Journal of Cancer Education
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Defining and accomplishing clinically related objectives in an eight‐hour oncology course for first‐year medical students Linda Z. Nieman PhD & Rosaline Joseph MD To cite this article: Linda Z. Nieman PhD & Rosaline Joseph MD (1992) Defining and accomplishing clinically related objectives in an eight‐hour oncology course for first‐year medical students, Journal of Cancer Education, 7:3, 227-231 To link to this article: http://dx.doi.org/10.1080/08858199209528172
Published online: 01 Oct 2009.
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Article views: 1
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 31 August 2017, At: 19:14
J. Cancer Education. Vol. 7, No. 3, pp. 227-231, 1992 Primed in the U.S.A. Pergamon Press Lid.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
DEFINING AND ACCOMPLISHING CLINICALLY RELATED OBJECTIVES IN AN EIGHT-HOUR ONCOLOGY COURSE FOR FIRST-YEAR MEDICAL STUDENTS
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
LINDA
Z. NIEMAN, PhD* and ROSALINE JOSEPH, MD†
Abstract—Designing a clinically relevant cancer curriculum for freshmen attending medical schools with a traditional curriculum poses the following challenges: (1) there is limited curriculum time; (2) the subject matter is complex. The authors defined some of the responsibilities of the general physician in regard to cancer and six related objectives that first-year students could accomplish in an eight-hour multidisciplinary oncology course. A case-based, modified essay examination required students to demonstrate that they could begin to integrate principles of prevention, screening, diagnosis and staging, and treatment modalities. Ninety percent of the students accomplished the objectives. However, in working up the cancer case, 70% of the students did not mention the physical examination and 53% forgot multidisciplinary consultation. In a curriculum with limited objectives, first-year students can begin to deal efficiently with the complexities of cancer. Evaluation data revealed those objectives and related physician responsibilities requiring reinforcement in subsequent training.
INTRODUCTION The growing amount of information included in the traditional, lecture-oriented basic science years makes it increasingly problematic for cancer educators to find required time to introduce students to basic scientific and clinical concepts concerning cancer. When dedicated time is given to cancer education, educators assume the difficult task of defining and evaluating objectives that are relevant to students early in their education while still reflecting the complex nature of the subject matter. A number of authors from medical schools in Europe and the United States have described different solutions to implementing and evaluating a preclinical oncology curricThis project was supported in part by the American Cancer Society, Philadelphia Division, Tuttleman Professorship of Clinical Oncology, (Rosaline Joseph, M.D.). *Office of Medical Education, Medical College of Pennsylvania, Philadelphia. †Division of Hematology/Oncology, Department of Medicine, Medical College of Pennsylvania, Philadelphia. Reprint requests and correspondence to: Linda Z. Nieman, Ph.D., Assistant Dean for Medical Education, Office of Medical Education, The Medical College of Pennsylvania, 3300 Henry Avenue, Philadelphia, PA 19129.
