A student-led clerkship primer: a near-peer orientation to clerkship.

The transition between pre-clerkship and clerkship can be difficult for medical students. Near-peer teaching may fill knowledge gaps within curricular clerkship orientation, leveraging recent, relatable, and up-to-date experiences from near-peers. These benefits have not been formally evaluated in the context of a clerkship orientation. We therefore created the Clerkship Primer, a near-peer teaching initiative that aimed to introduce incoming clerks to clerkship through a curricular session facilitated exclusively by senior clerkship students. Sessions had high satisfaction among students. This pilot project suggests that curricular near-peer teaching is a valuable component of clerkship orientation.

La transition entre le pré-externat et l'externat peut être difficile pour les étudiants en médecine. Un enseignement par les pairs a le potentiel de combler des lacunes dans les connaissances dans le cadre d'une orientation à l'externat, à partir d'expériences récentes et actualisées de pairs. Ces avantages n'ont pas été formellement évalués dans le contexte d'une orientation à l'externat. Nous avons donc créé le Clerkship Primer, une démarche d'enseignement par les pairs qui vise à présenter l'externat aux nouveaux externes dans le cadre d'une séance animée exclusivement par des externes séniors. Les séances ont été très appréciées par les étudiants. Ce projet pilote porte à croire qu'un enseignement par les pairs est une composante précieuse de l'orientation à l'externat.

Enhanced point of care ultrasound skills after additional instruction from simulated patients.

Background: Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience. Methods: Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation. Results: Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly. Conclusions: Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.

Contexte: L'enseignement de l'échographie ciblée (ÉC) dans les programmes de médecine de premier cycle au Canada est en pleine expansion. Jusqu'à présent, les patients simulés (PS) de notre programme ne fournissaient qu'une rétroaction sur leur confort et le professionnalisme. La participation de patients simulés en tant qu'instructeurs (PS-instructeurs) pour les compétences POCUS offre une occasion d'apprentissage supplémentaire. Dans cette étude pilote, nous avons exploré l'effet de l'intervention de PS-instructeurs dans le cadre d'une séance de formation en POCUS. Nous nous sommes intéressés tout particulièrement au niveau de compétence atteint par les stagiaires à la suite de la séance et sur le plan et de leur satisfaction à l'égard de cette expérience d'apprentissage. Méthodes: Des étudiants en deuxième année de médecine ont été répartis au hasard entre un groupe qui a reçu une formation traditionnelle et un groupe qui a reçu la formation avec rétroaction du PS-formateur. Les deux groupes ont eu accès au même tutoriel, aux mêmes conseils de l'instructeur et à une rétroaction de base de la part des PS (confort et professionnalisme). Les apprenants du groupe travaillant avec des PS-formateur i ont reçu des commentaires supplémentaires de la part de ces dernier (repères, manipulation de la sonde transducteur et dépannage) pendant que les instructeurs aidaient d'autres stagiaires. Les étudiants ont évalué la séance et ont ensuite fait l'objet d'une évaluation par observation directe. Résultats: Les étudiants qui ont bénéficié de l'intervention du PS-formateur ont obtenu des résultats nettement meilleurs élevés en ce qui concerne l'acquisition d'images (p=0,029, d=1,26) et leur score de confiance global (p=0,002, d=1,75). Les deux groupes ont évalué leur séance de formation de manière très positive. Conclusions: les étudiants qui ont bénéficié de commentaires supplémentaires de la part des leur PS-formateur ont eu de meilleurs résultats en acquisition d'images et un score de confiance plus élevé. D'après cette étude pilote, les PS-instructeurs ont eu un effet positif sur l'acquisition de compétences en POCUS.

Virtual Supervision of Third Year Medical Students Using Handheld POCUS Devices and Cloud-based Image Archiving Provides Opportunity for Feedback and Skill Improvement.

