There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 +/- 15% to 93 +/- 4%) and behaviors (from 65 +/- 18% to 85 +/- 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department.

BACKGROUND Attitudes influence behaviour. Developing and maintaining proper attitudes by medical students can impact on the quality of health care delivered to their patients as they assume the role of doctors. There is a paucity of longitudinal research reports on the extent to which students' attitude scores shift as they progress through medical school.OBJECTIVE This study examined the change in attitude scores of a large student cohort as they progressed through medical school. Whether student gender is related to attitude change was also investigated.METHOD Medical students from 3 consecutive classes (1999-2001) participated in this study. Students completed 2 instruments that included the Attitudes Toward Social Issues in Medicine and an in-house tool referred to as the Medical Skills Questionnaire. The instruments were administered at 3 milestones during the course of medical school training (entry, end of preclinical training and end of clerkship).RESULTS Reliability estimates for total (0.82-0.91) and subscale (0.41-0.81) attitudinal scores were in the acceptable range. Multivariate analyses of variance of mean attitudinal scores indicated a persistent decline in several attitude scores as students progressed through the medical educational programme. Females demonstrated higher attitude scores than males.CONCLUSIONS As students progress through medical school their attitude scores decline. The reasons for the shift in attitude scores are not clear but they may relate to a ceiling of high attitude scores at entry, loss of idealism and the impact of the unintended curriculum. Further study of the impact of medical education on student attitudes is warranted.

Purpose Cognitive psychology research supports the notion that experts use mental frameworks or 'schemes', both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success.Methods Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology.Results Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success.Conclusions These findings have significant implications for medical educators. It supports the introduction of 'schemes' as a means of enhancing memory organization and improving diagnostic success.

Purpose Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented.Method Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, 'working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire.Results The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score.Conclusions With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations.

This essay outlines the development and evaluation of the Research Project Program (RPP) ten years after its introduction into the medical curriculum at the University of Calgary. The RPP consists of two mandatory for-credit courses. Students have the option of conducting either two smaller independent research projects or one larger project over the two years. At the end of the second-year course the students complete an evaluation of the RPP in which they are asked to assess and comment upon various aspects of the program. The authors compared data available from years one (the class of 1990) and ten (the class of 2000) and found significant differences between the two classes' approaches to the RPP. Most of the class of 2000 (89%) carried out two-year independent in-depth research projects spanning a wide range of topics. Half of these projects involved individual collection and analyses of data using experimental methods; this represented a 2.25-fold increase over the first year of the program. In the class of 2000, 44% of students presented their results at a newly implemented research symposium; an additional 22% of students presented their results at local, national, or international meetings. Further, 59% of the class of 2000 had either submitted or were planning to submit their research for peer-reviewed publication. In contrast, none of the students of the class of 1990 formally presented their research, and only 11% planned to submit their research findings for publication. The RPP has evolved in the ten years since its implementation, but the authors believe the program continues to foster independent learning and analytic and problem-solving skills.

Standardized patients (SPs)function as patient, teacher, and evaluator by using their bodies asteaching and evaluation material. SPs can be asymptomatic, havestable findings, or be trained to simulate physical findings. SPs canbe taught to portray a variety of standardized clinical presentations.Their participation in teaching and evaluating the complex clinicalskills included in OSCEs has been well established.

Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reform movements that will define 21st-century medical education.

It is generally acknowledged that alternatives such as none of the above and all of the above should be used sparingly in multiple-choice (MC) items. But the effect that all of the above has on the reliability and validity of an MC item is unclear. This study compared the results of a single-response (SRa) item format that included all of the above as the correct response to a multiple-response (MR) item format that required examinees to select all of the available alternatives for a correct response. A crossover design was used to compare the effect of formats on student performance while item content, scoring method, and student ability levels remained constant. Results indicated that the SRa format greatly distorted examinee performance by elevating their scores because examinees who recognized two or more alternatives as being correct were cued to select all of the above. In addition, the SRa format significantly reduced the reliability and concurrent validity of examinee scores. In summary, the MR format was found to be superior. Based upon new empirical evidence, this study recommends that whenever an educator wishes to evaluate student understanding of an issue that has multiple facts, the SRa format should be avoided and the MR format should be used instead.

Previous research reported significant improvement in performance when students used a "scheme" rather than a "search & scan" approach to problem solving. To supplement the limited research in this area, a pilot study was conducted to determine whether students who are provided problem solving schemes demonstrate use of a scheme approach when problem solving and whether they perform differently oil a measure of diagnostic thinking fi-om students who are not provided schemes. Students in four consecutive family medicine rotations participated in the study. Students in two rotations were introduced to problem solving schemes during the clerkship orientation and encouraged to use the schemes throughout the rotation when attempting to diagnose clinical problems. Students in the other two rotations were not provided problem solving schemes. Students who were provided schemes showed evidence of scheme utilization on the written exam, However, differences between the two groups in diagnostic thinking were observable but not statistically significant. Students who were provided schemes reported minimal use of the schemes during the rotation. The findings and recommendations are discussed within the context of the "scheme" and "search & scan" strategies.