ulum. Bosman described a problem-based teaching program at the Limburg Medical School in Maastricht, which had a mandatory six-week block devoted to oncology.1 The Oncology course was evaluated in terms of the degree to which students integrated knowledge and appreciated the teaching. Love explained details of the curriculum offered at the University of Wisconsin Medical School, which had a mandatory 30-hour block in neoplastic diseases taught in year 2. 2 Oncology teaching at that institution included a variety of innovative teaching alternatives to the lecture. Students were assessed on presentations and an essay examination of cognitive knowledge. The most frequently described curriculum offering in Oncology was the preclinical elective.3"5 At the University of Arkansas an uncredited and ungraded elective combining self-study and clinical experiences was offered following the first year.3 The State University of New York at Buffalo provided a credited elective with no evaluation of students.4 Biological and environmental topics were presented in a seminar setting with discussion of sociomedical and treatment issues. A credited, semester-long elective with pretesting and posttesting of knowledge and attitudes
227
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
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L. Z. NEEMAN AND R. JOSEPH
was offered in the first year at the University petencies) that each student was expected to of Rochester School of Medicine and Den- demonstrate at each level of training. Each intistry.5 Positive student responses were noted terim skill related specifically to the responsiby all authors describing these oncology bilities of the practicing general physician. By making the relationship explicit, we encourofferings. In the well-publicized GPEP Report, Pre- aged faculty involved in teaching to direct paring Physicians for the Twenty-First Cen- their efforts toward clinically relevant matetury, The Association of American Medical rial and to involve students at all levels in esColleges affirmed that there was "a common sential clinical skills. Bakemeier and Edwards' foundation of knowledge, skills, values and listing of cancer education objectives was parattitudes" that all physicians should have re- ticularly helpful in the formulation of interim 8 gardless of their specialty.6 We could find no skills. The first-year curriculum fit within a manpreclinical course that was explicitly designed around the "common foundation." The pur- datory eight hours of teaching time. Students pose of this educational development project, were given the list of responsibilities and were then, was to define the "common foundation" informed that they should demonstrate six in regard to cancer prevention and manage- limited-interim objectives related to those rement and to design and evaluate a brief, first- sponsibilities by the end of the eight hours: year auricular intervention that would reflect 1. List environmental and lifestyle prethe foundation. ventable causes of cancer. 2. Define screening and identify qualities METHODS of a good screening test for cancer. At the Medical College of Pennsylvania, a multidisciplinary Cancer Coordinating Committee (clinical oncologists, pathologist, psyTable 1. List of professional responsibilities* chiatrist, social worker, and nurse) oversees of the general physician in regard to cancer prevention and management the integration of the cancer curriculum during both the undergraduate and graduate 1. Takes a medical history that includes questions years. One of the authors, who was an Amerregarding risk factors and warning signs of cancer. ican Cancer Society Professor (RJ), was des2. Advises patients on cancer prevention. - Assesses individual risk factors. ignated as the director of the longitudinal - Suggests behavioral changes to reduce risks. cancer curriculum. The model of Seegal et al. 3. Advises patients regarding available community for competency-based courses provided the resources for screening, costs of screening, risks and benefits of screening, and reimbursability. curriculum format.7 As a first step, the auConsiders cancer within the differential diagnosis. thors identified the "responsibilities" of the 4. 5. Conducts a complete cancer-related history and physpracticing general physician in regard to cancer ical examination. prevention and management. Responsibilities 6. Orders laboratory tests that make sense in terms of the patient's presentation and cost/risk benefits. are the activities for which medical students 7. Obtains appropriate consultation for the diagnostic will be accountable in their future professional workup. 8. Coordinates the care of the cancer patient. roles as physicians. Thus, the responsibilities - Seeks appropriate multidisciplinary consultation. communicated the common foundation (ie, - Remains available to the patient and patient's exit objectives in regard to cancer) that stufamily. dents should achieve. Eleven responsibilities 9. Assists patients with choosing among therapeutic options. (Table 1) were accepted by the Cancer Coor10. Provides emotional support to the patient. dinating Committee following slight revisions 11. States a plan for continuing self-education in the area of the authors' original statements. of cancer. As a second step in writing the curriculum, *The activities for which physicians in training will be the authors identified interim skills (ie, com- accountable in their future roles.
