The mini clinical evaluation exercise (mini-CEX) for assessing clinical performance of international medical graduates

Objective: To evaluate the feasibility, reliability and acceptability of the mini clinical evaluation exercise (mini-CEX) for performance assessment among international medical graduates (IMGs). Design, setting and participants: Observational study of 209 patient encounters involving 28 IMGs and 35 examiners at three metropolitan teaching hospitals in New South Wales, Victoria and Queensland, September-December 2006. Main outcome measures: The reliability of the mini-CEX was estimated using generatisability (G) analysis, and its acceptability was evaluated by a written survey of the examiners and IMGs. Results: The G coefficient for eight encounters was 0.88, suggesting that the reliability of the mini-CEX was 0.90 for 10 encounters. Almost half of the IMGs (7/16) and most examiners (14/18) were satisfied with the mini-CEX as a learning tool. Most of the IMGs and examiners enjoyed the immediate feedback, which is a strong component of the tool. Conclusion: The mini-CEX is a reliable tool for performance assessment of IMGs, and is acceptable to and well received by both learners and supervisors.

Clinical teaching: Maintaining an educational role for doctors in the new health care environment

Context and objectives: Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods: Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results: The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can 'teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion: Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers.

In-training assessment - Its potential in enhancing clinical teaching

Context In-training assessment (ITA) has established its place alongside formative and summative assessment at both the undergraduate and postgraduate level. In this paper the authors aimed to identify those characteristics of ITA that could enhance clinical teaching. Methods A literature review and discussions by an expert working group at the Ninth Cambridge Conference identified the aspects of ITA that could enhance clinical teaching. Results The features of ITA identified included defining the specific benefits to the learner, teacher and institution, and highlighting the patient as the context for ITA and clinical teaching. The ‘mapping’ of a learner’s progress towards the clinical teaching objectives by using multiple assessments over time, by multiple observers in both a systematic and opportunistic way correlates with the incremental nature of reaching clinical competence. Conclusions The importance of ITA based on both direct and indirect evidence of what the learner actually does in the real clinical setting is emphasized. Particular attention is given to addressing concerns in the more controversial areas of assessor training, ratings and documentation for ITA. Areas for future research are also identified.

Student perception of a new integrated anatomy practical program: Does students' prior learning make a difference?

While there is evidence that science and non-science background students display small differences in performance in basic and clinical sciences, early in a 4-year, graduate entry medical program, this lessens with time. With respect to anatomy knowledge, there are no comparable data as to the impact previous anatomy experience has on the student perception of the anatomy practical learning environment. A study survey was designed to evaluate student perception of the anatomy practical program and its impact on student learning, for the initial cohort of a new medical school. The survey comprised 19 statements requiring a response using a 5-point Likert scale, in addition to a free text opportunity to provide opinion of the perceived educational value of the anatomy practical program. The response rate for a total cohort of 82 students was 89%. The anatomy practical program was highly valued by the students in aiding their learning of anatomy, as indicated by the high mean scores for all statements (range: 4.04-4.7). There was a significant difference between the students who had and had not studied a science course prior to entering medicine, with respect to statements that addressed aspects of the course related to its structure, organization, variety of resources, linkage to problem-based learning cases, and fairness of assessment. Nonscience students were more positive compared to those who had studied science before (P levels ranging from 0.004 to 0.035). Students less experienced in anatomy were more challenged in prioritizing core curricular knowledge. © 2011 Wiley-Liss, Inc.

