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.

Pedagogies and critical reflection: key understandings for transformative gender justice

It is widely acknowledged that quality pedagogy is central to improving the educational outcomes of all students. In improving the social and academic outcomes of boys, and more specifically disengaged boys, the productive pedagogies model has been presented as a way forward. In terms of drawing on this model in socially just ways; to facilitate a broadening, rather than reinscribing of boys' narrow constructions of gender identity, this paper illustrates the imperative of teachers interacting with key feminist understandings of masculinity. Organized around the four dimensions of productive pedagogy, the paper draws on ( predominantly Australian-based) seminal work in the sphere of masculinities and schooling to discuss key strategies and initiatives for improving boys' educational outcomes. Against this backdrop, the paper demonstrates the importance of two principle understandings. The first relates to teachers understanding masculinity through feminist lenses, as constructed, regulated and maintained through inequitable social processes and the second relates to teachers understanding pedagogy as critical and transformative practice. These understandings are presented as vital to enabling gender justice.

Down Syndrome Across the Life Span

Beyond the myths: representing people with Down syndrome / Jan Gothard -- Learning in young children with Down syndrome: public perceptions, empirical evidence / Jennifer G. Wishart -- Self-regulation in children and young people with Down syndrome / Sheila Glenn and Cliff Cunningham -- What matters most? A reflection on a quarter century of early childhood intervention / Robin Treloar and Susan Cairns -- Making inclusion work: improving educational outcomes for students with Down syndrome in the regular classroom / Loretta R. Giorcelli -- Cognitive development and education: perspectives on Down syndrome from a twenty-year research programme / Susan Buckley and Gillian Bird -- Broadening approaches to literacy education for young adults with Down syndrome / Christina E. van Kraayenoord ... [et al.] -- Numeracy and money management skills in young adults with Down syndrome / Sandra Bochner ... [et al.] -- Life styles of adults with Down syndrome living at home / Anne Jobling and Monica Cuskelly -- Some studies involving individuals with Down syndrome and their relevance to a quality of life model / Verity Bottroff ... [et al.] -- From autonomy to work placement / Anna Contardi -- An appreciative inquiry about adults with Down syndrome / Susanne Muirhead -- Multiple perspectives of family life / Monica Cuskelly ... [et al.] -- Verbal-motor behaviour in persons with Down syndrome / Brian K.V. Maraj ... [et al.].

SQLator: An online SQL learning workbench

SQL (Structured Query Language) is one of the essential topics in foundation databases courses in higher education. Due to its apparent simple syntax, learning to use the full power of SQL can be a very difficult activity. In this paper, we introduce SQLator, which is a web-based interactive tool for learning SQL. SQLator's key function is the evaluate function, which allows a user to evaluate the correctness of his/her query formulation. The evaluate engine is based on complex heuristic algorithms. The tool also provides instructors the facility to create and populate database schemas with an associated pool of SQL queries. Currently it hosts two databases with a query pool of 300+ across the two databases. The pool is divided into 3 categories according to query complexity. The SQLator user can perform unlimited executions and evaluations on query formulations and/or view the solutions. The SQLator evaluate function has a high rate of success in evaluating the user's statement as correct (or incorrect) corresponding to the question. We will present in this paper, the basic architecture and functions of SQLator. We will further discuss the value of SQLator as an educational technology and report on educational outcomes based on studies conducted at the School of Information Technology and Electrical Engineering, The University of Queensland.

Resilience and male identity for at-risk males in alternative programs

This paper deals with the discourses of power and gender that influence the way in which at-risk adolescent boys think and solve problems within a specific educational context. The focus is on how some adolescent boys perceive their masculinities, identity, and support networks after they have completed an alternative education program. The position being presented in this paper is that for recovery from adversity, at-risk boys must be provided with protective processes that address masculinities and the impact of power relations within masculinities. In doing so, the research connects gender and protective processes and the role that gender construction plays in successful educational outcomes. It is also argued that for successful reintegration of at-risk adolescent males into an educational setting requires opportunity to be provided within the environment to challenge the legitimacy of traditional masculine performances.

A pragmatic 2 × 2 × 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care—methodology of the Palliative Care Trial [ISRCTN 81117481]

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005. (c) 2005 Elsevier Inc. All rights reserved.

Copying actions and copying outcomes: Social learning through the second year

The present work documents how the logic of a model's demonstration and the communicative cues that the model provides interact with age to influence how children engage in social learning. Children at ages 12, 18, and 24 months (n = 204) watched a model open a series of boxes. Twelve-month-old subjects only copied the specific actions of the model when they were given a logical reason to do so- otherwise, they focused on reproducing the outcome of the demonstrated actions. Eighteen-month-old subjects focused on copying the outcome when the model was aloof. When the model acted socially, the subjects were as likely to focus on copying actions as outcomes, irrespective of the apparent logic of the model's behavior. Finally, 24-month-old subjects predominantly focused on copying the model's specific actions. However, they were less likely to produce the modeled outcome when the model acted nonsocially.

Measuring outcomes of a communication program for older people with hearing impairment using the International Outcome Inventory

The main objective of this study was to describe the outcomes of a communication education program for older people with hearing impairment using the International Outcome Inventory - Alternative Interventions (IOI-AI) and the version for significant others (IOI-AI-SO). Ninety-six people aged 58 to 94 years participated in an interactive group education program for two hours per week for five weeks. The IOI-AI was administered at one to two weeks after the last educational session and 29 significant others also completed the IOI-Al-SO at this time. Overall, positive results were obtained using both questionnaires, and satisfaction with the program was particularly high. Findings also compared favourably to reports of outcomes for other audiological interventions (i.e., another communication training program and hearing aid fitting). Principal components analysis of the IOI-AI revealed a somewhat different factor structure than the original IOI-HA. The two versions of the 101 applied in this study are recommended as simple and effective measures of the outcomes of alternative interventions.