Oncology course for first-year medical students
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
3. Identify types of studies that are available/necessary for proper diagnosis and staging of cancer. 4. Identify major modalities for cancer treatment. 5. Identify the importance of multidisciplinary management of cancer. 6. Discuss psychosocial aspects of the patient's management. The eight-hour, required, lecture-based course was taught by faculty from the departments of pathology, Community and Preventive Medicine, Medicine, Psychiatry, Radiology, Obstetrics and Gynecology, and Surgery. There were four two-hour sessions providing an introduction to epidemiology, prevention, diagnosis, and staging of cancer. Principles of multimodality treatment, rehabilitation and psychosocial support of cancer patients were also taught. Cervical and ovarian cancer were used as models. During the last session students interviewed a cancer patient applying the skills they had gained during the course. EVALUATION Cervical cancer, which had been discussed in all aspects from prevention to treatment was selected as the appropriate disease model that would be used to assess the student's attainment of the six interim objectives. At the end of the course the students were administered a case study of 21-year old college student who sought advice regarding the possibility of her having cervical cancer. The format for the examination was the modified essay, which has been shown to be a reliable alternative to multiple choice examinations.9 Students were asked to read the case vignette and respond to the "patient" regarding (a) her risk factors, (b) what they would do if she had a precursor lesion, (c) the advice they would give her regarding prevention, {d) procedures that they would follow if she had a precursor lesion, and (e) the steps that they would take following diagnosis. Sample written responses were prepared
229
consisting of essential points relevant to each portion (a-e) of the examination. Essential points included (a) the number and degree of risk of the patient's sexual partners, frequency and age of onset of sexual activity, her history of sexually transmitted disease, and her smoking history; (6) the need for physical examination, pelvic examination, and pap smear; (c) safe sexual practices and American Cancer Society Guidelines for regular pap smears; (d) the need for a biopsy in case of a precursor lesion; and (e) staging and multidisciplinary consultation. Each student was graded according to the degree to which his/her responses agreed with the sample responses. Ninety percent of the 111 students accomplished the interim objectives adequately enough to receive an unqualified passing grade. The percent of these students who included each of the essential points is shown in Fig 1. Of interest, the most frequently missed concept related to objective 3. Seventy percent of students neglected to include physical examination in their diagnostic workup for cancer but moved directly to sophisticated tests. Fifty-three percent did not include multidisciplinary consultation in their management plans (objective 5), although they showed a good grasp of individual modalities. DISCUSSION Several curriculum models have been developed as ways of teaching preclinical students essential oncology knowledge, skills, and attitudes. None of these was based upon a curriculum that explicitly stated the responsibilities of the general physician in regard to cancer prevention and medicine. Yet, the Association for American Medical Colleges has made the education of the general physician a major goal. The responsibilities, which were defined for our graduates by the authors and the Cancer Coordinating Committee, may differ from those espoused by other educators. We learned that most of the six interim objectives of the first-year cancer curriculum could be accomplished within eight hours of teaching time when evaluation was restricted
230
L . Z. NlEMAN AND R. JOSEPH
100 90807072%
68%
60Percent of SOH Students
47% 40-
30-
30%
20-
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
10-
V
Y Dtecuswd Risk Assessment
Identified Cancer Behaviors
Biopsy
I
Y Physical Pelvic Exam
Y Multidlsciplinary ConsuHslion
Recommended Appropriate Studies
Figure 1. Achievement of Oncology objectives by first-year students as assessed by a case-based examination.
to a single disease model. The highest percentage of students achieved objectives associated with risk assessment and cancer prevention behaviors. They did less well with objectives related to recommended studies. Students more readily mention prevention rather than procedures such as physical examination and biopsy, perhaps because these are part of their general and preclinical education. We must be careful at this stage of course design not to generalize our results beyond the single cancer model that we tested. It is possible for first-year students to begin to deal effectively with the complexities of cancer by stating the responsibilities of the general physician in regard to cancer and by establishing limited objectives related to these responsibilities. Students need to be given the responsibilities and objectives toward which the course is directed. They also should know that they will be tested with a case-based evaluation instrument that requires them to integrate concepts. Oncology faculty can use case-based evaluation data to determine how well students have integrated the concepts or objectives and which of these require special reinforcement in subsequent training. Our findings suggest that students might integrate
material better if it is both taught and tested in a case-based format. We intend to modify the sophomore course so that this integration is reinforced as students continue their studies. Administrators can use the responsibilities as exit objectives for graduating students. Results of using this design in one medical school revealed that in our traditional curriculum, greater attention needs to be paid to reinforcing general clinical concepts since preclinical students seem to focus on specific facts. REFERENCES 1. Bosnian FT: Integrated Oncology course for first-year medical students. J. Cancer Educ 2:129-133, 1987. 2. Love RR: Methods for increasing active medical student participation in their own learning: Experience with a single 30-hour course for 111 preclinical students. J Cancer Educ 5:35-36, 1990. 3. Neilan BA, Westbrook KC, Riggs C, et al; Clinical oncology assistantship program for medical students. J Med Educ 30:473-77, 1985. 4. Peters AS, Schimpfhauser FT, Wright J, et al: Effect of a cancer education program on student interest and learning in cancer. J Med Educ 61:163-168, 1986. 5. Krackov S, Preston W, Rubin P: Effects of an oncology elective on first-year medical students' knowledge
Oncology course for first-year medical students
231
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
and attitudes about cancer. J Cancer Educ 5:43-49, 8. Bakemeier, RF, Edwards, MH: The American Association for Cancer Education: Cancer education for 1990. medical students. J Cancer Educ 1:112-136, 1986. 6. Muller, S (Chairman). Preparing Physicians for the Twenty-First Century. The GPEP Report. Washing- 9. Rainsberry P, Grava-Gubins I, Khan SB. A study of ton, DC: Association of American Medical Colleges, the reliability/generalizability of short answer manage1984. ment on the 1989 certification examination in family medicine. Unpublished manuscript, Royal College of 7. Seegal AJ, Vanderschmidt H, Burglass R, et al. SysFamily Physicians of Canada, 1988. tematic Course Design in The Health Fields. New York: John Wiley and Sons, 1975.