Media Education in the Finnish School System : A Conceptual Analysis of the Subject Didactic Dimension of Media Education

The aim of the doctoral dissertation was to further our theoretical and empirical understanding of media education as practised in the context of Finnish basic education. The current era of intensive use of the Internet is recognised too. The doctoral dissertation presents the subject didactic dimension of media education as one of the main results of the conceptual analysis. The theoretical foundation is based on the idea of dividing the concept of media education into media and education (Vesterinen et al., 2006). As two ends of the dimension, these two can be understood didactically as content and pedagogy respectively. In the middle, subject didactics is considered to have one form closer to content matter (Subject Didactics I learning about media) and another closer to general pedagogical questions (Subject Didactics II learning with/through media). The empirical case studies of the dissertation are reported with foci on media literacy in the era of Web 2.0 (Kynäslahti et al., 2008), teacher reasoning in media educational situations (Vesterinen, Kynäslahti - Tella, 2010) and the research methodological implications of the use of information and communication technologies in the school (Vesterinen, Toom - Patrikainen, 2010). As a conclusion, Media-Based Media Education and Cross-Curricular Media Education are presented as two subject didactic modes of media education in the school context. Episodic Media Education is discussed as the third mode of media education where less organised teaching, studying and learning related to media takes place, and situations (i.e. episodes, if you like) without proper planning or thorough reflection are in focus. Based on the theoretical and empirical understanding gained in this dissertation, it is proposed that instead of occupying a corner of its own in the school curriculum, media education should lead the wider change in Finnish schools.

Dimensions of University Student Learning in Medicine and Pharmacy

Study orientations in higher education consist of various dimensions, such as approaches to learning, conceptions of learning and knowledge (i.e. epistemologies), self-regulation, and motivation. They have also been measured in different ways. The main orientations typically reported are reproducing and meaning orientations. The present study explored dimensions of study orientations, focusing in particular on pharmacy and medicine. New versions of self-report instruments were developed and tested in various contexts and in two countries. Furthermore, the linkages between study orientations and students epistemological development were explored. The context of problem-based (PBL) small groups was investigated in order to better understand how collaboration contributes to the quality of learning. The participants of Study I (n=66) were pharmacy students, who were followed during a three-year professionally oriented program in terms of their study orientations and epistemologies. A reproducing orientation to studying diminished during studying, whereas only a few students maintained their original level of meaning orientation. Dualism was found to be associated with a reproducing orientation. In Study II practices associated with deep and surface approaches to learning were measured in two differing ways, in order to better distinguish between what students believed to be useful in studying, and the extent to which they applied their beliefs to practice when preparing for examinations. Differences between domains were investigated by including a sample of Finnish and Swedish medical students (n=956) and a Finnish non-medical sample of university students (n=865). Memorizing and rote learning appeared as differing components of a surface approach to learning, while understanding, relating, and critical evaluation of knowledge emerged as aspects of a deep approach to learning. A structural model confirmed these results in both student samples. Study III explored a wide variety of dimensions of learning in medical education. Swedish medical students (n=280) answered the questionnaire. The deep approach to learning was strongly related to collaboration and reflective learning, whereas the surface approach was associated with novice-like views of knowledge and the valuing of certain and directly applicable knowledge. PBL students aimed at understanding, but also valued the role of memorization. Study IV investigated 12 PBL tutorial groups of students (n=116) studying microbiology and pharmacology in a medical school. The educational application was expected to support a deep approach to learning: Group members course grades in a final examination were related to the perceived functioning of the PBL tutorial groups. Further, the quality of cases that had been used as triggers for learning, was associated with the quality of small group functioning. New dimensions of study orientations were discovered. In particular, novel, finer distinctions were found within the deep approach component. In medicine, critical evaluation of knowledge appeared to be less valued than understanding and relating. Further, collaboration appeared to be closely related to the deep approach, and it was also important in terms of successful PBL studying. The results of the studies confirmed the previously found associations between approaches to learning and study success, but showed interesting context- and subgroup-related differences in this respect. Students ideas about the nature of knowledge and their approaches to learning were shown to be closely related. The present study expanded our understanding of the dimensions of study orientations, of their development, and their contextual variability in pharmacy and medicine.

