Medical Magazine

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was ‘gender blind’ by not considering gender whenever relevant. Secondly, medicine is said to be ‘male biased’ because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.

Petra Verdonk1,2　Yvonne W. M. Benschop3　Hanneke C. J. M. de Haes4　Toine L. M. Lagro-Janssen2

Background Computer-assisted tools are rarely adopted for dental education in China. In China, 3D digital technology, such as Virtual Reality Systems, are often rejected in the dental field due to prohibitive pricing. There is also a reluctance to move away from traditional patterns of dental education. Objective The current study is one of a series of research programs designed to investigate the effects of introducing a software program, named the Dental 3D Multimedia System (D3DM), into the education of a group of junior dental students in their preclinical practice. It was theorized that using 3D technology would improve certain aspects of subjects’ performance, thus lending support to the idea that electronic media is a useful & valuable means for dental education in China. Methods A paired-sample contrast study between two groups of dental students was conducted. One group received their training program in the traditional way, unassisted by 3D technology. The second group received their training program in the traditional manner, but also used the D3DM to supplement their education. Data indicating the study efficiency of the two groups were gathered and analyzed. The results between the two groups were then compared. Results Statistical differences were detected on several points between the two groups. These differences indicated that the D3DM-assisted group worked faster, and no worse than the traditional group during the training in labs. The D3DM-assisted group also spent less time interacting with faculty members and seeking feedback during practice. Finally, the results also show that the D3DM-assisted group achieved higher scores in theory exams. Conclusion The results indicate that the usage of 3D multimedia PC software had a positive impact on several aspects of subjects’ performance. At present, no significant drawbacks from applying the software have been identified.

Jian Hu1　Hao Yu1　Jun Shao2　Zhiyong Li1　Jiawei Wang3　Yining Wang1,3

Although studies have begun to shed light on medical students’ attitudes towards peer physical examination (PPE), they have been conducted at single sites, and have generally not examined changes in medical students’ attitudes over time. Employing both cross-sectional and longitudinal designs, the current study examines medical students’ attitudes towards PPE at schools from different geographical and cultural regions and assess changes in their attitudes over their first year of medical study. Students at six schools (Peninsula, UK; Durham, UK; Auckland, New Zealand; Flinders, Australia; Sapporo, Japan and Li Ka Shing, Hong Kong) completed the Examining Fellow Students (EFS) questionnaire near the start of their academic year (T1), and students at four schools (Peninsula, Durham, Auckland and Flinders) completed the EFS for a second time, around the end of their academic year (T2). Univariate and multivariate analyses revealed a high level of acceptance for PPE of non-intimate body regions amongst medical students from all schools (greater than 83%, hips, at T1 and 94.5%, hips and upper body, at T2). At T1 and T2, students’ willingness to engage in PPE was associated with their gender, ethnicity, religiosity and school. Typically, students least comfortable with PPE at T1 and T2 were female, non-white, religious and studying at Auckland. Although students’ attitudes towards PPE were reasonably stable over their first year of study, and after exposure to PPE, we did find some statistically significant differences in attitudes between T1 and T2. Interestingly, attitude changes were consistently predicted by gender, even when controlling for school. While male students’ attitudes towards PPE were relatively stable over time, females’ attitudes were changeable. In this paper, we discuss our findings in light of existing research and theory, and discuss their implications for educational practice and further research.

Charlotte E. Rees1　Andy M. Wearn2　Anna K. Vnuk3　Toshio J. Sato4

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators’ career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.

Yan Guo1　Emily Sippola2　Xinglin Feng1　Zhe Dong1　Debing Wang1　Cheryl A. Moyer2,3　David T. Stern2,3

Background Adaptation to learning styles has been proposed to enhance learning. Objective We hypothesized that learners with sensing learning style would perform better using a problem-first instructional method while intuitive learners would do better using an information-first method. Design Randomized, controlled, crossover trial. Setting Resident ambulatory clinics. Participants 123 internal medicine residents. Interventions Four Web-based modules in ambulatory internal medicine were developed in both “didactic” (information first, followed by patient problem and questions) and “problem” (case and questions first, followed by information) format. Measurements Knowledge posttest, format preference, learning style (Index of Learning Styles). Results Knowledge scores were similar between the didactic (mean ± standard error, 83.0 ± 0.8) and problem (82.3 ± 0.8) formats (p = .42; 95% confidence interval [CI] for difference, −2.3 to 0.9). There was no difference between formats in regression slopes of knowledge scores on sensing-intuitive scores (p = .63) or in analysis of knowledge scores by styles classification (sensing 82.5 ± 1.0, intermediate 83.7 ± 1.2, intuitive 81.0 ± 1.5; p = .37 for main effect, p = .59 for interaction with format). Format preference was neutral (3.2 ± 0.2 [1 strongly prefers didactic, 6 strongly prefers problem], p = .12), and there was no association between learning styles and preference (p = .44). Formats were similar in time to complete modules (43.7 ± 2.2 vs 43.2 ± 2.2 minutes, p = .72). Conclusions Starting instruction with a problem (versus employing problems later on) may not improve learning outcomes. Sensing and intuitive learners perform similarly following problem-first and didactic-first instruction. Results may apply to other instructional media.

