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.

Communicative repair strategies and problem behaviours of children with autism

The use of strategies by children with developmental disabilities to repair communicative breakdowns has received little attention in the research literature to date. The research that is available suggests that children with severe communication impairments may be more likely to experience communicative breakdowns than their typically developing peers. These children may also have fewer strategies available to them to repair these breakdowns. The present article reviews some of the research in this area and discusses the possible links between communicative breakdowns and the emergence of problem behaviour in children with autism. Theoretical and practical implications are considered and areas for future research are highlighted.

Risk reduction: Recontexualizing health as a physical education curriculum

While there is sufficient evidence to suggest that physical activity is inversely related to lifestyle diseases, researchers are far from being certain that this evidence extends to children. Nevertheless, the school physical education curriculum has been targeted as an institutional agency that could have a significant impact on health during childhood and later during adulthood if individuals could be habituated to assume a physically active lifestyle. The purpose of this article is to examine the recontextualization of biomedical knowledge into an ideology of healthism in which health is conceived as a controllable certainty and used as a pedagogical construction to transform school physical education. Using a Foucauldian perspective, we explore how the atomized biomedical model of chemical and physical relationships is constructed, reproduced, and perpetuated to service and empower the discourse and the practices of researchers and scholars. In this process the sociological or cultural aspects of public health are marginalized or ignored. As a result of this examination, alternative approaches are proposed that engage the limitations of the biomedical model and openly consider the insights that are available from the social sciences regarding what participation in physical activity means to individuals.

The effects of different review opportunities on schematisation of knowledge

Recent research suggests that early in learning, students primarily use episodic memory when recalling information, but as learning develops and schematisation occurs, students' knowledge is likely to be dominated by semantic memory. This shift has been examined through student's memory awareness; 'remembering' is linked to episodic memory and 'knowing' is linked to semantic memory. This paper explores the effect of different review opportunities on students' memory awareness and schematisation, and reports on findings that indicate students are more likely to shift from 'remembering' to 'knowing' if they have the opportunity to review the learning material, but regularly and in different formats. (C) 2002 Elsevier Science Ltd. All rights reserved.

Surveillance as a technique of power in physical education

This paper analyses surveillance as a technique of power in the culture of physical education, including its impact upon the health of teachers. Additionally, gendered aspects of surveillance are investigated because physical education is an important location in and through which bodies are inscribed with gendered identities. The embodied nature of physical educators' work renders the body as particularly significant in patterns of privilege and domination. The research was guided by Michel Foucault's work and poststructural feminist perspectives on the importance of power in social life. At nine schools across two international research sites, the functioning of surveillance was evidenced through the multi-directional workings of power in top-down, lateral, and bottom-up configurations. Data indicated that surveillance occurred on, through and about bodies. It had a strong gender dimension as the male gaze inscribed both female teachers' and students' bodies with value and competence. In terms of teachers' health, as well as responses to surveillance on a physical and emotional level, the workings of power were also influential in shaping teachers' identities.

Changes in neighborhood walking are related to changes in perceptions of environmental attributes

Background: Several studies have found significant cross-sectional associations of perceived environmental attributes with physical activity behaviors. Prospective relations with environmental factors have been examined for vigorous activity, but not for the moderate-intensity activities that environmental and policy initiatives are being designed to influence. Purpose: To examine prospective associations of changes in perceptions of local environmental attributes with changes in neighborhood walking. Methods: Baseline and 10-week follow-up telephone interviews with 512 adults (49% men). Results: Men who reported positive changes in aesthetics and convenience were twice as likely to increase their walking. Women who reported positive changes in convenience were more than twice as likely to have increased their walking. There were contrasting findings for men and women who reported traffic as less of a problem: Men were 61% less likely to have increased walking; however women were 76% more likely to have done so. Conclusions: Further studies are needed to determine the possibly causal nature of such environment-behavior relations and to elucidate relevant gender differences. Such evidence will provide underpinnings for public health initiatives to increase participation in physical activity.