Proceedings of the Eighteenth International Sea Turtle Symposium, 3-7 March 1998, Mazatlán, Sinaloa, Mexico

For the first time in its history, the International Symposium on Sea Turtle Biology and Conservation migrated to a site outside of the United States. Thus the Eighteenth edition was hosted by the Mazatlán Research Unit of the Instituto de Ciencias del Mar y Limnología of the Mexican National Autonomous University (UNAM) in Mazatlán, Sinaloa (Mexico) where it was held from 3-7, March, 1998. Above all, our symposium is prominent for its dynamism and enthusiasm in bringing together specialists from the world´s sea turtle populations. In an effort to extend this philosophy, and fully aware of how fast the interest in sea turtles has grown, the organizers paid special attention to bring together as many people as possible. With the tremendous efforts of the Travel Committee and coupled with a special interest by the Latin American region´s devotees, we managed to get 653 participants from 43 countries. The number of presentations increased significantly too, reaching a total of 265 papers, ranging from cutting-edge scientific reports based on highly sophisticated methods, to the experiences and successes of community-based and environmental education programs. A priority given by this symposium was the support and encouragement for the construction of "bridges" across cultural and discipline barriers. We found success in achieving a multinational dialogue among interest groups- scientists, resource managers, decision makers, ngo's, private industry. There was a broad representation of the broad interests that stretch across these sectors, yet everyone was able to listen and offer their own best contribution towards the central theme of the Symposium: the conservation of sea turtles and the diversity of marine and coastal environments in which they develop through their complicated and protracted life cycle. Our multidisciplinary approach is highly important at the present, finding ourselves at a cross roads of significant initiatives in the international arena of environmental law, where the conservation of sea turtles has a key role to play. Many, many people worked hard over the previous 12 months, to make the symposium a success. Our sincerest thanks to all of them: Program committee: Laura Sarti (chair), Ana Barragán, Rod Mast, Heather Kalb, Jim Spotilla, Richard Reina, Sheryan Epperly, Anna Bass, Steve Morreale, Milani Chaloupka, Robert Van Dam, Lew Ehrhart, J. Nichols, David Godfrey, Larry Herbst, René Márquez, Jack Musick, Peter Dutton, Patricia Huerta, Arturo Juárez, Debora Garcia, Carlos Suárez, German Ramírez, Raquel Briseño, Alberto Abreu; Registration and Secretary: Jane Provancha (chair), Lupita Polanco; Informatics: Germán Ramírez, Carlos Suárez; Cover art: Blas Nayar; Designs: Germán Ramírez, Raquel Briseño, Alberto Abreu. Auction: Rod Mast; Workshops and special meetings: Selina Heppell; Student prizes: Anders Rhodin; Resolutions committee: Juan Carlos Cantú; Local organizing committee: Raquel Briseño, Jane Abreu; Posters: Daniel Ríos and Jeffrey Semminoff; Travel committee: Karen Eckert (chair), Marydele Donnelly, Brendan Godley, Annette Broderick, Jack Frazier; Student travel: Francisco Silva and J. Nichols; Vendors: Tom McFarland and J. Nichols; Volunteer coordination: Richard Byles; Latin American Reunión: Angeles Cruz Morelos; Nominations committee: Randall Arauz, Colleen Coogan, Laura Sarti, Donna Shaver, Frank Paladino. Once again, Ed Drane worked his usual magic with the Treasury of the Symposium Significant financial contributions were generously provided by government agencies. SEMARNAP (Mexico´s Ministry of Environment, Natural Resources and Fisheries) through its central office, the Mazatlán Regional Fisheries Research Center (CRIP-Mazatlán) and the National Center for Education and Capacity Building for Sustainable Development (CECADESU) contributed to the logistics and covered the costs of auditoria and audiovisual equipment for the Symposium, teachers and their hotels for the Community Development and Environmental Education workshop in the 5th Latin American Sea Turtle Specialists; DIF (Dept of Family Affairs) provided free accomodation and food for the more than 100 participants in the Latin American Reunion. In this Reunion, the British Council-Mexico sponsored the workshop on the Project Cycle. The National Chamber of the Fisheries Industry (CANAINPES) kindly sponsored the Symposium´s coffee breaks. Personnel from the local Navy (Octave Zona Naval) provided invaluable aid in transport and logistics. The Scientific Coordination Office from UNAM (CICUNAM) and the Latin American Biology Network (RELAB) also provided funding. Our most sincere recognition to all of them. In the name of this Symposium´s compilers, I would like to also express our gratitude to Wayne Witzell, Technical Editor for his guidance and insights and to Jack Frazier for his help in translating and correcting the English of contributions from some non-native English speakers. Many thanks to Angel Fiscal and Tere Martin who helped with the typing in the last, last corrections and editions for these Proceedings. To all, from around the world, who generously helped make the 18th Symposium a huge success, shared their experiences and listened to ours, our deepest gratitude! (PDF contains 316 pages)

