. CONCLUSIONS: The findings highlight the perceived strengths and weaknesses in clinical competence and self-assessment skills and provide direction for programme training needs

Objetivo: El examen clínico objetivo estructurado (ECOE) ha sido reconocido no sólo como una herramienta de evaluación útil, sino también como un valioso método para promover el aprendizaje del estudiante. La auto-evaluación estudiantil es vista también como un medio de ayudar a que los estudiantes reconozcan sus fortalezas y debilidades, entiendan la relevancia de los objetivos de aprendizaje comunes, y tomen más responsabilidad en cada etapa de su trabajo. Los autores buscaron evaluar la exactitud de la auto-evaluación del rendimiento del estudiante de medicina en la estación pediátrica del ECOE, obteniendo de eso modo datos preliminares a ser usados en el fortalecimiento del programa. Diseño y métodos: Una autoencuesta fue completada por grupos sucesivos de estudiantes inmediatamente después del ECOE al final de cada rotación de las estaciones. Los estudiantes evaluaron su rendimiento en cada estación, usando una escala de evaluación del rendimiento. Los datos del rendimiento fueron resumidos utilizando tests descriptivos y no paramétricos. El análisis estadístico básico de los ítems tipo Likert se llevó a cabo calculando las frecuencias, medias y desviaciones estándar. El análisis de regresión fue usado para correlacionar la calificación autoreportada con el desempeño real en cada estación. Un valor de p < 0.05 fue considerado significativo. Ochenta y un estudiantes (92%) respondieron la encuesta. Resultados: Cincuenta y ocho (72%) de los estudiantes lograron un rendimiento por encima del mínimo en sus resultados (puntuaciones) generales. Se observó una correlación positiva significativa (p < 0.05) entre la autocalificación del estudiante y el resultado real en las estaciones siguientes: habilidades técnicas, examen cardiovascular, evaluación del dismorfismo, dermatología, y las estaciones de comunicación e interpretación fotográficas. Los estudiantes encima de-estimaron su actuación en el examen gastrointestinal, la interpretación de gas de sangre radiológica y arterial. Los estudiantes subvaloraron su competencia en las siguientes estaciones: sistema respiratorio, examen de la cabeza, evaluación del desarrollo y la nutrición. Conclusiones: Los hallazgos resaltan las fortalezas y las debilidades percibidas en la competencia clínica y la autoevaluación de las habilidades, a la par que proveen dirección a las necesidades de entrenamiento en los programas.

Initial experience with beating-heart single valve replacement surgery at the University Hospital of the West Indies, Kingston, Jamaica

The objective of this study was to examine the consequences of performing single cardiac valve replacement procedures utilizing a beating-heart technique on typical patients presenting to the cardiothoracic surgery service for aortic or mitral valve replacement. Beating heart aortic (4) or mitral valve (1) replacement was performed on patients from July 2000 to November 2002. A stratified sample of five patients who underwent standard arrested-heart single valve replacement procedures between April 1997 and November 2002 was selected for retrospective comparison with the beating-heart group. Operative and post-operative variables were compared between the two groups of patients and subjected to statistical analysis. There was no statistical difference between the two groups with respect to age, pre- or post-operative New York Heart Association (NYHA) scores, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative blood transfusion, or post-operative hospital stay. Post-operatively, in the beating heart group, ventilation time, mediastinal blood loss and requirements for inotropic drugs were significantly reduced (p = 0.0054), p = 0.0019 and 0 = 0.02 respectively) compared to the arrested-heart group. Single cardiac valve replacement surgery utilizing a beating heart technique may offer benefits to patients over traditional arrested-heart surgery. Post-operative blood loss, inotrope requirements and ventilation times are significantly reduced, possibly resulting in better recovery and potentially fewer complications in the post-operative period. There may be cost benefits, important in the context of healthcare delivery in developing nations. These early results suggest the need for a regional prospective randomized trial to compare beating-heart single valve replacement surgery with traditional techniques

Motivation for and concerns about entering a medical programme

The motivation for and concerns about studying medicine and future career plans of students at the Faculty of Medical Sciences, The University of the West Indies (UWI), were studied using a cross-sectional survey that included Year 1 medical students at both the Mona (Jamaica) and St Augustine (Trinidad and Tobago) medical schools of the UWI. The data were collected using a self-administered questionnaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences. A total of 193 students took part in the study, 103 from Mona and 90 from St Augustine (88 response rate). Seventy per cent of the students were between 18 to 22 years of age with 59 being females. The highest rated motives for studying medicine were the 'opportunity for working with people' and an 'interest in human biology'. Female students scored significantly higher for the motive of an 'opportunity for working with people', while males rated the 'social prestige/status' significantly higher. The greatest concerns of the students were 'fear of failure' and 'contracting diseases'. The female students had a greater concern for dealing with the long hours involved in medical training than their male counterparts. Surgical specialties (43), family medicine (38) and paediatrics (34) were the top choices of the students for future specialty and more women than men chose obstetrics. Although the motives that students have reported are varied, there was a reasonable spread of desirable motives. This study provides a baseline for observing possible changes as students advance through medical training. A programme of study that strives to maintain these well-placed motives while providing opportunities for dealing with the concerns of the students will assist in creating caring, empathetic physicians for the Caribbean