Summative assessments are more powerful drivers of student learning than resource intensive teaching formats

BACKGROUND: Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students. METHODS: A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material. RESULTS: Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance. CONCLUSIONS: Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation

Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling

Background: Diseases associated with smoking are a foremost cause of premature death in the world, both in developed and developing countries. Eliminating smoking can do more to improve health and prolong life than any other measure in the field of preventive medicine. Today's medical students will play a prominent role in future efforts to prevent and control tobacco use. Methods: A cross-sectional, self-administered, anonymous survey of fifth-year medical students in Berlin, Germany was conducted in November 2007. The study explored the prevalence of smoking among medical students. We assessed their current knowledge regarding tobacco dependence and the effectiveness of smoking cessation methods. Students' perceived competence to counsel smokers and promote smoking cessation treatments was also explored. Analyses were based on responses from 258 students (86.6% response rate). Results: One quarter of the medical students surveyed were current smokers. The smoking rate was 22.1% among women, 32.4% among men. Students underestimated smoking-related mortality and the negative effect of smoking on longevity. A considerable number of subjects erroneously assumed that nicotine causes coronary artery disease. Students' overall knowledge of the effectiveness of smoking cessation methods was inadequate. Only one third of the students indicated that they felt qualified to counsel patients about tobacco dependence. Conclusions: This study reveals serious deficiencies in knowledge and counseling skills among medical students in our sample. The curriculum of every medical school should include a tobacco module. Thus, by providing comprehensive training in nicotine dependence interventions to medical students, smokers will have access to the professional expertise they need to quit smoking

Slow breathing reduces sympathoexcitation in COPD

Neurohumoral activation has been shown to be present in hypoxic patients with chronic obstructive pulmonary disease (COPD). The aims of the present study were to investigate whether there is sympathetic activation in COPD patients in the absence of hypoxia and whether slow breathing has an impact on sympathoexcitation and baroreflex sensitivity. Efferent muscle sympathetic nerve activity, blood pressure, cardiac frequency and respiratory movements were continuously measured in 15 COPD patients and 15 healthy control subjects. Baroreflex sensitivity was analysed by autoregressive spectral analysis and the alpha-angle method. At baseline, sympathetic nerve activity was significantly elevated in COPD patients and baroreflex sensitivity was decreased (5.0+/-0.6 versus 8.9+/-0.8 ms.mmHg(-1)). Breathing at a rate of 6 breaths.min(-1) caused sympathetic activity to drop significantly in COPD patients (from 61.3+/-4.6 to 53.0+/-4.3 bursts per 100 heartbeats) but not in control subjects (39.2+/-3.2 versus 37.5+/-3.3 bursts per 100 heartbeats). In both groups, slow breathing significantly enhanced baroreflex sensitivity. In conclusion, sympathovagal imbalance is present in normoxic chronic obstructive pulmonary disease patients. The possibility of modifying these changes by slow breathing may help to better understand and influence this systemic disease

Piloting an outcome-based programme evaluation tool in undergraduate medical education

Aims: Different approaches to performance-oriented allocation of resources according to teaching quality are currently being discussed within German medical schools. The implementation of these programmes is impeded by a lack of valid criteria to measure teaching quality. An assessment of teaching quality should include structural and procedural aspects but focus on learning outcome itself. The aim of this study was to implement a novel, outcome-based evaluation tool within the clinical phase of a medical curriculum and address differences between the novel tool and traditional evaluation methods

Standardized and quality-assured video-recorded examination in undergraduate education: informed consent prior to surgery

AbstractBackgroundCommunication skills combined with specialized knowledge are fundamental to the doctor–patient relationship in surgery. During a single-station video-recorded objective structured clinical examination (VOSCE), students were tasked with obtaining informed consent. Our aim was to develop a standardized and quality-assured assessment method in undergraduate education.MethodsOne hundred fifty-five students in their fifth year of medical school (78 videos) participated in a summative VOSCE within the framework of the teaching module “Operative Medicine.” They prepared for three clinical scenarios and the surgical procedures involved. The examination comprised participants having to obtain informed consent from simulated patients, video recording their performance. Students were assessed by two independent raters, the background of one of whom was nonsurgical. Results were statistically tested using SPSS.ResultsStudents' scores were all beyond the pass mark of 70%, averaging 91.0% (±4.0%), 88.4% (±4.4%), and 87.0% (±4.7%) for the appendectomy, cholecystectomy, and inguinal hernia repair checklist, respectively. Most items (68%–89% of the checklists) were found to have fair to excellent discrimination values. Cronbach's α values ranged between 0.565 and 0.605 for the individual checklists. Interrater agreement was strong (Pearson correlation coefficient = 0.80, P < 0.01; intraclass correlation coefficient 2.1 = 0.78).ConclusionsThe VOSCE is both feasible and reliable as a method of assessing student communication skills and the application of clinical knowledge while obtaining informed consent in surgery. This method is efficient (flexible rating outside normal working hours possible with reductions in administrative load) and may be used for high-stakes evaluation of student performance

Outcome of a four-hour smoking cessation counselling workshop for medical students

Introduction Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling. We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes. Material and Methods Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation. Results Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p < 0.0005). Major features of the students’ counselling skills improved. Significant and highly relevant attitude changes reflected increased motivation to counselling smokers. Conclusions Implementing a four-hour smoking intervention workshop into a medical curriculum was highly effective in improving students’ knowledge, skills and attitudes towards smoking counselling, as well as providing them with additional clinical competencies

Smoking Cessation Counselling: What Makes Her or Him a Good Counsellor? Can Counselling Technique Be Deduced to Other Important Lifestyle Counselling Competencies?

Smoking is a major health concern in both developed and developing countries. Smoking cessation counselling is of major importance for health care providers such as physicians, psychologists, nurses and many further therapeutic workers. We recently have demonstrated feasibility of a 4-hour “student-to-student course” (1 hour of scientific background and 3 hours of role plays and intervision) that provided knowledge, skills and attitude to smoking cessation counselling. A key question remains whether such knowledge, skills and attitude can be further deduced to key public health or lifestyle counselling areas like body weight management in overweight persons, management of addictions like alcohol and substance or situation (e.g., Internet and shopping) abuse, management of physical activity/exercise or lifestyle modification like workaholic lifestyle. The authors try to develop such a base for enabling patients to adapt healthier behaviour and give objectives for such counselling situations including the elaboration of clear therapeutic aims for counsellors