Teaching clinical epidemiology to medical students using a collaborative learning model.

Epidemiology and biostatistics are difficult to teach in medical school. To determine the feasibility of applying a collaborative learning model, we randomly assigned one section of an epidemiology and biostatistics class to use this teaching model. Students in this section did not attend lectures or follow the regular curriculum but instead learned epidemiologic concepts by identifying clinical problems of interest to them and reviewing relevant journal articles, with the group leader functioning as facilitator. All students took an identical examination and anonymously evaluated the course. Examination performance was comparable between the study group (mean 72.1%) and the other students (mean 73.5%). However, the students' evaluation of the study group method was more favorable, especially in their perceived mastery of specific cognitive skills. The data suggest that this model can be successfully applied in teaching epidemiology and biostatistics to medical students.

Training physicians to care for the dying.

PROBLEM: The education of medical students and house staff regarding management of death and timely discussions of death with patients and families has been deficient, leaving physicians ill-equipped to provide appropriate care to dying patients. METHOD: We propose a five-pronged curriculum in terminal care to be ongoing from medical school through postgraduate training. This program includes: Clinical skills--including pain and symptom management, prognostication and care in various settings; Communication skills--including listening and how to discuss bad news with patient and family; Psychosocial issues; Administrative/management and team interaction, and Bioethical issues, including DNR and living wills. CONCLUSION: It is hoped that such training will teach physicians to accept death as inevitable, to recognize and acknowledge the state of dying and, finally, to understand that appropriate care includes appropriate death, which is one arrived at with minimal suffering, with minimal social and emotional impoverishment, with preservation or restoration of important relationships and with resolution of residual conflicts.