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Defining and accomplishing clinically related objectives in an eight‐hour oncology course for first‐year medical students Linda Z. Nieman PhD & Rosaline Joseph MD To cite this article: Linda Z. Nieman PhD & Rosaline Joseph MD (1992) Defining and accomplishing clinically related objectives in an eight‐hour oncology course for first‐year medical students, Journal of Cancer Education, 7:3, 227-231 To link to this article: http://dx.doi.org/10.1080/08858199209528172
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 31 August 2017, At: 19:14
J. Cancer Education. Vol. 7, No. 3, pp. 227-231, 1992 Primed in the U.S.A. Pergamon Press Lid.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
DEFINING AND ACCOMPLISHING CLINICALLY RELATED OBJECTIVES IN AN EIGHT-HOUR ONCOLOGY COURSE FOR FIRST-YEAR MEDICAL STUDENTS
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
LINDA
Z. NIEMAN, PhD* and ROSALINE JOSEPH, MD†
Abstract—Designing a clinically relevant cancer curriculum for freshmen attending medical schools with a traditional curriculum poses the following challenges: (1) there is limited curriculum time; (2) the subject matter is complex. The authors defined some of the responsibilities of the general physician in regard to cancer and six related objectives that first-year students could accomplish in an eight-hour multidisciplinary oncology course. A case-based, modified essay examination required students to demonstrate that they could begin to integrate principles of prevention, screening, diagnosis and staging, and treatment modalities. Ninety percent of the students accomplished the objectives. However, in working up the cancer case, 70% of the students did not mention the physical examination and 53% forgot multidisciplinary consultation. In a curriculum with limited objectives, first-year students can begin to deal efficiently with the complexities of cancer. Evaluation data revealed those objectives and related physician responsibilities requiring reinforcement in subsequent training.
INTRODUCTION The growing amount of information included in the traditional, lecture-oriented basic science years makes it increasingly problematic for cancer educators to find required time to introduce students to basic scientific and clinical concepts concerning cancer. When dedicated time is given to cancer education, educators assume the difficult task of defining and evaluating objectives that are relevant to students early in their education while still reflecting the complex nature of the subject matter. A number of authors from medical schools in Europe and the United States have described different solutions to implementing and evaluating a preclinical oncology curricThis project was supported in part by the American Cancer Society, Philadelphia Division, Tuttleman Professorship of Clinical Oncology, (Rosaline Joseph, M.D.). *Office of Medical Education, Medical College of Pennsylvania, Philadelphia. †Division of Hematology/Oncology, Department of Medicine, Medical College of Pennsylvania, Philadelphia. Reprint requests and correspondence to: Linda Z. Nieman, Ph.D., Assistant Dean for Medical Education, Office of Medical Education, The Medical College of Pennsylvania, 3300 Henry Avenue, Philadelphia, PA 19129.