A comunidade disciplinar de ensino de Biologia na produção de políticas de currículo

Esta dissertação se insere no estudo de políticas de currículo em múltiplos contextos educacionais, com base na abordagem teórico-metodológica do ciclo de políticas de Stephen Ball, na forma como interpretado para o campo do Currículo por Lopes e Macedo. Essa análise é subsidiada também pela concepção de comunidade disciplinar de Ivor Goodson e pela teoria do discurso de Ernesto Laclau. O objeto desta pesquisa é a investigação da produção de políticas curriculares pela comunidade disciplinar de ensino de Biologia. Para tanto, são analisados os principais documentos curriculares relacionados à Biologia no nível médio produzidos em âmbito federal os Parâmetros Curriculares Nacionais para o Ensino Médio (PCNEm), as Orientações Complementares aos Parâmetros Curriculares Nacionais para o Ensino Médio (PCN+) e as Orientações Curriculares Nacionais para o Ensino Médio (OCNEM). Igualmente buscando entender o processo de produção da política, foram realizadas entrevistas com professores e pesquisadores reconhecidos nessa comunidade disciplinar que participaram da elaboração dos documentos curriculares supramencionados. Nessa análise, são identificadas demandas em disputa no âmbito dessa comunidade disciplinar assim como distanciamentos e aproximações entre esses documentos. Concluímos que mesmo em governos diferentes, representantes das comunidades disciplinares podem se manter atuantes no contexto de produção de textos das políticas e produzir sentidos e significados semelhantes nas políticas.

Agentes Comunitários de Saúde: trabalho e formação profissional numa perspectiva emancipatória

Este estudo tem por objeto a trajetória profissional e de escolarização do Agente Comunitário de Saúde (ACS), entendendo a escolarização como um processo de avançar no aprendizado dentro da escola formal e não apenas na formação profissional. Entende-se o trabalho como um princípio emancipatório, mas ao mesmo tempo repleto de contradições e, ainda, campo de exploração, na lógica do modelo de acumulação em curso. O objetivo geral do estudo é descrever e discutir a trajetória de trabalho, formação e escolarização dos Agentes Comunitários de Saúde inseridos na Área Programática 5.2 (AP 5.2). O estudo apresenta uma abordagem qualitativa, com base nas narrativas sobre o trabalho e vida dos ACS e o método de análise dos dados foi de base interpretativa com apoio do referencial da Hermenêutica-Dialética. Além disso, foi obtido um perfil quantitativo de escolaridade de todos os ACS. O campo da pesquisa foi a AP 5.2, no município do Rio de Janeiro. Os resultados evidenciam ampliação significativa em todas as faixas de escolaridade desses ACS após o início do trabalho. As razões apontadas para o ingresso no trabalho de ACS estão relacionadas à oportunidade de ingresso ou reingresso no mercado formal de trabalho e a proximidade da residência. A desvalorização e a falta de reconhecimento são apontadas como os principais motivos para os ACS deixarem a profissão. Alguns sujeitos apontaram como provisório o trabalho de ACS e sua permanência está vinculada a falta de outras perspectivas e também a sua identificação com o trabalho comunitário, remetendo a um caráter de dádiva. O princípio emancipatório do trabalho também foi apontado por alguns sujeitos, já que o trabalho propiciou a retomada de antigos objetivos, no caso, voltar a estudar. Também foram encontrados achados da influência do enfermeiro no trabalho do ACS e na sua opção profissional. Parece haver um desejo deste trabalhador em mudar de função, porém continuando na área da saúde, mas a garantia dessa mudança só será possível com uma ordem social mais justa. Com base nos resultados e no referencial teórico, conclui-se que o ACS deve ser olhado não apenas como um trabalhador que reproduz um modelo de relação de trabalho, mas que, como membro das classes populares, permite pensar mudanças a partir do conceito de inédito viável. Sua permanência como ACS e a garantia de que se cumpra a proposta de mudança indicada pela Estratégia de Saúde da Família (ESF) depende do reconhecimento técnico e político desse trabalhador.