Background : Feedback on Point of Care Ultrasound (POCUS) skills is essential for skill development. Providing feedback can be difficult in a large province with several distributed medical education sites. Use of handheld POCUS devices and a cloud-based image archiving enables virtual supervision. We evaluated the quality of uploaded images as well as feedback provided to students. Methods: Volunteer third year students were given access to handheld POCUS devices at various training sites. Students were encouraged to upload educational POCUS scans to their accounts where they would then receive feedback from faculty. Subsequently, images that met inclusion criteria were randomized and reviewed by a blinded expert using a global rating scale. Feedback was also analyzed. Finally, students completed a questionnaire on their technology-enhanced POCUS learning experience. Results: An independent-sampled t-test comparing mean ratings for initial images submitted prior to any feedback with those submitted after three rounds of feedback showed significant effect on image scores (2.60 vs 3.50, p = .040, d = .93). Feedback included 4 performance domains (indications, image generation, interpretation, and integration). Students found the technology easy to use and felt feedback was tailored to their learning needs. Conclusions: We observed that virtual feedback provided to medical students through a cloud-based work platform can be effective for enhancing POCUS skills.

The value of admissions characteristics for predicting the practice location of University of Saskatchewan College of Medicine graduates.

Background: The physician workforce in Saskatchewan depends upon the retention of locally trained physicians. Characteristics collected at the time of medical school application may predict future practice location, but these associations have not been explored. Methods: We identified the current practice location of University of Saskatchewan College of Medicine graduates who matriculated between 2000 and 2013 and extracted data from their admission applications including gender, age, high school, previous university, and current location at the time of application. We then conducted univariate and multivariate analyses to evaluate associations between these characteristics and rural- and Saskatchewan-based practice. Results: We identified the current practice location of 1,001 (98.9%) of the graduates of the included cohorts. Attending a Saskatchewan high school (p < 0.001), a high school in a smaller population center (p < 0.01), and a Saskatchewan university (p < 0.001) were predictive of Saskatchewan-based practice. Attending a high school outside of Saskatchewan (p < 0.05), a high school in a smaller population center (p < 0.001), and living in a small population centre at the time of application (p < 0.05) were predictive of rural-based practice within or outside of Saskatchewan. Conclusion: Demographic characteristics collected at time of medical school application are associated with future Saskatchewan- and rural-based practice. These findings will guide admissions policies in Saskatchewan and may inform admission practices of other medical schools.

Contexte: La main-d'œuvre médicale en Saskatchewan dépend de la rétention des médecins formés dans la province. Les informations recueillies au moment de la demande d'admission à la faculté de médecine peuvent permettre de prédire le lieu de pratique futur, mais ces liens n'ont pas été explorés. Méthodes: Nous avons trouvé le lieu de pratique actuel des diplômés de la faculté de médecine de l'Université de la Saskatchewan qui se sont inscrits entre 2000 et 2013 et avons extrait de leurs demandes d'admission les données concernant le sexe, l'âge, l'école secondaire et l'université précédente fréquentées, et le lieu de résidence au moment de la demande. Nous avons ensuite effectué des analyses univariées et multivariées pour évaluer les liens entre ces éléments et la pratique en milieu rural et en Saskatchewan. Résultats: Nous avons trouvé le lieu de pratique actuel de 1001 (98,9 %) des diplômés des cohortes incluses. La fréquentation d'une école secondaire de la Saskatchewan (p<0,001), d'une école secondaire dans une petite agglomération (p<0,01) et d'une université de la Saskatchewan (p<0,001) étaient des facteurs prédictifs de la pratique en Saskatchewan. La fréquentation d'une école secondaire à l'extérieur de la Saskatchewan (p < 0,05), d'une école secondaire dans une petite agglomération (p < 0,001) et le fait de vivre dans une petite agglomération au moment de la demande d'admission (p < 0,05) étaient des facteurs prédictifs d'une pratique en milieu rural à l'intérieur ou à l'extérieur de la Saskatchewan. Conclusion: Les caractéristiques démographiques recueillies au moment de la demande d'admission à la faculté de médecine sont corrélées à la pratique future en Saskatchewan et en milieu rural. Ces résultats guideront les politiques d'admission en Saskatchewan et pourraient éclairer les pratiques d'admission d'autres facultés de médecine.

