Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students.

Background: Medical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance.

Methods: All third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation.

Aggregated student confidence estimates support continuous quality improvements in a competencies-oriented curriculum.

Introduction: Competencies oriented medical curricula are intended to support the development of those specific tasks likely to improve patient care outcomes. In 2005, our institution developed curricular objectives and instructional activities intended to enable our students to competently perform four specific clinical tasks (diagnose, treat, manage and explain phenomena) for each of approximately 100 common and/or important patient presentations (eg, dyspnoea). However, competencies oriented curricula must also develop outcome metrics aligned with their objectives and instructional activities in order to launch a continuous quality improvement (CQI) programme.

Outcomes-Oriented Medical Training: A Critical Curricular Design Consideration in Developing 21st Century Health Care Professionals.

The core competencies of medical schools and residencies have initiated a change in curricular design but have been limited in their execution of systems-based practice. The introduction of milestones and entrustable professional activities has emerged to enhance the current educational paradigm. Linking public health systemic approaches with evidence-based practices focused on population-level health care will affect patients more than current non-systems-based approaches.

Faculty Development Directed at Curricular Reforms Designed to Improve Patient Outcomes.

Three initiatives involving quality of patient outcomes that evolved in the late 1990s must be considered in the design of 21st century undergraduate medical curricula. They involve (1) the question of how to best teach and assess medical competencies, (2) growing concerns regarding the frequency and severity of error in medical care, and (3) the role physicians might play in weaving together the overlapping elements of population-, community-, and systems-based practice into a codified approach to medical care. With these initiatives in mind, the University of North Texas Health Science Center Texas College of Osteopathic Medicine has formed an Academy of Medical Educators whose goal is to develop faculty programs intended to expedite curricular modifications and reforms.

Evidence of the preferential use of disease prototypes over case exemplars among early year one medical students prior to and following diagnostic training.

Background: Two core dual processing theory (DPT) System I constructs (Exemplars and Prototypes) were used to: 1) formulate a training exercise designed to improve diagnostic performance in year one medical students, and 2) explore whether any observed performance improvements were associated with preferential use of exemplars or prototypes.

Methods: With IRB approval, 117 year one medical students participated in an acute chest pain diagnostic training exercise. A pre- and post-training test containing the same 27 case vignettes was used to determine if the subjects' diagnostic performance improved via training in both exemplars and prototypes.

Learning sciences principles that can inform the construction of new approaches to diagnostic training.

The author suggests that the ill-defined nature of human diseases is a little appreciated, nonetheless important contributor to persistent and high levels of diagnostic error. Furthermore, medical education's continued use of traditional, non-evidence based approaches to diagnostic training represents a systematic flaw likely perpetuating sub-optimal diagnostic performance in patients suffering from ill-defined diseases. This manuscript briefly describes how Learning Sciences findings elucidating how humans reason in the face of the uncertainty and complexity posed by ill-defined diseases might serve as guiding principles in the formulation of first steps towards a codified, 21st century approach to training and assessing the diagnostic capabilities of future health care providers.

Improving diagnostic capabilities of medical students via application of cognitive sciences-derived learning principles.

Purpose: There is limited experimental evidence concerning how best to train students to perform differential diagnosis. We compared 2 different methods for training 2nd-year medical students to perform differential diagnosis (DDX) of heart failure: a traditional classroom-based lecture (control group) versus a cognitive sciences-based approach to DDX instruction implemented through a computer-based tutor (treatment group).

Methods: Following random assignment to either group, students were trained for 75 minutes, and then given a 40-item examination comprised of cases that varied along a typicality gradient from prototypical (easy) to less typical (hard).