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.

Structuring cooperative group work in classrooms

Cooperative, small-group learning is widely recognised as a pedagogical practice that promotes learning and socialisation across a range of curriculum areas from primary school through to high school and college. When children work cooperatively together, they learn to give and receive help, share their ideas and listen to other students’ perspectives, seek new ways of clarifying differences, resolving problems, and constructing new understandings and knowledge. The result is that students attain higher academic outcomes and are more motivated to achieve than they would be if they worked alone. This paper provides an overview of five different studies that the author has conducted that demonstrate clearly the importance of explicitly structuring cooperative small-group work in classrooms if children are to derive the benefits widely attributed to this pedagogical practice.

Learning mathematics in a classroom community of inquiry

This article considers the question of what specific actions a teacher might take to create a culture of inquiry in a secondary school mathematics classroom. Sociocultural theories of learning provide the framework for examining teaching and learning practices in a single classroom over a two-year period. The notion of the zone of proximal development (ZPD) is invoked as a fundamental framework for explaining learning as increasing participation in a community of practice characterized by mathematical inquiry. The analysis draws on classroom observation and interviews with students and the teacher to show how the teacher established norms and practices that emphasized mathematical sense-making and justification of ideas and arguments and to illustrate the learning practices that students developed in response to these expectations.

Parenting and adolescent self-regulation

This study examined the relationship between adolescents' academic and non-academic self-regulation (SR), authoritative parenting (as demonstrated by high levels of Involvement, Strictness, and Autonomy Granting), and parent self-efficacy in four areas. Participants were 214 Australian high school students and their parents. There was a moderate correlation (r = 0.63) between academic and non-academic SR. Adolescents and their parents differed significantly in their perceptions of parenting behaviours, with parents rating themselves higher than their children on Involvement, Autonomy Granting, and Strictness behaviours. A model of the relationships between the constructs was developed showing a strong path from parent self-efficacy to both academic and non-academic SR via high parental Involvement (as perceived by adolescents). Strict parenting and the granting by parents of psychological autonomy to their adolescent children did not appear to be important in the development of young people's self-regulatory behaviours. (C) 2004 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The role of orthographic-motor integration in the production of creative and well-structured written text for students in secondary school

There is a strong relationship between orthographic-motor integration related to handwriting and students' ability to produce creative and well-structured written text. This relationship is thought to be due to the cognitive load which results when attention is required by writers to write letters and words on the page. Lack of automaticity in orthographic-motor integration means that writers do not have sufficient cognitive resources to accomplish the more demanding aspects of text production such as ideation, text monitoring, and pragmatic awareness. A systematic handwriting program can significantly improve the quality of written text by young children experiencing problems with orthographic-motor integration. This study investigated the effectiveness of a handwriting program in remediating older students' problems in orthographic-motor integration and consequently enhancing their written language skills. Two groups of students in Grades 8 and 9 were provided with either practice in handwriting or daily completion of a written journal. There were no differences between the two groups at pre-test. However, at post-test, the handwriting group had significantly higher scores in orthographic-motor integration as well as for the length and quality of the text they wrote.

Stress associated with the transition from high school to university: The effect of social support and self-efficacy

The present study aimed to evaluate the role of social support and self-efficacy on the level of stress associated with the transition from high school to university. One hundred and eight-five university students who had completed high school in the previous year completed a three-part questionnaire designed to gather information on their levels of self-efficacy, social support, and stress associated with their transition. The results showed that self-efficacy was a significant predictor of stress associated with the transition to university in that higher levels of self-efficacy were associated with lower levels of stress while social support was a non-significant predictor of stress. [Author abstract]