The effect of case nodes in problem-based learning on the length and quality of discussion: a 2x2 factorial study.

Background: Problem-based learning (PBL) relies heavily on case structure for their success. To make more meaningful cases, faculty introduced a "case node" that requires students to make a group decision on the action they will take at a given point in the case. The purpose of this study was to determine whether case nodes enhance PBL discussions. Methods: Two PBL cases were designed with and without a node. In 2011, 2012, and 2015, first-year medical students were assigned one PBL case with a node and one without a node. In total, 26 groups processed cases with a node while 27 groups processed the same cases without the node. All sessions were audio recorded and analyzed to determine the length and quality of discussions. Results: Groups with a node, regardless of case (M = 25.62, SD = 12.25) spent significantly more time in discussion on the node topic than those without a node (M = 16.54, SD = 10.33, p=.005, d = .80). Groups with a node, regardless of case (M = 14.38, SD = 8.04) expressed an opinion significantly more frequently than those without a node (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Case nodes increased both the length and depth of discussion on a topic and may be an effective way to enhance case-based instruction.

Contexte: Le succès de l'apprentissage par problèmes (APP) repose en grande partie sur la structure des cas. Pour rendre les cas plus significatifs, les membres du corps professoral ont introduit dans les scénarios un «nœud¼, ou un point nodal, marquant un moment où les étudiants doivent prendre une décision de groupe quant à l'action à entreprendre. L'objectif de cette étude était de déterminer si les cas comportant de tels points nodaux amélioraient la discussion dans le cadre de l'APP. Méthodes: On a conçu deux cas d'APP en deux versions, l'une comportant un nœud, l'autre non. En 2011, 2012 et 2015, on a soumis à des étudiants en première année de médecine un cas d'APP avec un nœud et un cas sans nœud. Au total, 26 groupes ont travaillé sur le cas avec un nœud et 27 groupes sur le cas sans nœud. Toutes les séances ont été enregistrées et analysées afin de déterminer la durée et la qualité des discussions. Résultats: Les groupes qui ont travaillé sur un cas comportant un nœud, quel que soit le cas (M = 25.62, SD = 12.25), ont consacré significativement plus de temps à la discussion que ceux qui avaient un cas sans nœud (M = 16.54, SD =1 0.33, p = .005, d = .80). Les premiers ont également exprimé des opinions significativement plus fréquemment, quel que soit le cas (M = 14.38, SD = 8.04), que les seconds (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Les nœuds introduits dans les cas ont entraîné des discussions à la fois plus longues et plus approfondies sur le sujet abordé. Par conséquent, ils constitueraient un moyen efficace d'améliorer l'enseignement fondé sur l'étude de cas.

Evolution of a community-centred experiential learning module: A mixed-methods approach to promote social accountability and community partnership in undergraduate medical education.

This article was migrated. The article was marked as recommended. Background: Education in social determinants of health (SDH) has become an important part of medical curricula, facilitated increasingly through students' experiential learning with communities. The Community and Workplace Centred Learning Experience (CWCLE) module of the University of Saskatchewan, Canada, intends to integrate and extend second-year medical students' attitudes, skills, and knowledge about SDH and community resources. We aimed to: 1) Solicit students' self-evaluation of their ability to perform module learning objectives, 2) Assess module impact on student attitudes toward SDH, 3) Obtain feedback from community partners and students about their community experiences, and 4) Use feedback to collaboratively develop recommendations to enhance the CWCLE module. Methods: We used a mixed-method approach to combine quantitative data with stories and personal experiences. We developed an online survey for two cohorts of students who had completed the module, soliciting students to self-evaluate their perceived abilities to perform the module's learning objectives and evaluating students' attitudes towards SDH. We invited representatives from community agencies involved in the CWCLE module to participate in focus groups. We also held separate focus groups with students who participated in the online survey to elaborate on their survey comments. Results: In total, 145 students participated in the online survey (response rate=72.5%). Eleven community agency representatives and seven students participated in five focus groups. Our results demonstrate that medical students benefit from community-based experiential learning of SDH and community resources. We trace evaluations and discussions in the ongoing development of this community-based experiential learning module from its initial, primarily medical-school driven designs, towards a substantial involvement of community-based organizations in its operation and continuing redevelopment. Conclusions: Our mixed method offered us a better understanding of module impact and opportunities for improvement. This module evaluation and reform generated opportunities for community partners to influence decisions in medical education and led to a collaborative evolution of a community-centred learning experience. Medical schools should actively engage community partners in teaching behavioural and social components of the curriculum and acknowledge their partners' expertise to promote community engagement and social accountability in medical education.