ulum. Bosman described a problem-based teaching program at the Limburg Medical School in Maastricht, which had a mandatory six-week block devoted to oncology.1 The Oncology course was evaluated in terms of the degree to which students integrated knowledge and appreciated the teaching. Love explained details of the curriculum offered at the University of Wisconsin Medical School, which had a mandatory 30-hour block in neoplastic diseases taught in year 2. 2 Oncology teaching at that institution included a variety of innovative teaching alternatives to the lecture. Students were assessed on presentations and an essay examination of cognitive knowledge. The most frequently described curriculum offering in Oncology was the preclinical elective.3"5 At the University of Arkansas an uncredited and ungraded elective combining self-study and clinical experiences was offered following the first year.3 The State University of New York at Buffalo provided a credited elective with no evaluation of students.4 Biological and environmental topics were presented in a seminar setting with discussion of sociomedical and treatment issues. A credited, semester-long elective with pretesting and posttesting of knowledge and attitudes
227
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
228
L. Z. NEEMAN AND R. JOSEPH
was offered in the first year at the University petencies) that each student was expected to of Rochester School of Medicine and Den- demonstrate at each level of training. Each intistry.5 Positive student responses were noted terim skill related specifically to the responsiby all authors describing these oncology bilities of the practicing general physician. By making the relationship explicit, we encourofferings. In the well-publicized GPEP Report, Pre- aged faculty involved in teaching to direct paring Physicians for the Twenty-First Cen- their efforts toward clinically relevant matetury, The Association of American Medical rial and to involve students at all levels in esColleges affirmed that there was "a common sential clinical skills. Bakemeier and Edwards' foundation of knowledge, skills, values and listing of cancer education objectives was parattitudes" that all physicians should have re- ticularly helpful in the formulation of interim 8 gardless of their specialty.6 We could find no skills. The first-year curriculum fit within a manpreclinical course that was explicitly designed around the "common foundation." The pur- datory eight hours of teaching time. Students pose of this educational development project, were given the list of responsibilities and were then, was to define the "common foundation" informed that they should demonstrate six in regard to cancer prevention and manage- limited-interim objectives related to those rement and to design and evaluate a brief, first- sponsibilities by the end of the eight hours: year auricular intervention that would reflect 1. List environmental and lifestyle prethe foundation. ventable causes of cancer. 2. Define screening and identify qualities METHODS of a good screening test for cancer. At the Medical College of Pennsylvania, a multidisciplinary Cancer Coordinating Committee (clinical oncologists, pathologist, psyTable 1. List of professional responsibilities* chiatrist, social worker, and nurse) oversees of the general physician in regard to cancer prevention and management the integration of the cancer curriculum during both the undergraduate and graduate 1. Takes a medical history that includes questions years. One of the authors, who was an Amerregarding risk factors and warning signs of cancer. ican Cancer Society Professor (RJ), was des2. Advises patients on cancer prevention. - Assesses individual risk factors. ignated as the director of the longitudinal - Suggests behavioral changes to reduce risks. cancer curriculum. The model of Seegal et al. 3. Advises patients regarding available community for competency-based courses provided the resources for screening, costs of screening, risks and benefits of screening, and reimbursability. curriculum format.7 As a first step, the auConsiders cancer within the differential diagnosis. thors identified the "responsibilities" of the 4. 5. Conducts a complete cancer-related history and physpracticing general physician in regard to cancer ical examination. prevention and management. Responsibilities 6. Orders laboratory tests that make sense in terms of the patient's presentation and cost/risk benefits. are the activities for which medical students 7. Obtains appropriate consultation for the diagnostic will be accountable in their future professional workup. 8. Coordinates the care of the cancer patient. roles as physicians. Thus, the responsibilities - Seeks appropriate multidisciplinary consultation. communicated the common foundation (ie, - Remains available to the patient and patient's exit objectives in regard to cancer) that stufamily. dents should achieve. Eleven responsibilities 9. Assists patients with choosing among therapeutic options. (Table 1) were accepted by the Cancer Coor10. Provides emotional support to the patient. dinating Committee following slight revisions 11. States a plan for continuing self-education in the area of the authors' original statements. of cancer. As a second step in writing the curriculum, *The activities for which physicians in training will be the authors identified interim skills (ie, com- accountable in their future roles.
