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.

Ethics and intervention: The 'humanitarian exception' and the problem of abuse in the case of Iraq

This article investigates the ethics of intervention and explores the decision to invade Iraq. It begins by arguing that while positive international law provides an important framework for understanding and debating the legitimacy of war, it does not cover the full spectrum of moral reasoning on issues of war and peace. To that end, after briefly discussing the two primary legal justifications for war (implied UN authorization and pre-emptive self-defence), and finding them wanting, it asks whether there is a moral 'humanitarian exceptions to this rule grounded in the 'just war' tradition. The article argues that two aspects of the broad tradition could be used to make a humanitarian case for war: the 'holy war' tradition and classical just war thinking based on natural law. The former it finds problematic, while the latter it argues provides a moral space to justify the use of force to halt gross breaches of natural law. Although such an approach may provide a moral justification for war, it also opens the door to abuse. It was this very problem that legal positivism from Vattel onwards was designed to address. As a result, the article argues that natural law and legal positivist arguments should be understood as complementary sets of ideas whose sometimes competing claims must be balanced in relation to particular cases. Therefore, although natural law may open a space for justifying the invasion of Iraq on humanitarian terms, legal positivism strictly limits that right. Ignoring this latter fact, as happened in the Iraq case, opens the door to abuse.

The ethics pyramid: Making ethics unavoidable in the public relations process

To move from the realm of good intent to verifiable practice, ethics needs to be approached in the same way as any other desired outcome of the public relations process: that is, operationalized and evaluated at each stage of a public relations campaign. A pyramid model—the "ethics pyramid" —is useful for incorporating ethical reflection and evaluation processes into the standard structure of a typical public relations plan. Practitioners can use it to integrate and manage ethical intent, means, and ends, by setting ethics objectives, considering the ethics of each campaign tactic, and reporting whether ethical outcomes have been attained.

Levinasian ethics and the representation of the other in international and cross-cultural management

In this paper, we seek to further the discussion, problematization and critique of west/east identity relations in ICM studies by considering the ethics of the relationship – an issue never far beneath the surface in discussions of Orientalism. In particular we seek to both examine and question the ethics of representation in relation to a critique of what has come to be known as international and cross-cultural management (ICM). To pursue such a discussion, we draw specifically on the ethical elaborations of Emmanuel Levinas as well as his chief interlocutors Jacques Derrida and Zygmunt Bauman. The value of this discussion, we propose, is that Levinas offers a philosophy that holds as its central concept the relationship between the self and Other as the primary ethical and pre-ontological relation. Levinas’ philosophy provides a means of extending the post-colonial critique of ICM, and ICM provides a context in which the Levinasian ethics can be brought to bear on a significant issue on contemporary business and management.

Sharing Narratives Online: An international, self-organising curriculum in rural health

The aim of the Rural Medicine Rotation (RMR) at the University of Queensland (UQ) is to give all third year medical students exposure to and an understanding of, clinical practice in Australian rural or remote locations. A difficulty in achieving this is the relatively short period of student clinical placements, in only one or two rural or remote locations. A web-based Clinical Discussion Board (CDB) has been introduced to address this problem by allowing students at various rural sites to discuss their rural experiences and clinical issues with each other. The rationale is to encourage an understanding of the breadth and depth of rural medicine through peer-based learning. Students are required to submit a minimum of four contributions over the course of their six week rural placement. Analysis of student usage patterns shows that the majority of students exceeded the minimum submission criteria indicating motivation rather than compulsion to contribute to the CDB. There is clear evidence that contributing or responding to the CDB develops studentâ??s critical thinking skills by giving and receiving assistance from peers, challenging attitudes and beliefs and stimulating reflective thought. This is particularly evident in regard to issues involving ethics or clinical uncertainty, subject areas that are not in the medical undergraduate curriculum, yet are integral to real-world medical practice. The CDB has proved to be a successful way to understand the concerns and interests of third year medical students immersed in their RMR and also in demonstrating how technology can help address the challenge of supporting students across large geographical areas. We have recently broadened this approach by including students from the Rural Program at The Ohio State University College of Medicine. This important international exchange of ideas and approaches to learning is expected to broaden clinical training content and improve understanding of rural issues.