David A. Cook1　Warren G. Thompson2　Kris G. Thomas3　Matthew R. Thomas3

Purpose To examine the predictive ability of preadmission variables on United States Medical Licensing Examinations (USMLE) step 1 and step 2 performance, incorporating the use of a neural network model. Method Preadmission data were collected on matriculants from 1998 to 2004. Linear regression analysis was first used to identify predictors of performance on step 1 and step 2. A generalized regression neural network (GRNN) as well as a feed forward neural network (FFNN) was then developed in an effort to more accurately predict step 1 and step 2 scores from these preadmission data. Results Statistically significant predictors for step 1 and step 2 included science grade point average (SGPA), the biologic science (BS) section of the Medical College Admissions Test (MCAT), college selectivity, race, and age of the applicant. Neural networks were found to predict a significant portion of the variance, and the FFNN demonstrated some superiority over that obtained with linear regression models as well as the GRNN. Conclusions The results have implications that could impact the selection of applicants to medical school and the neural networks that we developed could be used in a prospective manner.

James Kleshinski1　Sadik A. Khuder1　Joseph I. Shapiro1　Jeffrey P. Gold2

Although educational experts recommend the use of formative assessment, there is a dearth of empirical studies on its impact on academic achievement. In this research the authors analyse to what extent participation and performance in formative assessment are associated with positive academic outcomes of pre-graduate students of health sciences. A total of 548 students from three health science degrees (Medicine, Psychology and Biology) from four Spanish universities were involved in this study. The students who carried out mid-term formative assessment got better marks and had higher success rates in final summative assessment that the students who did not participate. In addition, success in formative assessment tests was associated with better summative marks. Interestingly, participation in formative assessment was a better predictor of final outcome than success in formative assessment, a result that supports the key role of feedback in formative assessment. Students who took the mid-term examination, irrespective of their success, obtained feedback about their achievement and probably this determined their greater involvement in the learning process. Although causal relationships between formative and summative assessment cannot be established from this research, the generalized benefits of formative assessments found here encourage the practice of them in health sciences education.

María T. Carrillo-de-la-Pe#241　a1　Eva Baillès2　Xavier Caseras3　àlvar Martínez3　Generós Ortet4　Jorge Pérez2

Despite public health initiatives targeting rapid action in response to symptoms of myocardial infarction (MI), people continue to delay in going to a hospital when experiencing these symptoms due to lack of recognition as cardiac-related. The objective of this research was to characterize lay individuals’ knowledge of symptoms of acute myocardial infarction (AMI) and associated decision processes for timely action. Thirty participants were interviewed about their knowledge of AMI, then presented with unrelated, unfamiliar and familiar scenarios of AMI symptoms and instructed to “think aloud” as they made decisions in response to the scenarios in order to capture the decision process directly. Data were analyzed using qualitative and quantitative methods to identify the semantic relationships between knowledge and decisions. Results showed that most participants (80%) identified three symptoms or less (e.g., chest pain: 93%; dyspnea: 53%). All participants identified urgent actions (calling 911, going to ED) as the appropriate response to AMI symptoms. Urgent action decisions increased with familiarity of symptoms (57% for unrelated symptoms to 83% for most familiar symptoms), and was highest for the cardiac group. Lay knowledge of AMI is necessary, but not sufficient for people to develop required heuristics for timely action. This ineffective decision increases as a function of ambiguous and unfamiliar situations. Health education interventions should focus on teaching clusters of problems with varying levels of familiarity and complexity to increase flexibility in making decisions.

Kayla N. Cytryn1,2　Nicole A. Yoskowitz3　James J. Cimino3　Vimla L. Patel4

Different lines of research have suggested that context is important in acting and learning in the clinical workplace. It is not clear how contextual information influences residents’ constructions of the situations in which they participate. The category accessibility paradigm from social psychology appears to offer an interesting perspective for studying this topic. We explored the effect of activating medically irrelevant mental concepts in one context, so-called ‘priming’, on residents’ interpretations as reflected in their judgments in another, work-related context. Obstetric-gynecologic residents participated in two unrelated-tasks experiments. In the first experiment residents were asked to indicate affect about a change in a routine procedure after performing an ostensibly unrelated ‘priming’ task which activated the concept of either ineffective coping or effective coping. The second experiment concerned residents’ patient management decisions in a menorrhagia case after ‘priming’ with either action or holding off. Contextually activated mental concepts lead to divergent affective and cognitive evaluations in a subsequent medical context. Residents are not aware of this effect. The strength of the effect varies with residents’ level of experience. Context influences residents’ constructions of a work-related situation by activating mental concepts which in turn affect how residents experience situations. Level of experience appears to play a mediating role in this process.

P. W. Teunissen1　D. A. Stapel2　F. Scheele3　A. J. J. A. Scherpbier4　K. Boor3　J. A. A. M. van Diemen-Steenvoorde1　C. P. M. van der Vleuten4

Consumers’ autonomy regarding health increasingly requires competences to critically appraise health information. Critical health literacy refers to the concept of evidence-based medicine. Instruments to measure these competences in curriculum evaluation and surveys are lacking. We aimed to develop and validate an instrument to measure critical health competences (CHC test). Development and testing of the questionnaire covered three phases: (1) test construction (and feasibility, (2) first field test of scalability and items revision (3) second field test to validate the instrument. Model fit analyses were performed for both field tests for Rasch-, Mixed Rasch- and Hybrid model. Participants were secondary school and university students with and without prior training in evidence-based medicine (1. field test n = 322; with training n = 87; 2. field test n = 107; with training n = 13). The second field test resulted in Rasch scalability of all items in one person class. Mean values (±SD) of person parameters were 716.14 (±53.74) for trained students and 470.11 (±59.63) for untrained students. Reliability of the instrument was 0.91 (WINMIRA ANOVA). In conclusion the CHC instrument is a feasible, reliable and valid instrument to measure critical health literacy. The generalizability of the instrument is to be explored in ongoing studies in different educational settings.

Anke Steckelberg1　Christian Hülfenhaus2　Jürgen Kasper2,3　Jürgen Rost4　Ingrid Mühlhauser1