Ensino e aprendizado em serviços de atenção básica do SUS: desafios da formação médica com a perspectiva da integralidade narrativas e tessituras

Esta investigação enfoca processos de ensino, aprendizagem e avaliação na graduação médica, que acontecem em serviços básicos do Sistema Único de Saúde (SUS), com ênfase nos entraves e potencialidades para a transformação das relações entre a formação e a assistência na perspectiva da integralidade, tendo como referência as Diretrizes Curriculares Nacionais para os Cursos de Graduação em medicina, homologadas pelo Conselho Nacional de Educação em 2001. Com uma abordagem metodológica qualitativa que reúne contribuições da etnografia, da pesquisa transdisciplinar e da cartografia, a pesquisadora propõe ao leitor um diálogo com os relatos de suas observações (de experiências formativas na atenção básica) e dados oriundos da sua própria preceptoria de estudantes de medicina envolvidos em atividades em um centro municipal de saúde. Aponta desafios que necessitam ser enfrentados como: a hegemonia da racionalidade biomédica na conformação do modelo tecnoassistencial e a necessidade de efetivar uma política de recursos humanos no setor que incentive a integração universidade-serviço-comunidade, na aproximação da graduação ao cotidiano do trabalho em saúde e à realidade de vida da população. Estas questões estão associadas ao atual debate sobre integração curricular , educação permanente visando uma práxis formativa criativa que envolva o desenvolvimento de competências (técnico-políticas) e o compromisso para com o cuidado no SUS. Conclui que é justamente na trama local cotidiana, na problematização e intercâmbio entre experiências, que afloram caminhos criativos na superação das rotinas e práticas mecanizadas . Estes processos transformadores são matérias de reflexão para que novos projetos de cuidado sejam construídos coletivamente, emergindo novos patamares na assistência e na formação.

Avaliação da efetividade de intervenção de base comunitária voltada para a promoção do consumo de frutas e hortaliças em territórios de baixa renda da cidade do Rio de Janeiro

Evidências cada vez mais consistentes têm subsidiado a definição de recomendações acerca do consumo de frutas e hortaliças (F&H) como um fator de proteção contra o desenvolvimento de doenças crônicas não-transmissíveis. Essas recomendações têm sido transformadas em iniciativas de promoção do consumo de F&H. A escassez de estudos sobre a efetividade de intervenções voltadas para mudanças no consumo de F&H motivou a concepção desta tese, que teve por objetivo avaliar a efetividade de uma estratégia que integra diversas ações de promoção do consumo de frutas e hortaliças em múltiplos cenários, desenvolvidas junto a famílias que vivem em comunidades de baixa renda no Rio de Janeiro, RJ, Brasil. O estudo foi realizado em três comunidades cobertas pela Estratégia Saúde da Família na Zona Oeste do município do Rio de Janeiro, no período de 2007 a 2010. Trata-se de um estudo de intervenção comunitária tipo antes-e-depois. A coleta de dados incluiu duas avaliações pré-intervenção e uma avaliação pós-intervenção sobre a disponibilidade intradomiciliar e consumo de F&H e outras práticas alimentares. A intervenção mostrou-se efetiva para aumentar a disponibilidade intra-domiciliar de frutas e hortaliças nas três comunidades. Famílias mais expostas ao conjunto de elementos da intervenção apresentaram um maior aumento na aquisição de F&H entre o período pré e pós-intervenção. Mesmo em cenários sócio-demográficos menos favoráveis, quando as famílias foram mais expostas à intervenção, houve aumento pontual na disponibilidade intra-domiciliar de frutas e/ou hortaliças, apesar de não estatisticamente significativo. Por outro lado, também foi demonstrado que aumentos na aquisição de refrigerantes e biscoitos atenuaram o efeito da intervenção.