Affective Responses to Gay Men Using Facial Electromyography: Is There a Psychophysiological "Look" of Anti-Gay Bias.

Despite a wealth of attitudinal studies that elucidate the psychological correlates of anti-gay bias, studies that provide evidence of the physiological correlates of anti-gay bias remain relatively scarce. The present study addresses the under-representation of physiological research in the area of homonegativity by examining psychophysiological markers, namely the affective manifestations of anti-gay prejudice, and their correspondence with anti-gay behavior. Facial electromyography (EMG) was the technique used to acquire the psychophysiological markers via recordings from two facial muscle sites. Whether heterosexual men's implicit affective reactions to gay male couples best predicted their overt and covert discriminatory behavior toward a presumed gay male confederate was determined. The strength of the implicit affective reactions to predict anti-gay discrimination was then tested against the strength of participants' implicit cognitive reactions acquired via the Implicit Association Test (IAT). Results indicated that the affective reactions recorded via facial EMG emerged as the strongest predictor of discrimination toward gay men compared to the cognitive reactions recorded using the IAT. Findings support the contention that emotional reactions to gay men using implicit techniques such as facial EMG are potentially valuable pathways toward understanding the nature and sequelae of anti-gay behavior.

The roles of attachment and resilience in perceived stress in medical students.

BACKGROUND: Medical students are susceptible to high levels of psychological stress, while being equipped with lower levels of resilience, especially females. Adult attachment is a known risk factor for a broad range of mental health difficulties and poor coping. The purpose of this study is to examine relationship attachment style, perceived stress, and resilience in medical students. METHODS: Data was collected via an online survey using self-report measures from University of Saskatchewan undergraduate medical students (n = 188). Attachment was assessed with the Relationship Questionnaire and Experiences in Close Relationships Scale. Resilience and stress were assessed with the Connor-Davidson Resilience Scale and Perceived Stress Scale, respectively. RESULTS: Approximately half of our sample endorsed secure attachment style (49.4%). Females reported significantly more attachment insecurity, higher attachment anxiety, higher perceived stress, and lower resilience compared to males, as expected. As predicted, attachment anxiety and avoidance were predictors of perceived stress. Mediation analyses supported the hypothesis that resilience acted as a partial mediator between attachment insecurity and perceived stress. CONCLUSION: These findings suggest attachment plays a role in perceived stress in medical students. In addition, the role of resiliency in protecting against this effect highlights potential areas for intervention to improve medical student well-being and provides a foundation for longitudinal follow-up.

Point-of-Care Ultrasound in Undergraduate Urology Education: A Prospective Control-Intervention Study.

OBJECTIVES: The effect of point-of-care ultrasound (US) training on clinical reasoning in undergraduate medical education remains largely unknown, with concerns arising about possible confusion among learners when such clinical tools are introduced too early. We studied the effect of a urology point-of-care US module on the performance of questions designed to assess clinical reasoning in urinary tract obstruction and voiding dysfunction. METHODS: All second-year medical students at the University of Saskatchewan (Regina [n = 36] and Saskatoon [n = 61]) were enrolled in the study. Each cohort participated in the urology point-of-care US module concurrently with its Foundations in the Kidney and Urinary Tract course. The Regina cohort completed the point-of-care US module 1 week before the Saskatoon cohort, thus allowing for a control-intervention comparison of script concordance question scores to evaluate the effect that the urology point-of-care US module had on clinical reasoning skills. Secondary outcomes included program evaluation metrics, such as overall course performance, urology point-of-care US objective structured clinical examination performance, and student course evaluation data. RESULTS: The introduction of the urology point-of-care US module was not associated with a deterioration in scores on script concordance questions. There were no statistically significant differences between the Regina and Saskatoon students in their responses to the script concordance questions. There were statistically significant increases in student self-reported achievement of learning objectives, with the effect size being medium to large (Cohen d, 0.5-0.8). CONCLUSIONS: Point-of-care US training complements standard undergraduate classroom teaching of urology. Students effectively learned the skills to apply point-of-care US in their assessment of patients, and this process did not interfere with achieving the course objectives.

