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      Medical students’ attitudes towards early clinical exposure in Iran

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          Abstract

          Objectives

          This study was carried out to investigate the medical students’ attitudes towards early clinical exposure at Tehran University of Medical Sciences.

          Methods

          A cross-sectional study was conducted during 2012-2015. A convenience sample of 298 first- and second-year students, enrolled in the undergraduate medical curriculum, participated in an early clinical exposure program. To collect data from medical students, a questionnaire consisting of open-ended questions and structured questions, rated on a five-point Likert scale, was used to investigate students’ attitudes toward early clinical exposure.

          Results

          Of the 298 medical students, 216 (72%) completed the questionnaires. The results demonstrated that medical students had a positive attitude toward early clinical exposure. Most students (80.1%) stated that early clinical exposure could familiarize them with the role of basic sciences knowledge in medicine and how to apply this knowledge in clinical settings. Moreover, 84.5% of them believed that early clinical exposure increased their interest in medicine and encouraged them to read more. Furthermore, content analysis of the students’ responses uncovered three main themes of early clinical exposure, were considered helpful to improve learning: “integration of theory and practice”, “interaction with others and professional development” and “desire and motivation for learning medicine”.

          Conclusions

          Medical students found their first experience with clinical setting valuable. Providing clinical exposure in the initial years of medical curricula and teaching the application of basic sciences knowledge in clinical practice can enhance students’ understanding of the role they will play in the future as a physician.

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          Most cited references15

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          What can experience add to early medical education? Consensus survey.

          To provide a rationale for integrating experience into early medical education ("early experience"). Small group discussions to obtain stakeholders' views. Grounded theory analysis with respondent, internal, and external validation. Problem based, undergraduate medical curriculum that is not vertically integrated. A purposive sample of 64 students, staff, and curriculum leaders from three university medical schools in the United Kingdom. Without early experience, the curriculum was socially isolating and divorced from clinical practice. The abruptness of students' transition to the clinical environment in year 3 generated positive and negative emotions. The rationale for early experience would be to ease the transition; orientate the curriculum towards the social context of practice; make students more confident to approach patients; motivate them; increase their awareness of themselves and others; strengthen, deepen, and contextualise their theoretical knowledge; teach intellectual skills; strengthen learning of behavioural and social sciences; and teach them about the role of health professionals. A rationale for early experience would be to strengthen and deepen cognitively, broaden affectively, contextualise, and integrate medical education. This is partly a process of professional socialisation that should start earlier to avoid an abrupt transition. "Experience" can be defined as "authentic human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional."
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            Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden.

            Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Linköping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Linköping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.
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              Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine.

              Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.
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                Author and article information

                Journal
                Int J Med Educ
                Int J Med Educ
                IJME
                International Journal of Medical Education
                IJME
                2042-6372
                19 June 2016
                2016
                : 7
                : 195-199
                Affiliations
                [1 ]Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
                [3 ]Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence: Azim Mirzazadeh, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran. Email: mirzazad@ 123456tums.ac.ir
                Article
                7-195199
                10.5116/ijme.5749.78af
                4939216
                27318794
                a6ada9b3-0138-4596-861f-afa45b1ac3ab
                Copyright: © 2016 Mahboobeh Khabaz Mafinejad et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0/

                History
                : 28 May 2016
                : 24 November 2015
                Categories
                Original Research
                Early Clinical Exposure

                early clinical exposure,reflection,undergraduate medical curriculum

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