Computer databases of medical school curricula.

As the pace of curriculum reform in medical education has accelerated during the past decade, so too have demands on curriculum managers to supply increasingly detailed information about the curriculum. In response, a number of schools have joined together to begin work on designs for computer databases of the curriculum. The authors describe three of the most mature curriculum database prototypes, developed by groups at the medical schools of the University of North Carolina at Chapel Hill (UNC), The University of Maryland, and the University of Miami. All three groups have employed relational database management systems to organize information about each "instructional unit" in the preclinical curriculum, including a set of keywords defining the major concepts presented. The keywords are indexed to a controlled vocabulary, either the Medical Subject Headings (MeSH) or a MeSH derivative. The UNC database also employs a textfile management system to provide users with an overview of the entire curriculum. Future work will focus on identifying a suitable controlled vocabulary; capturing content in greater contextual detail; incorporating alternative learning formats, such as problem-based learning; creating links between content items and examination questions; and capturing information generated by student-patient interactions in clinical settings. As a result of recent collaboration with the Association of American Medical Colleges, work to define a prototype national database has begun and a consortium of interested schools is addressing further development activities.

Evaluation of a self-instructional method for improving doctor-patient communication.

The purpose of the project reported here was to develop and evaluate an educational intervention to improve the interviewing skills learned in medical school. Sixty fourth-year medical students in a required ambulatory care rotation were randomly selected and randomly assigned to one of four conditions. All students interviewed a simulated patient who presented with one of five main complaints, and the interview was videotaped. Students were assigned to a control group or to one of three intervention groups: viewing a self-instruction videotape, viewing and critiquing a videotape of their interview, or both of these activities. The students assigned to the control group did not participate in any educational interventions. At the end of the intervention period, the students again interviewed a simulated patient and were videotaped. The 120 videotaped interviews were reliably rated by a scoring system developed by the project team. The postintervention interviews conducted by students in the two groups that used the self-instruction videotape received significantly higher ratings than those in the control group. These results suggest that this self-instruction intervention can improve the interviewing skills of senior medical students.

An assessment of entering freshman medical students' knowledge of and attitudes toward AIDS.

The purpose of this survey was to determine entering freshman medical student awareness of and attitudes toward AIDS. It is encouraging to find that, in general, students are well informed about AIDS before entering medical school; they have very real concerns about the possibility of contracting AIDS themselves as future care givers; and that they, in the final analysis, will consent to function as care givers to patients who have or may have AIDS while assuming responsibility to take appropriate precautions. It is important to stress that this survey reflects the pre-formed attitudes of entering freshman medical students. The University of Maryland School of Medicine is actively involved with the integration of AIDS education officially into the medical school curriculum. The results of this survey highlight the need for the inclusion of learning experiences designed to enhance physician/patient interaction skills when administering care to AIDS patients. It is believed that the acquisition of these desirable skills will generalize to better quality care for all patients. It is planned to administer the HIV/AIDS Questionnaire in a follow-up study to graduating seniors to assess their knowledge and attitudes toward AIDS. This will permit a comparison of attitude change among medical students, and an evaluation of newly implemented curricular changes.

The value of the California Psychological Inventory in predicting medical students' career choice.

Much of the research in medical education has focused on the prediction of medical students' future career choices. This longitudinal study evaluates the effectiveness of the California Psychological Inventory (CPI) in predicting career choices of students attending the University of Maryland School of Medicine. While results did reveal some significant and consistent differences between career choice groups, these differences were not of the magnitude to allow discrimination among all specialty groups. There is no evidence to support the hypothesis that career choice can be predicted from CPI data. It was concluded that future research into career choice prediction should focus on variables other than personality characteristics as measured by the CPI or similar tests.

A model for peer tutoring in the medical school setting.

For the past several years, the University of Maryland School of Medicine has operated a successful and efficient basic science peer tutorial program through the management of the Office of Medical Education. During the 1981-82 and 1982-83 academic years, 122 tutoring dyads were formed to take advantage of the tutoring program in nine of the 10 basic science courses encountered during the first two years of medical training. The success of the program is evident in that tutored students received passing grades in 102 (84 percent) of the courses in which they were tutored. In this paper, the authors discuss the systematic procedure of managing a peer tutorial program and the potential positive effects the program has on student tutors as well as on the medical student in academic difficulty.

Developing a cancer prevention elective course.

A comprehensive course on cancer prevention was developed for medical students at the University of Maryland School of Medicine. This course was developed under a three-year contract with the National Cancer Institute during the period from 1979 to 1982. The course development team was multidisciplinary and consisted of faculty members from the departments of pathology, epidemiology and preventive medicine, and family medicine and the Office of Medical Education. The finished course consisted of 20 instructional modules which can be used individually, in groups, or as a complete course in cancer prevention. During the developmental process, all educational objectives were subjected to intensive review and critique by faculty members from the University of Maryland School of Medicine and several other medical schools. The course was pilot tested as a four-week "minimester" elective, revised, and field tested again. This innovative, multidisciplinary, modular curriculum package is now considered complete and appropriate for use by other health sciences institutions.

The impact of external examinations on medical education programs and students.

The use of externally produced comprehensive examinations by medical schools as assessment instruments for promotion and as mechanisms for curricular evaluation is discussed and assessed for validity in this article. The pros and cons of the development of a single route to licensure by an externally produced series of comprehensive examinations are examined, and potential effects that emphasis on external examinations may have on students' psychological and ethical behavior are discussed. Recommendations for development of a national library test bank are proposed as alternatives to the current dependency on the externally produced comprehensive examinations. The necessity for each individual medical school to validate any external examination being used as an evaluation tool of the school's specific curriculum is stressed. The author recommends criterion-referencing as an appropriate mechanism for test construction and grading and that "passing" an externally produced comprehensive examination be defined in terms of basic minimal competency levels.

A nontraditional geriatric teaching model: interprofessional service/education sites.

Recognizing the consistent increase in the numbers of Americans age 65 and over, medical educators must prepare their students to provide quality health care to the geriatric population in order to meet future medical needs adequately. The University of Maryland School of Medicine, in cooperation with the five other campus professional schools, is striving to meet this challenge with a comprehensive, interdisciplinary geriatric training program for students entering the health care professions. The curriculum model includes discipline-specific and interdisciplinary basic minimum competencies for providing satisfactory geriatric care associated with a variety of curriculum processes designed to assure students' realization of these competencies. The educational process as presented is offered as a potential operational model for medical educators interested in the development of geriatric curriculum design.