Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective.

Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reform movements that will define 21st-century medical education.

Further evidence of the relationship between case typicality and diagnostic performance: implications for medical education.

We have produced further evidence demonstrating that DDx performance is a function of a test case's typicality. Medical educators might consider exploring how cognitive scientists have used the typicality assumption to investigate and enhance the instruction and assessment of subjects engaged in other classification tasks. Further substantiation of the applicability and utility of the assumptions making up the abstraction and exemplar theories used to explain DDx performance could serve as the basis for effective and efficient curricular reforms in medical education.

Research secures the future of osteopathic medicine: Part 1. Research--foundation for faculty development, institutional recognition.

The first of a two-part feature examining the role of research in securing the future of osteopathic medicine, this article describes the historical development of research, specifically how it has come to symbolize valued intellectual and institutional markers in society. Administrators of colleges of osteopathic medicine are called on to increasingly support research-related activities to fully develop the intellectual potential of their faculty. Only through faculty development can osteopathic medical training institutions achieve their fullest potential and thereby secure a stable future for the profession.

A computer-assisted learning tool designed to improve clinical problem-solving skills.

A computer-based teaching and learning program was developed to supplement the case load of students on a one-month emergency medicine clinical rotation and interactively measure and support improvements in their acute chest pain differential diagnostic skills. Students using the program demonstrated a significantly higher level of diagnostic accuracy than a control group (one-tailed t test; N = 88; P less than .018). The success of the program was attributed in part to its unique application of advanced interactive software. Specifically, students use the software (an expert system shell) to develop a computer-based acute chest pain differential diagnostic protocol. Students can subsequently challenge their protocol with a number and variety of training cases in the program's data bank. The software interactively apprises students of the performance of their protocol in terms of its diagnostic accuracy against the cases. Students make protocol modifications to improve its diagnostic accuracy against the training cases. Interactive reassessments of the protocol's performance against the cases follow each modification. This repetitive cycle of protocol modifications rapidly followed by interactive performance reassessments against training cases appears to result in efficient and effective differential diagnostic skills improvements. A new generation of computer-based teaching and learning tools may have a significant impact on undergraduate clinical education.

Time to defibrillation: a controlled laboratory study comparing three automated and semi-automated defibrillators.

Currently there are three vendors marketing first-responder defibrillation units. Each vendor's unit has its own distinct features, advantages, and disadvantages, making the selection of one vendor's unit a complex decision. However, two critical performance criteria upon which a decision to choose one vendor's unit over another could be 1) differences in dysrhythmia recognition sensitivity and specificity and 2) time to delivery of a defibrillation shock. While there appears to be evidence suggesting no significant differences between the three units in terms of dysrhythmia recognition, there do not appear to be any controlled 'time-to-defibrillation' studies. The purpose of this study was to determine if, under controlled conditions, any performance differences existed between these three units in time to delivery of a defibrillation shock. The results of this study suggest that there are no pragmatic differences between the three defibrillation units. In the absence of time-to-defibrillation differences, EMS systems managers can place more emphasis on other features so as to better address the needs, concerns, and resources of their system.

Management challenges confronting new EMS systems.

Acute, critical patients require a rapidly applied, highly refined diagnostic approach if their chances for survival are to be maximized. EMS systems have made great strides in addressing the management challenges confronting them, especially via the development and refinement of severity assessment instruments. EMS systems, however, must also evaluate and develop reliable prehospital communications procedures; must develop and maintain a list of needed changes and then prioritize the changes; and must enhance prehospital problem-oriented diagnostic data-gathering protocols. The methodology for the development of the latter has not yet even been explored in the EMS literature. It is hoped that this sharing of Port Worth's recent experiences will help other EMS professionals who find themselves either in the early stages of major system redesign or the initiation of a new EMS system.

An emergency medicine clinical problem-solving system.

The availability of complete, accurate, and current medical information is an important aspect of clinical problem solving. As the body of medical information grows and increasingly is reformatted into problem-oriented references, information processing by physicians will grow in importance. The most popular clinical problem-solving method, the Weed problem-oriented medical record, primarily records information; it does not provide an explicit information-processing model. An emergency medicine clinical problem-solving system containing information recording and processing methodologies is presented. The information processing methodology of this system is highlighted.