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples.

Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.

The Interdisciplinary Patient Partner Program: Building Better Health Care Professionals through Mentorship with Patients and Families.

This article was migrated. The article was marked as recommended. Introduction: Patient- and Family Centered Care (PFCC) aims to promote collaborative empowering relationships among patients, families, and health care professionals. Best practice for teaching patient- and family-centred care is unknown. Methods, Results: Patient and Family Advisors were matched with an interdisciplinary group of 2-3 students from medicine, pharmacy, and nursing over a five month period to teach PFCC. Advisors provided their journey in the health care system as a basis for further exploration of the 4 pillars of Patient and Family Centered Care. 28 students and 14 Patient and Family Advisors completed the program. Overall, students and advisors were satisfied with the program. Attitudes toward family centeredness were evaluated on a scale of 1 (Strongly Disagree) to 5 (Strongly Agree). Paired samples t-tests were conducted to gauge perceived increases over the program. All items increased significantly with large effect sizes. Discussion: Patient and Family Advisors highlighted the importance of sharing stories and exploring them through dialogue with students as a key factor in the success of the program. The Interdisciplinary Patient Partner Program also reinforced the power of relationship as a learning tool for students. The interdisciplinary nature of this program resulted in additional learning opportunities such as learning about the interdependencies between health care professionals and the importance of an interdisciplinary approach to health care Conclusion: Matching medicine, pharmacy and nursing students with Patient and Family Advisors is an effective way to improve students' understanding of Patient and Family Centered Care.

Type 2 Diabetes in Canadian Aboriginal Adolescents: Risk Factors and Prevalence.

PURPOSE: To identify the risk factors and prevalence rates of prediabetes and type 2 diabetes among northern Canadian Aboriginal adolescents. DESIGN AND METHODS: In this novel exploratory, quantitative study, 160 high school students (aged 13-21) from three northern, predominantly Canadian Aboriginal communities were screened for risk for prediabetes and type 2 diabetes including demographic data, family medical history, anthropometric measurements, blood pressure, and hemoglobin A1c (HbA1c). Descriptive and inferential statistics, in addition to chi-square analysis, were used to establish risk and prevalence rates for prediabetes and type 2 diabetes in Aboriginal adolescents. RESULTS: At least half of the adolescents presented with multiple risk factors for type 2 diabetes. In this sample, 10% had an HbA1c>5.7%, 22.5% were overweight, 17.5% were obese, and 26.6% had prehypertension or hypertension. CONCLUSIONS: Prediabetes and type 2 diabetes are emerging as serious health concerns for young Aboriginal Canadians. This is troubling because both result from modifiable risk factors. As this study is the first to examine the prevalence of prediabetes in Canadian Aboriginal adolescents in the last decade, the findings underscore the necessity for early screening of Aboriginal adolescents for both prediabetes and type 2 diabetes. PRACTICE IMPLICATIONS: Recommendations toward positive health outcomes include the introduction of early age screening programs, followed by culturally relevant interventions, specific to the modifiable risk factors (overweight/obesity and hypertension), and developed in collaboration with the communities. Such approaches have the potential to prevent the progression of prediabetes to diabetes and reduce complications related to type 2 diabetes.

Predictors of Physical Activity in Positive Deviant Adolescents.

