Proto-professionalism and the dissecting laboratory.

This essay argues for medical students' dissection of cadavers because this activity offers medical students opportunities to have certain experiences and reflect on them in ways facilitating their development of mature medical professionalism at the time they enter clinical practice. Issues central to professionalism as we envision it are (1) cognitive abilities identified as reflective judgment and principled ethical reasoning as they are exercised in four practice domains and (2) learning to learn in medical settings. We argue further that a key feature of such setting is practitioners' having to deal with ill-structured problems, and so we identify their features and relate their management to the sophisticated cognitive and learning abilities required of medical professionals.

Learning to use learning resources during medical school and residency.

Objectives: This study (1) examined the natural history of learning to use learning resources by medical students and residents and (2) considered whether that history is consistent with the ways in which physicians approach their learning tasks.

Methods: The authors conducted and analyzed thirty-two open-ended interviews of first-year and third-year medical students and first-year and senior residents in internal medicine, family medicine, or pediatrics.

Results And Discussion: Learning to use learning resources occurs at the same time as learning done to address instructional and clinical problems that physicians-in-training face, with all kinds of learning following well-documented stages.

Proto-professionalism: how professionalisation occurs across the continuum of medical education.

Introduction: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training.

Thesis And Discussion: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility.

Use of theory to interpret elements of change.

Actions useful in reducing unacceptable variation in physicians' clinical activities have been identified through critical reviews of randomized controlled trials, and, from them, Richard Grol proposed six elements of effective change for mounting programs to improve clinical practice. The elements include consideration of the complex reality of clinical practice, attention to the designated change, analysis of the target group and setting, mixed interventions to address needs, and a plan of action. Although empirically based, the elements lack a theoretical underpinning that explains why the elements work.

The epidemiology of physician learning.

Because medicine and education share a striking number of attributes, the authors explored epidemiology-a tool useful in medicine-as a perspective on the education of physicians. More specifically, the parallel between medicine and education was examined, key features of epidemiology were identified, and these were used in exploring attributes of the continuing education of physicians. This exploration involved both a regional study of primary care physicians for adults and a national study of a single specialty.

How doctors learn: education and learning across the medical-school-to-practice trajectory.

People have needs they address daily over the course of their lives. They address these needs through identifying and resolving problems in ways that reflect their identities. This means that education, including medical education, is an identity development process because it provides people with more and better ways to satisfy their needs.

Changes in learning-resource use across physicians' learning episodes.

Introduction: This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems.

Materials And Methods: A survey of a statewide random sample of doctors estimated the number of resources used at each stage in solving various general problems.

Results: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for nonfaculty physicians was too low to allow generalization.

Physicians' learning strategies.

This article examines the two categories of learning strategies that physicians use in clinical practice. The strategies are similar in their overall architectures and differ (1) according to nature of the clinical problem that precipitated the need to learn, and (2) the ways in which learning resources are used.

Predictors of success in undergraduate human physiology.

This study tested the hypothesis that measurable attributes in students' backgrounds are related to their successful completion of an undergraduate human physiology course. Demographic, general academic performance, and science achievement data were obtained from student records for students enrolled during the 1995-1996 academic year, and additional demographic data were obtained from students enrolled during the 1996-1998 academic years. A hierarchical logistic regression analysis explored the relationship fo these variables to the percentage of students passing the human physiology course.

How doctors learn: physicians' self-directed learning episodes.

Purpose: To qualitatively examine the self-directed learning activities of physicians in light of several lines of research on how doctors learn.

Method: Under the auspices of the Royal College of Physicians and Surgeons of Canada, the author elicited from physicians narratives about past learning experiences. He analyzed the narratives (1) seeking themes among the doctors' approaches and (2) examining those themes in light of the existing literature.

An introductory hospice experience for third-year medical students.

Background: An organized and distinct curriculum in hospice and palliative care education is lacking in most United States medical school programs. Because of this knowledge deficit, physicians are often not able to meet the needs of their terminally ill patients and their families.

Methods: A five-day combined didactic and clinical rotation in hospice and palliative care for third-year medical students was developed and is presented.

How doctors learn: the role of clinical problems across the medical school-to-practice continuum.

The author proposes a theory of how physicians learn that uses clinical problem solving as its central feature. His theory, which integrates insights from Maslow, Schön, Norman, and others, claims that physicians-in-training and practicing physicians learn largely by deriving insights from clinical experience. These insights allow the learner to solve future problems and thereby address the learner's basic human needs for security, affiliation, and self-esteem.

A preliminary study of the relationship between central auditory processing disorder and attention deficit disorder.

Fifteen boys aged six to ten who met the criteria for attention deficit disorder (ADD) were compared with ten boys who did not have ADD in a double-blind, placebo-controlled, single-crossover study of methylphenidate. To assess the degree of overlap between ADD and central auditory processing disorder (CAPD), all subjects were assessed on parent and teacher behavior rating scales, as well as a battery of CAPD tests at baseline and after three and six weeks of treatment. Twelve of the 15 subjects with ADD and none of the subjects without ADD met the criteria for CAPD.

Multivariate interpretation of laboratory tests used in monitoring patients.

This study demonstrates an approach to the problem of minimizing false-negative and false-positive laboratory findings. In this approach, we consider the fact that results of laboratory tests are correlated, utilize within-person test results to interpret current results, and minimize the impact of multivariate conservatism by examining test results in small groups. The procedure requires panels of tests to be divided into related subpanels, testing each subpanel independently, and using the Bonferroni inequality to determine whether any of the observed values for a given subpanel is "out-of-range.

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures.

N,N dimethylglycine and epilepsy.

Nineteen institutionalized patients with frequent seizures (group average two to three per day; seizure types--generalized, akinetic/myoclonic), were treated randomly with either placebo or N,N dimethylglycine (DMG) for 28 days. Dosage was 300 mg/day for the first 14 days and then 600 mg/day. Plasma levels were measured at baseline, days 2, 5, 8, 15, 22, 30, and 1 and 2 weeks after the study ended.

Communication, social support and alcohol use in first-year medical students.

Increased communication from significant others and perceived interpersonal support correlated with reduced student drinking during the first 12 weeks of medical school. Writing brief essays on any subject of personal interest which were read, annotated and quickly returned by a faculty member correlated with reduced student drinking during the final 12 weeks of the first year.

A simple technique for collecting, analyzing, and interpreting evaluative data.

Best Liked/Least Liked (BL/LL) is a straightforward technique for collecting information used in evaluation. The technique is composed of stages (data collection, data analysis, and data interpretation) that are characterized by the ease with which they are accomplished. Further, the technique admits of flexibility in both range of applicability (some achievement testing and the measuring of effect) and scope of use (it can be narrowly focused or used to collect information on unintended outcomes).

Identifying and remediating specific deficiencies of entering medical students.

For many reasons some entering medical students have specific deficiencies in substantive areas. This study describes a methodology used successfully in the areas of anatomy terminology, behavioral science concepts, and applied mathematics both to identify students with these deficiencies and to provide the required remediation. The methodology involves empirical identification of what students need to know, the use of specially constructed criterion-referenced tests, and "stand-alone" instructional materials.