Psychometric properties of an instrument to measure the clinical learning environment

Objectives: The clinical learning environment is an influential factor in work-based learning. Evaluation of this environment gives insight into the educational functioning of clinical departments. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an evaluation tool consisting of a validated questionnaire with 3 subscales. In this paper we further investigate the psychometric properties of the PHEEM. We set out to validate the 3 subscales and test the reliability of the PHEEM for both clerks (clinical medical students) and registrars (specialists in training). Methods: Clerks and registrars from different hospitals and specialties filled out the PHEEM. To investigate the construct validity of the 3 subscales, we used an exploratory factor analysis followed by varimax rotation, and a cluster analysis known as Mokken scale analysis. We estimated the reliability of the questionnaire by means of variance components according to generalisability theory. Results: A total of 256 clerks and 339 registrars filled out the questionnaire. The exploratory factor analysis plus varimax rotation suggested a 1-dimensional scale. The Mokken scale analysis confirmed this result. The reliability analysis showed a reliable outcome for 1 department with 14 clerks or 11 registrars. For multiple departments 3 respondents combined with 10 departments provide a reliable outcome for both groups. Discussion: The PHEEM is a questionnaire measuring 1 dimension instead of the hypothesised 3 dimensions. The sample size required to achieve a reliable outcome is feasible. The instrument can be used to evaluate both single and multiple departments for both clerks and registrars. © 2007 Blackwell Publishing Ltd

Is being a medical educator a lonely business? The essence of social support

Teaching and Teacher Learning (ICLON

Why don't they know enough about anatomy? A narrative review.

Item does not contain fulltextBACKGROUND: Publications in a variety of journals have described the problem of medical students' decreasing anatomical knowledge. Interestingly, the number of people making this assertion is growing, despite a lack of empirical evidence that today's medical graduates actually know less about anatomy than medical students in the past. Nevertheless, many people are claiming that students' anatomical knowledge is impaired due to negative effects from several factors, including teaching by non-medically qualified teachers, diminished use of cadaver dissection as a teaching tool and neglect of vertical integration of anatomy teaching. AIM: To find empirical evidence for the factors claimed to have an influence on anatomical knowledge of students. METHOD: A literature search. RESULTS: There is a lack of sufficient quantity and quality of information within the existing literature to support any of the claims, but the gathered literature did reveal some fascinating insights which are discussed. CONCLUSION: Anatomy education should be made as effective as possible, as nobody will deny that medical students cannot do without anatomical knowledge. Because of promising findings in the areas of teaching in context, vertical integration and assessment strategies, it is recommended that future research into anatomy education should focus on these factors

The Murray River Turtle, Emydura macquarii: Population Dynamics, Nesting Ecology and Impact of the Introduced Red Fox, Vulpes vulpes

