Assessment of ethical decisions and values.

The development and pilot testing of the Professional Decisions and Values Test (PDV) is described. The PDV is designed to assess how ethical conflicts are dealt with by medical and law students and which moral values motivate them. Data from two consecutive classes of entering medical and law students are presented and their action tendencies and ethical values are compared. The findings support the construct validity of the test. Regarding reliability, stability over time is present for action tendencies but not for values. Perhaps the ethical values of entering medical and law students do not become stable until later. Change in ethical values can be studied with the PDV for groups, not individuals, during the first year of professional education.

What is missing from patient histories?

Second year students' proficiency in history taking was evaluated by the Objective Structured Clinical Examination (OSCE) and a written test, with particular attention to Risk Factors and Psychosocial Data. Students concentrated on obtaining Diagnostic Information on both tests, but those students who worked with preceptors in the community, (PCC program), included a wider range of data. Overall performance was higher on the OSCE which emphasized diagnostic information. Student histories tend to exclude Risk Factors and Psychosocial Data unless their inclusion is modeled and expected by faculty.

Residency performance of graduates from a problem-based and a conventional curriculum.

Performance of 130 graduates in residency from a community-oriented, problem-based medical curriculum, and from a parallel, conventional track, were compared on eight dimensions: knowledge, communication with patients, independent learning ability, teamwork, patient education, critical thinking ability, attention to health care costs, and self-assessment. Ratings were obtained from three evaluators: a doctor-supervisor, a nurse and the resident him/herself. The study was undertaken to identify differences between graduates from the two curricular tracks. Differences were observed in the areas of health care costs (supervisors) and communication with patients (residents), and a trend was observed in patient education (supervisors) and knowledge (nurses), The outcomes of the study are discussed in light of the literature on residency performance, and in terms of the educational experiences that characterize the two medical curricula.

Who goes into family medicine?

A study was designed to identify criteria that could help select applicants to medical school with a lasting commitment to family medicine and to test the application of such criteria to predict career choice. The sample included 43 residents and physicians who chose family medicine when they entered medical school and five residents who decided on family medicine later. From the initial group, 19 remained stable in their choice of family medicine, and 24 switched to another specialty. Medical school folders and telephone interviews were used as data sources. The characteristics of stable family physicians and those who became specialists were identified, and the predictive power of these criteria was tested with 30 graduates selected at random. Based only on their entrance records, 25 of the 30 graduates were correctly identified as future family physicians or specialists. The use of these criteria in the admission process is discussed in terms of increasing the number of students who will become stable family physicians.

Self-assessment in problem-based groups.

Medical students in a tutorial program rated themselves in Year 1 and again in Year 2 on Knowledge, Reasoning, Communication and Interpersonal Skills. Student and tutor ratings were similar in Year 1 but different in Year 2. Both self- and tutor ratings increased from Year 1 to Year 2 but self-ratings were independent of achievement while tutor ratings were related to achievement. Possible reasons for these results were discussed with reference to the learning goals of the tutorials.

Factors in the choice of academic or practice careers in pulmonary medicine.

The characteristics, motives, and sources of job satisfaction were compared between persons choosing a research career in academic pulmonary medicine and those choosing a career in the practice of pulmonary medicine. In a first study, established practitioners and academic researchers were asked what the main influences were on their career decisions, from what they obtained job satisfaction, and why they did or did not choose academic medicine. After these results were obtained a second questionnaire was sent to all pulmonary fellows in U.S. programs asking them their future career plans, reasons for their career choices, factors in their job satisfaction, and attitudes toward an academic career. Both current and future researchers desired intellectual challenge, continued learning, and an opportunity to investigate, whereas established and future practitioners derived more satisfaction from patient care. The opportunity to be creative, the chance to work fixed hours, and to gain national recognition were more important to future academic researchers. The prospective practitioners rated helping people, freedom from bureaucracy, and income level as the major determinants of their career choice. In addition to the personal qualities, many environmental factors, such as participating in a successful research project and encouragement from faculty, were important in leading a pulmonary fellow to select a research career.

Affect and research in medical education.

All studies addressing affective issues were identified from a review of the Proceedings of Research in Medical Education (RIME) volumes between 1970 and 1982. A total of seventy-seven papers were sorted into the following seven categories according to the major issues addressed: (1) descriptive studies of personality, values and attitudes; (2) changes in attitudes; (3) interviewing skills; (4) personality and admission; (5) personality and career choice; (6) stress and coping style; and (7) miscellaneous. Several trends emerged from 13 years of research with implications for medical education. This review clarifies findings which could contribute to a better understanding of student affect and how it may be influenced by teachers. The potency of role models and informal learning in shaping student affect is particularly noteworthy. The authors suggest that studies involving role models need to go beyond observation and description and incorporate feed-back to the subjects of the study.