UNLABELLED: The purpose of this analysis was to examine the predictors of PA in positive deviant adolescents in comparison to average or underachieving adolescents on the same criterion. DESIGN AND METHODS: A survey of Canadian adolescents aged 13-20 (N=603), based on a multidimensional wellness model and an ecological model, provided the data for a multiple regression analysis to identify predictors of PA in positive deviant adolescents defined as having higher than average levels of PA. RESULTS: Significant predictors of PA for positive deviant girls were recreational time, an increased sense of wellness, age, and family support (explaining 47.7% of variance for girls). Within the positive deviant group, older girls were less active than younger girls. For positive deviant boys, use of recreational time was the only significant predictor of PA (explaining 5.9% of the variance). CONCLUSIONS: Wellness as a significant predictor of PA in positive deviant adolescent girls is a new and unique finding. The measurement of wellness in this study was a composite score of the physical, social, and psychological developmental dimensions of adolescent lives. PRACTICE IMPLICATIONS: Pediatric nurses may wish to consider a multidimensional wellness approach, family support, and recreation time as major foci of PA interventions in adolescents.

A Multidimensional Investigation Into the Predictors of Physical Activity in Canadian Adolescents.

BACKGROUND: The percentage of overweight and obese Canadian children and youth is dramatically increasing. Approaches to reducing obesity in adolescents should include the promotion of physical activity (PA) because a continued physically active lifestyle into adulthood may lower rates of chronic diseases associated with unhealthy body weight. PURPOSE: The current study expands on existing assessments of PA to include predictors based in a multidimensional adolescent wellness and ecological model. METHOD: Canadian adolescents (N = 603) were surveyed and the resulting data analyzed using multiple regression analysis. FINDINGS: Overall, 57.5 and 52.9% of the unique variance in PA for females and males, respectively, were explained by the predictors. Significant predictors for females included age, recreational time, family, leadership, and social comparison (cognitive development) skills. For males, equipment at home was also associated with increased PA. CONCLUSIONS: The finding that social comparison and leadership skills are significant predictors of PA in adolescents is new. Nurses should consider a holistic approach to promoting PA whereby these developmental dimensions are included in assessment and prioritized in providing nursing care. Additionally, individualized PA intervention strategies can then be tailored to this unique population.

University of Saskatchewan Radiology Courseware (USRC): an assessment of its utility for teaching diagnostic imaging in the medical school curriculum.

PROBLEM: We have found it very challenging to integrate images from our radiology digital imaging repository into the curriculum of our local medical school. Thus, it has been difficult to convey important knowledge related to viewing and interpreting diagnostic radiology images. We sought to determine if we could create a solution for this problem and evaluate whether students exposed to this solution were able to learn imaging concepts pertinent to medical practice. INTERVENTION: We developed University of Saskatchewan Radiology Courseware (USRC), a novel interactive web application that enables preclinical medical students to acquire image interpretation skills fundamental to clinical practice. This web application reformats content stored in Medical Imaging Resource Center teaching cases for BlackBoard Learn™, a popular learning management system. We have deployed this solution for 2 successive years in a 1st-year basic sciences medical school course at the College of Medicine, University of Saskatchewan. The "courseware" content covers both normal anatomy and common clinical pathologies in five distinct modules. We created two cohorts of learners consisting of an intervention cohort of students who had used USRC for their 1st academic year, whereas the nonintervention cohort was students who had not been exposed to this learning opportunity. CONTEXT: To assess the learning experience of the users we designed an online questionnaire and image review quiz delivered to both of the student groups. OUTCOME: Comparisons between the groups revealed statistically significant differences in both confidence with image interpretation and the ability to answer knowledge-based questions. Students were satisfied with the overall usability, functions, and capabilities of USRC. LESSONS LEARNED: USRC is an innovative technology that provides integration between Medical Imaging Resource Center, a teaching solution used in radiology, and a Learning Management System.

Teaching the RAPID approach at the start of emergency medicine clerkship: an evaluation.