I studied aspects of the ecology of the Murray River turtle, Emydura macquarii, to determine the impact of the introduced red fox, Vulpes vulpes. The fox is one of Australia's worst vertebrate pests through its predation on livestock and native mammals, but their impact on reptilian communities is not known. I conducted a large-scale mark-recapture study to evaluate population growth of E. macquarii in the Albury region of the upper Murray River by determining growth, reproduction and survival. The study was conducted downstream of the first, and largest, impoundment on the Murray River, Lake Hume. Emydura macquarii predominantly inhabit the lagoons in the upper Murray River, as the mainstream and Lake are possibly too cool to maintain metabolic processes. They are easily captured in hoop traps and the use of live decoys maximises trap success. Over 2000 hatchling turtles were marked and released into two lagoons between January 1997 and January 1998. Growth of these individuals is rapid over the first few years but declines towards maturity, and is indeterminate after maturity. Although growth annuli are not well defined, even on young individuals, the von Bertalanffy model describes the growth of both male and female E. macquarii. Male turtles mature at 5-6 years and females mature at 10-12 years. Female turtles may maximise reproductive potential by delaying maturity and producing one relatively large clutch (mean = 21 eggs) per year, which is positively correlated with body size (PL). Although primarily related to body size, clutch size varies annually because of environmental conditions. If winter and summer rainfalls are below average and temperatures are above average, E. macquarii may reduce clutch size to increase the chance of the eggs surviving. Nesting predominantly occurs during the first major rain-bearing depression in November. Habitat variables, including distance from water, nearest nest, and tree, and soil type were measured for each nest to determine characteristics that attract predators. Nests close to the shoreline and trees are heavily preyed on, and nests constructed in sand are less likely to be destroyed by predators. Foxes detect nests through a combination of chemical cues from eggs and slight soil disturbances, whereas birds only destroy nests observed being constructed during the day. Female turtles alter nesting behaviour and construct nests much further away from water when foxes were removed and as a result, nests are less dense and away from trees. Thus in high predation risk areas, turtles minimise emergence and search times to reduce the risk of direct predation by foxes. Predation is reduced when nests are in lower densities and away from trees, because predators increase search efforts when nests are in higher densities and birds are more likely to destroy nests close to trees. Reproductive success is further reduced in high predation risk areas because more nests are constructed in sandy substrates where clutch success is reduced compared to incubation in more dense substrates. Where predators are a significant source of mortality, prey may use indirect methods, such as chemical recognition, to avoid encounters. Nesting turtles did not avoid areas where fox odour was present, suggesting that they assess predation pressure from foxes by other mechanisms, such as visual recognition. However, an innate response occurs to the odour of a once common predator on the Murray River, the eastern quoll (Dasyurus viverrinus), whereby turtles recognise and avoid nesting in areas where quoll odour is present. Therefore nesting turtles show a similar avoidance response to two different predators, using different mechanisms of detection. Similarly, predation risk may influence hatching times and nest emergence. The rate of embryonic development of E. macquarii may increase or eggs may hatch early so that the clutch hatches synchronously, thereby reducing the risk of predation through group emergence from the nest. Emydura macquarii reach densities of over 100 turtles.ha-1, with the majority of the population consisting of sexually mature individuals. Emydura macquarii has a Type III survival curve where mortality is extremely high in the egg stage (93% nest predation), remaining high over the hatchling stage (minimum survival rate- 10%), but decreasing rapidly throughout the juvenile stage (~70% juvenile survival). Adult survival is extremely high, with greater than 95% of adults surviving each year. Foxes through nest predation cause most mortality but a small proportion (~3%) of nesting adult females are killed by foxes each year. A removal program evaluated the impact of foxes. In 1996, fox numbers were monitored around four lagoons by spotlighting and non-toxic bait uptake. Foxes were removed from around two of the lagoons throughout 1997 and 1998, using spotlight shooting and 1080 bait poisoning. Fox numbers were continually monitored around all four lagoons during the study. Nest predation rates remained around 90% in all sites where foxes were present, but fell to less than 50% when foxes were removed. At the same time, predation on nesting female turtles was eliminated where foxes were removed. Demographic models using staged based survival schedules, together with growth and fecundity values for E. macquarii show a decline of 4% per year in these populations. Elasticity analyses shows that survival of adult female E. macquarii has the major influence on population stability and a reduction of nest predation alone is unlikely to address the population decline. Management options, such as reducing foxes prior to nesting around key lagoons, will stabilise the population decline, and eliminating foxes completely from certain areas with high dispersal potential, will promote recruitment of juvenile E. macquarii

The role of the teacher in remediating at-risk medical students

Item does not contain fulltextBackground: Previous work identified complex ingredients of a remediation programme for at-risk medical students: mandatory, stable, facilitated small groups promote both cognitive and affective developments, with improved self-regulation, metacognition and reflection resulting in significant performance gains. Aim: We explore the teachers' role in this intervention, aiming to expand and deepen understanding of remediation methods in medical education. Methods: Extensive qualitative data from student surveys and in-depth teacher interviews, along with quantitative student performance data, produced a rich description of remediation processes. Results: Remediation should support emotional needs and foster cognitive and metacognitive skills for self-regulation and critical thinking. Teachers of remediation need to motivate, critique, challenge and advise their learners, applying teaching and contextual expertise in a constructivist, student-centred environment that fosters curiosity and joy for learning. Teachers of remediation can mediate these processes through embodiment of five core roles: facilitator, nurturing mentor, disciplinarian, diagnostician and modeller of desired skills, attitudes and behaviours. Conclusion: Remediation of struggling medical students can be achieved through a cognitive apprenticeship within a small community of inquiry that motivates and challenges the students. This community needs teachers capable of performing a unique combination of roles that demands high levels of teaching presence and practical wisdom