The more precise our assessment measures and instructional feedback, the more likely both students and training institutions can take those steps necessary to developing and refining the knowledge base constructs underlying diagnostic competency. This paper provides a theoretical description of how, literature elucidating the factors underlying diagnostic performance could be used to produce more valid assessments of diagnostic competency. More specifically, literature suggesting that diagnostic performance is disease class-specific, coupled with evidence of a positive relationship between a case's typicality and diagnostic accuracy represent a potentially important by important for medical educators. Use of disease class-specific, typicality-graded test items may make it possible to mol-e directly link assessment measures with the constructs or latent traits responsible for observed performance. Such items make possible the development of construct-referenced as opposed to norm-referenced assessments of diagnostic performance. Construct-reference assessments of diagnostic performance could prove to be more appropriate, meaningful and useful testing procedures for students, faculty and society.

There are several artificial intelligent tools available today that run on microcomputers. Neural networks (i.e., multilayer perceptrons) are particularly good at modelling complex problems, and problems where the data is masked by noise. This capability makes them well suited to model the diagnostic behaviour of a physician. Other inferencing tools are also available. It is debatable which tool and method of abstracting information from a doctor is best. One expedient method of getting information from a physician is to obtain probability estimates of the presence of signs/symptoms for different diseases. A more laborious method is to have the physician diagnose many cases of a disease. However, to have a physician solve many clinical problems is a laborious and time-consuming task. The purpose of this study was to determine whether probability estimates or actual diagnostic decisions equally modelled physicians' diagnostic I, behaviours. Three physicians were asked to provide both probability ability estimates and solve 108 pencil & paper chest-pain cases. The probabilities were entered into a knowledge-based infer inferencing tool (KBIT) and the diagnostic decisions were entered into a back-propagation neural net (BPNN) program. The two models were then used to simulate the physician's diagnostic behaviour on 50 real and 43 computer-generated, chestpain cases. The study found that KBIT and BPNN were equally capable of undertaking the task and that both tools could successfully mimic the diagnostic behaviours of physicians.

A 20-station OSCE was used to evaluate 25 candidates for a Canadian Academy of Sport Medicine diploma. The examination has been used to assess candidates' clinical competence for the last seven years. Each year the examination was found to produce highly reliable scores (0.83-0.95) and clinical competence was based on an overall exam score of 65%. Over the years the examining board observed that a few candidates had passed the exam based on their total score but had done poorly on one or two typical, common clinical problems. In 1995, the board identified five critical stations and assigned each a minimal score of 50%. They decided that any candidate who failed one of these critical stations would fail to receive a diploma in Sport Medicine. Two observers were assigned to these stations to ensure reliable critical station scores. The analysis of the data indicated that the inter-observer reliability for the five critical stations was high. No candidate failed the exam because of their poor performance on critical station J (lowest interobserver correlate of 0.70). In total, seven candidates failed to pass the 1995 exam (3 based on the overall MPL of 65% plus 4 additional candidates who failed to pass one or more critical stations). The merits of using critical cases to determine competency in a "high stakes" OSCE is discussed.

The relationship between the Myers-Briggs Type Indicator and Gregorc Style Delineator, and achievement was examined by administering these instruments to 259 first-year nursing students enrolled in an introductory human anatomy and physiology course. A principal component factor analysis using a varimax rotation of the scores from the two psychometric instruments, achievement examinations, and an over-all grade point average indicated that each learning style from the Gregorc Style Delineator corresponds to certain traits on the Myers-Briggs Type Indicator. An individual who had a preference for the learning style of Concrete Sequential tended to have the traits of sensing and judging on the Myers-Briggs Type Indicator, while an individual who used the learning style of Concrete Random tended to have the traits of intuition and perceiving on the Myers-Briggs Type Indicator. One who had a preference for the learning style of Abstract Sequential tended to use the trait of thinking while another who used the learning style of Abstract Random tended to have the trait of feeling. The factor analysis also indicates no relationship of any scores of the traits on the Myers-Briggs Type Indicator or learning styles of the Gregore Style Delineator with the examination scores achieved in the human anatomy and physiology course or to the students' over-all grade point average. However, factor analysis indicates that the Myers-Briggs Type Indicator traits of Judging vs Perceiving collapsed into the Sensing vs Intuition scale, and that the Gregore Style Delineator consists of two bipolar scales that are different from those proposed by Gregorc.

The results from the Myers-Briggs 7Tpe Indicator (MBTI), which identified preferred psychological traits for 131 nursing students, were compared to their usage levels of course objectives in an undergraduate course in anatomy and physiology. The three usage levels (user, occasional user, and nonuser) were also compared to exam scores in the course, overall grade point averages (GPA) in first-year nursing, and the various psychological traits measured by the MBTI. A multivariate analysis of variance (MANOVA) indicated that users of objectives achieved significantly higher exam scores and maintained a higher GPA than occasional and nonusers. The MANOVA also indicated that users of course objectives preferredasensingjudging modality, whereas nonusers preferred an intuiting perceiving style to guide their studying and learning.

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The processing of applications for medical school is often time-consuming and costly, given the large number of applicants and the relative scarcity of positions. Modern computer technology can be used to alleviate the laborious task of processing applications. At the University of Calgary (UofC), the admissions process has been streamlined through the use of the Student Admission to Medicine (SAM) program. The current application procedure is largely paperless, using a computer data entry program that is mailed out to applicants for input of required information. The diskettes are downloaded on a database that converts grades of UofC standards. The database is then used to assist with the administrative details, statistical analysis, and reporting of results. SAM has made admissions processing more efficient and flexible. This paper describes SAM and its successful implementation in the University of Calgary Admissions Office.