BACKGROUND: The RAPID approach (Resuscitation, Analgesia and assessment, Patient needs, Interventions, Disposition) was developed as an approach to managing emergency department patients. It is a mental checklist to help trainees provide comprehensive care, addressing issues in priority. Its impact on trainee performance has not been assessed. METHODS: Forty-two clerkship students were enrolled, with 21 students in each group. They received or did not receive the teaching intervention on an alternate basis. Students were assessed through daily encounter cards, a case presentation, a self-assessment form, a prerotation case (case E), and a six-case short-answer exit examination (cases A to F) with case E repeated. Case E was designed specifically to assess students' ability to provide comprehensive care. Fourteen students participated in focus groups. RESULTS: Students in the intervention group had significantly higher exit examination case E scores (11.67 of 14 v. 10.26 of 14, p  =  0.008) and improvement in their case E scores from pre- to postrotation (1.82 v. 0.26, p  =  0.006). There were no significant differences in the other outcome measures. Intervention group students made positive comments around analgesia, addressing nonmedical needs and counseling on health promotion during focus groups. CONCLUSIONS: Students exposed to the RAPID approach at the start of their emergency medicine rotation performed better on the one component of the written examination for which it was designed to improve performance. Students found it to be a useful mental checklist for comprehensive care, possibly addressing the hidden curriculum. Emergency medicine educators should consider further study and careful implementation of the RAPID approach.

Student perceptions of the care of children: impacts of pre-clerkship pediatric and primary care clinical teaching.

BACKGROUND: Pediatric clinical skills teaching sessions provide an early opportunity for students to be exposed to the medical care of children. This report describes second and third year medical students' perceptions of and attitudes towards working with children before and after the pediatric clinical skills teaching sessions, and the experiences of those students precepted by pediatricians only compared to those students working with a combination of pediatricians and family physicians. METHOD: A 13 question survey was voluntarily completed before and after teaching sessions. Written reflective assignments were qualitatively analyzed for key themes. Response rate averaged 68% with class sizes of 84 and 85 students. RESULTS: Students' perceptions of the care of children were generally very positive. Some differences were found based on gender, phase of study and prior clinical exposure to pediatric care. Pre and post responses were similar, regardless of preceptor specialty. Students with family physician preceptors identified the themes of prevention, health promotion and multidisciplinary care in their reflections. CONCLUSIONS: Students had already formed positive attitudes toward the medical care of children and intended to care for children in their future practice. Further research is needed into the effects of pre-clerkship experiences in the care of children on choice of medical specialty.

Evidence for the validity of grouped self-assessments in measuring the outcomes of educational programs.

There is compelling empirical evidence in support of the use of grouped self-assessment data to measure program outcomes. However, other credible research has clearly shown that self-assessments are poor predictors of individual achievement such that the validity of self-assessments has been called into question. Based on the reanalysis of two previously published studies and an analysis of two original studies, we show that grouped self-assessments may be good predictors of and hence valid measures of performance at the group level, an outcome commonly used in program evaluation studies. We found statistically significant correlation coefficients (between 0.56 and 0.87), when comparing across performance items using the group means of self-assessments with the group means of individual achievement on criterion tests. We call for further research into the conditions and circumstances in which grouped self-assessments are used, so that they can be employed more effectively and confidently by program evaluators, decision makers, and researchers.

Efficacy of a step-by-step carving technique for dental students.

This study demonstrates the effectiveness of a step-by-step carving technique that is quickly and efficiently mastered by dental students. Thirty-six final-year dental students volunteered to participate in this study. The students were given pre-prepared lower right first molar simulation teeth that had the occlusal half replaced in carving wax. The study was conducted in three time phases: pre-test (Time 1), participative learning (Time 2), and post-test (Time 3). The pre-test had the students carve the wax with no instruction. Instruction and demonstration of the technique were given at Time 2, and the post-test had the students carve the tooth again with no guidance but with training. A statistically significant increase with a nearly medium effect size was found from Time 1 to Time 2. A statistically significant increase with a medium effect size was found when comparing Time 2 to Time 3. A statistically significant increase with a large effect size was found when comparing Time 1 to Time 3. This technique has proved to be an effective method of simultaneously teaching a large cohort of predoctoral dental students. The technique is consistent with constructivist learning theory.