Meta-analysis: quantitative integration of independent research results.

Meta-analysis, a quantitative method of combining the results of independent research studies, is described as a method for reviewing research literature. Four steps are taken to summarize the research in an area. First, a thorough literature review is conducted to identify a group of research studies with the relevant treatment variable. Second, an effect size is calculated for each study. Third, an overall (composite) effect size is determined by a weighted combination of the obtained effect sizes. Fourth, a fail-safe N (the number of unpublished studies with opposing conclusions needed to negate the published literature) is calculated to assess the certainty of the overall effect size. Meta-analysis was applied to 33 studies of chymopapain in an illustrative example. The analysis produced a large effect size of 0.8082 and a fail-safe N of 214, indicating strong support for the effectiveness of the treatment with chymopapain. Meta-analysis can be a useful tool if it is used properly. It is particularly useful as an adjunct to other methods of review that are used in pharmacy practice.

Six years of experience using patient instructors to teach interviewing skills.

In 1974 a competency-based program was developed at the University of Arizona College of Medicine that used patient instructors (PIs) to evaluate interviewing skills objectively. PIs are nonphysicians who are taught to function in the multiple roles of patient, teacher, and evaluator. For each specialty area, objective evaluation instruments have been developed to measure the student's interviewing technique (interview process) and the amount of relevant historical information obtained from the patient (interview content). Data from the six most recent classes of second-year medical students demonstrate that: (a) there is a positive correlation between process and content scores; (b) students learn from their interviews with PIs; and (c) there is a positive relationship between the scores students obtain on their first interview with each of two different PIs in two different specialty areas. It is concluded that the PI program provides an effective way to teach interviewing skills to medical students.

Effect of immediate student evaluations on a multi-instructor course.

Immediate student feedback and peer evaluation by a single physician were used to evaluate and monitor an interdisciplinary multi-instructor course. Clinical Correlations with Pathology is taught during the second year of medical school by 50 instructors, each of whom has a limited exposure to sophomore medical students. The format of the course, in which the same students evaluate multiple lecturers in multiple content areas, provided a unique opportunity to demonstrate the reliability and validity of student evaluations. About one-half of the lectures were repeated by the same instructors the following year to the next class of medical students, who also evaluated all of the lectures. Comparison of two consecutive sophomore classes of medical students documented overall course improvement and showed higher ratings given to instructors who presented the same lecture both years. Student evaluation is a powerful technique that can result in positive changes leading toward course improvement.

Results of a survey of pediatric clerkship programs in American medical schools.

Pediatric clerkship coordinators from 119 medical schools responded to a questionnaire about administration, resources, goals, instructional design, evaluation, and perceived strengths and weaknesses of their own programs. Problems were reported in the definition of objectives, the evaluation of students' knowledge, interviewing and physical-examination skills, and problem-solving ability. A dedicated faculty and house staff interested in teaching and a large and varied patient population were perceived as strengths of many programs. Weaknesses cited included a lack of uniformity in students' experience, insufficient time spent on the pediatric clerkship, too many students with decreased faculty contact, overemphasis on tertiary care, an inadequate ambulatory experience, lack of specific objectives, and unsystematic evaluation methods. It is hoped that this survey will provide an impetus for further fruitful exchanges among clerkship directors.

Patient instructors as teachers and evaluators.

To provide objective and reliable evaluation of students' physical diagnosis skills, nonphysician patient instructors (PIs) with stable findings were trained by physicians to function in the multiple roles of patient, teacher, and evaluator. The PIs were taught physical examination techniques and the significance of each of their positive findings. Each second- and third-year medical student examined a cardiovascular and pulmonary PI. At the completion of each examination the PI evaluated the thoroughness and proficiency of the student's examination technique and ascertained whether the student correctly identified and described the abnormal findings. Objective and reliable evaluation instruments were developed. Data are presented to indicate that PIs can be used to evaluate objectively physical diagnosis skills of medical students.

Students transferring into an American medical school. Remediating their deficiencies.

Thirty US citizen foreign-trained medical students (USFMS) and eleven US-trained medical students (USMS) were accepted with advanced standing to the University of Arizona College of Medicine (UACM) in September 1978. Each student was required to meet predetermined mastery criteria in physical diagnosis skills during a six-week intensive training program before entering clinical clerkships. On entrance, USFMS showed severe deficiencies in physical examination and medical interviewing skills compared with both USMS and sophomore students at UACM. By the completion of the program, all differences between the USFMS and the USMS were nonsignificant, except for factual knowledge of pathophysiology. The transfer students received lower ratings than the UACM students on preceptorship evaluations and patient write-ups. Deficiencies in clinical skills of USFMS were reduced by a brief, intensive training program characterized by specific mastery criteria.

Speech and language testing with distinct ethnic-racial groups: a survey of procedures for improving validity.

Several procedures are being used currently to improve the validity of speech and language evaluation for ethnic or racial groups from lower-income populations. Procedures mentioned in this article include: (1) developing a new test, (2) modifying test items or keyed responses on existing tests, and (3) developing new norms for existing tests. Examples are given for each procedure, and advantages and disadvantages are discussed.

Using a competency-based program to assess interviewing skills of pediatric house staff.

A program has been initiated to assess objectively the interviewing skills of pediatric house staff. Each entering house staff member interviews and is evaluated by a nonphysician mother who presents the medical history of her child. Remedial instruction is provided for all who do not perform in accordance with established minimum criteria. As a result of this competency-based program, all house staff members are now known to have attained at least a minimum level of competence in interviewing technique.

The use of live models in the teaching of gross anatomy.

Live models were introduced into the first-year gross anatomy course to provide medical students with an opportunity to apply to the living person what they learned from cadaver dissection. After each major segment of the cadaver dissection, clinical correlation sessions were presented for the students by clinicians using live models for demonstration, examination and correlation. At the completion of the course, an evaluation questionnaire was given to students. Their response indicated that the new teaching technique made anatomy seem more relevant to clinical medicine than using cadavers alone. Live models were rated superior to using cadavers, especially in demonstrating superficial anatomical structures and landmarks. On the basis of student response it was concluded that this programme provided medical students with a unique introduction to living human anatomy.

Use of trained mothers to teach interviewing skills to first-year medical students: a follow-up study.

This report describes an attempt to evaluate the effectiveness of "trained mother" interviews early in the medical school curriculum. As an adjunct to a first-year course that teaches interviewing techniques, half of the students were exposed to an interview with one of three trained mothers early in the course. This treatment interview was immediately followed by a feedback session which concentrated on the content and process of interviewing. At the end of the course, all students had an evaluative interview. Those students who had an initial interview and feedback session with a trained mother scored significantly higher on both the content and process of their interviews than the control group. This technique is an effective and efficient way to teach interviewing skills to medical students prior to entering any of their clinical clerkships. A follow-up assessment conducted one year later indicated that one interview with a trained mother is sufficient for optimal learning and that the skills learned are retained over at least that period of time.

The use of paraprofessionals to teach interviewing skills.

Two nonphysician mothers were each trained to give a consistent and authentic history of a child's common medical problem. At the beginning of a Pediatric Clerkship, one half the students were randomly assigned to interview one of the trained mothers. The interviews were videotaped and then replayed in an evaluative feedback session with each student. At the end of the clerkship these students were rated significantly higher on the process of interviewing than those students who did not have the initial evaluative feedback session.