Clinical reading and writing skills of junior medical students.

A three-year study was designed to assess general reading and writing skills of 231 entering medical students and to compare these scores with those of clinically oriented reading and writing skills in the same cohort of students three years later. Standardized reading and writing tests were administered to all entering freshmen in the class of 1982. Clinical reading and writing examinations were developed by the authors and members of the faculty. The reading test consisted of 16 multiple-choice questions in response to three short discussions in medical journals. Clinical writing was assessed through scoring each student's latter of referral to another physician after he read a "mock" chart of a patient's hospital care. The results showed that entry-level reading comprehension and clinical reading had a significant association as did entry-level English composition and clinical writing. Regression analysis showed that the entry-level reading and writing scores were better predictors of clinical reading and writing skills than any other prematriculation variables. The implications of these findings for medical education are discussed.

Using simulated case studies to evaluate a clinical ethics course for junior students.

An experimental teaching program in clinical ethics was developed and evaluated. All junior medical students who rotated through a general internal medicine service (75 percent of the class) were required to attend 12 to 14 hours of a clinical ethics seminar which met on a general medicine unit. The teaching sessions were structured around actual cases presented by the junior medical students. One of the evaluation techniques developed is discussed here: the use of simulated clinical-ethical cases. The questions themselves, the method of scoring them, and the findings will be examined. On the basis of this evaluation procedure, some tentative conclusions can be drawn: (a) it is possible to develop evaluation techniques to assess objectively students' ethical reasoning after participating in such a course, and (b) junior medical students who participate in a clinical ethics course show increased reflectiveness regarding ethical decisions.

Interprofessional education in medical school.

The opinions of entering medical students regarding interprofessional education (IPE), and their reasons, are described in this article. More female than male students favour IPE, 49 as compared to 25%. Students who endorse IPE give different reasons for their position than students who oppose it. The former group refer to increased communication and respect among health professionals, increased knowledge about mutual roles and function, greater equality among members of the health team and improved patient care. The opposing group fear that IPE would lower the quality of education by increasing class size and slow the pace of instruction to accommodate students with limited scientific backgrounds. Students also protest against having to study irrelevant subjects and acquire irrelevant skills. The opposing group is concerned primarily with IPE's effect on medical students; the group in favour is concerned more with the effect on patients and interprofessional relations. It seems that opinions about IPE are part of a basic attitudinal structure that medical students bring with them when they enter medical school. The implications for IPE in medical school are discussed.

The Learning Preference Inventory.

The development, validity, and reliability of the Learning Preference Inventory (LPI) and its use with health professions' students and practitioners are described in this paper. The LPI yields six scores to register preferences for the following kinds of learning: Abstract, Concrete, Individual, Interpersonal, Student-structured, and Teacher-structured. The six scales of the LPI have been supported by factor analysis, thereby establishing content validity. Construct validity is demonstrated in studies with allied health and pharmacy students. Internal consistency reliabilities for the six scales range from .72 to .88. While the majority of allied health and pharmacy students tested prefer teacher-structured and concrete learning tasks and situations, many individuals differ from this pattern. Use of the LPI permits identification of individual learning preferences with a fair degree of accuracy. Ways to improve motivation for learning by adjusting teaching methods and assignments to learning preferences are suggested.

Hope for that hopeless essay test.

Despite the fact that essay tests have been under attack, teachers continue to use them. Although preparation and scoring of questions can be problematic, they can, however, be employed successfully if the teacher 1) recognizes their limitations, 2) prepares the questions carefully so that they will test what the teacher intends, and 3) uses methods of scoring that will judge the answers as accurately as possible. With continued practice, the teachers can develop skill in using the essay format.

A comparison of personality types among female student health professionals.

The purpose of the study reported here was to focus on the personality traits of six groups of women students in medicine, pharmacy, medical technology, physical therapy, dietetics, and occupational therapy. The Myers-Briggs Type Indicator was administered to all groups to measure Extroversion-Introversion, Sensing-Intuition, Thinking-Feeling, and Judging-Perception. Results show that (a) medical students in contrast to the other five groups are guided more by thinking than feelings in their approach to work and people and (b) pharmacy students prefer well-planned, routine work in contrast to occupational therapy students who like changing situations and flexibility. Some implications of these findings for the health team are mentioned.