Fish farming through community partiicipation in Assam

The community tanks and ponds in India are seldom used for fish culture. Fish culture as a community based activity has been shown to be economically viable in some parts of the country. This paper describes the success story of fish farming in a community tank in Assam.

Village fisheries management and community-owned marine protected areas in Samoa

As in many tropical countries, subsistence fishers in Samoa live in discrete communities which have a high level of marine knowledge and some degree of control of adjacent waters. These factors provide an ideal basis for motivating communities to manage their marine resources. In Samoa, a community-based fisheries extension program encouraged each village community to define its key problems, discuss causes, propose solutions and take appropriate actions. Various village groups provided information which was recorded as problem/solution trees. The extension process culminated in a Village-Fisheries Management Plan which listed the resource management and conservation undertakings of the community. Undertakings range from enforcing laws banning destructive fishing methods to protecting critical marine habitats. Within the first eighteen months, the extension process commenced in 57 villages of which 40 have produced Village Fisheries Management Plans. An unexpectedly large number (32) or these villages chose to establish Marine Protected Areas, the first community-owned marin reserves in the country.

Beel fishery and livelihood of the local community in Rajdhala, Netrakona, Bangladesh

Baseline survey and Participatory Rural Appraisal (PRA) during January 2003 to December 2004 on the fishing community revealed that unregulated fishing, use of destructive fishing gears, poaching of fishes, difficulties encountered in enforcing fisheries regulation and the helplessness of fishers to find alternative sources of income during banned fishing period (June to October) were the major management problems. CBFM (Community Based Fisheries Management) system as an alternative management strategy has been introduced to ensure active participation of the target group-the poor fishers living around the beet who were previously deprived to get access to the beet. Establishing a leasing system for controlled access, ensuring greater user-group participation through equitable distribution of all resource benefits among members, attempting to enforce penalties for illegal fishing linked with surprise checks to enforce management regulations are some of the recent steps taken by the BMC (Beel Management Committee). Chapila fish intake by the community was 31.25 g/head/day before stocking the beel by carp fingerlings. After stocking, they consumed chapila as fish protein from 8.33 g to 20.8 g/head/day during the fishing season (November to May) indicating that due to introduction of carp fingerlings, chapila production has been decreased in 2003-2004. About 77.5% families around the beel were found to be dependent directly and/or indirectly on chapila and other indigenous fishes of the beel for their livelihood, through fishing, marketing and other activities like net and boat preparation and nets mending etc. Particularly fishers' families were found to face serious problem during non-fishing period like June to October for their livelihood. Analyzing the present research result it was also observed that other than declination in biodiversity, the fishing pressure on promising chapila of the beel was found high and that is why the production of chapila has also been decreased. To get sustainable chapila production from the heel, it is suggested to ensure successful spawning and recruitment as juveniles, and hence the chapila should be undisturbed during its breeding period from March to July, and fishing pressure on the same species needs to be reduced for obtaining sustainable fish production.

Technology for the community: SEAFDEC-designed artificial reefs

An account is given of the fabrication and deployment of artificial reefs used in the SEAFDEC/AQD's Community Fishery Resource Management project, which focused on Malalison Island located in west Central Philippines. The project aimed to apply community-based techniques of fishery resource management through the collaboration of community organizations, biologists and social scientists. The 3 types of reefs (building blocks, concrete pipe culvert, and modified concrete pipe culvert) were deployed at Gui-ob reef covering an area of less than 1 ha.