How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

From Zheng Qiang to Jiang Shuiying: The feminization of a revolutionary hero in Maoist theatre's 'Song of the Dragon River'

Since the 1980s, analysis of the representation of women in Maoist theatre has argued that the heroines of the Cultural Revolution model works (yangbanxi) were 'gender-less revolutionaries erased of anything feminine. This article challenges such a view through a case study of Song of the Dragon River in which the male hero of the 1964 spoken drama version was changed to a female in the 1972 yangbanxi adaptation. Evidence is presented that the characterization of the heroine in the latter work conforms closely not only with traditional beliefs in innate female characteristics but also with current Chinese beliefs in the characteristics of successful women in leadership. Rosemary Roberts is a lecturer in Chinese at the University of Queensland, Australia. She completed postgraduate studies at Beijing University in the early 1980s and has a PhD in Chinese literature from the Australian National University. She has published numerous articles and translations in the field of Chinese literature and culture and is currently writing a book on gender in Maoist theatre of the Cultural Revolution.

My system of career influences: Responding to challenges facing career education

The present article explores major challenges facing career psychology, specifically within the field of career education. Several issues are identified including the need for more effective links between theory and practice, the movement towards constructivist theories and the related challenges of applying such theories. These issues are explored within the context of the reformulation of career education and through the lens of the constructivist Systems Theory Framework of career development and its applied activity, the My Systems of Career Influences.