Oncology course for first-year medical students
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
3. Identify types of studies that are available/necessary for proper diagnosis and staging of cancer. 4. Identify major modalities for cancer treatment. 5. Identify the importance of multidisciplinary management of cancer. 6. Discuss psychosocial aspects of the patient's management. The eight-hour, required, lecture-based course was taught by faculty from the departments of pathology, Community and Preventive Medicine, Medicine, Psychiatry, Radiology, Obstetrics and Gynecology, and Surgery. There were four two-hour sessions providing an introduction to epidemiology, prevention, diagnosis, and staging of cancer. Principles of multimodality treatment, rehabilitation and psychosocial support of cancer patients were also taught. Cervical and ovarian cancer were used as models. During the last session students interviewed a cancer patient applying the skills they had gained during the course. EVALUATION Cervical cancer, which had been discussed in all aspects from prevention to treatment was selected as the appropriate disease model that would be used to assess the student's attainment of the six interim objectives. At the end of the course the students were administered a case study of 21-year old college student who sought advice regarding the possibility of her having cervical cancer. The format for the examination was the modified essay, which has been shown to be a reliable alternative to multiple choice examinations.9 Students were asked to read the case vignette and respond to the "patient" regarding (a) her risk factors, (b) what they would do if she had a precursor lesion, (c) the advice they would give her regarding prevention, {d) procedures that they would follow if she had a precursor lesion, and (e) the steps that they would take following diagnosis. Sample written responses were prepared
229
consisting of essential points relevant to each portion (a-e) of the examination. Essential points included (a) the number and degree of risk of the patient's sexual partners, frequency and age of onset of sexual activity, her history of sexually transmitted disease, and her smoking history; (6) the need for physical examination, pelvic examination, and pap smear; (c) safe sexual practices and American Cancer Society Guidelines for regular pap smears; (d) the need for a biopsy in case of a precursor lesion; and (e) staging and multidisciplinary consultation. Each student was graded according to the degree to which his/her responses agreed with the sample responses. Ninety percent of the 111 students accomplished the interim objectives adequately enough to receive an unqualified passing grade. The percent of these students who included each of the essential points is shown in Fig 1. Of interest, the most frequently missed concept related to objective 3. Seventy percent of students neglected to include physical examination in their diagnostic workup for cancer but moved directly to sophisticated tests. Fifty-three percent did not include multidisciplinary consultation in their management plans (objective 5), although they showed a good grasp of individual modalities. DISCUSSION Several curriculum models have been developed as ways of teaching preclinical students essential oncology knowledge, skills, and attitudes. None of these was based upon a curriculum that explicitly stated the responsibilities of the general physician in regard to cancer prevention and medicine. Yet, the Association for American Medical Colleges has made the education of the general physician a major goal. The responsibilities, which were defined for our graduates by the authors and the Cancer Coordinating Committee, may differ from those espoused by other educators. We learned that most of the six interim objectives of the first-year cancer curriculum could be accomplished within eight hours of teaching time when evaluation was restricted
230
L . Z. NlEMAN AND R. JOSEPH
100 90807072%
68%
60Percent of SOH Students
47% 40-
30-
30%
20-
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
10-
V
Y Dtecuswd Risk Assessment
Identified Cancer Behaviors
Biopsy
I
Y Physical Pelvic Exam
Y Multidlsciplinary ConsuHslion
Recommended Appropriate Studies
Figure 1. Achievement of Oncology objectives by first-year students as assessed by a case-based examination.
to a single disease model. The highest percentage of students achieved objectives associated with risk assessment and cancer prevention behaviors. They did less well with objectives related to recommended studies. Students more readily mention prevention rather than procedures such as physical examination and biopsy, perhaps because these are part of their general and preclinical education. We must be careful at this stage of course design not to generalize our results beyond the single cancer model that we tested. It is possible for first-year students to begin to deal effectively with the complexities of cancer by stating the responsibilities of the general physician in regard to cancer and by establishing limited objectives related to these responsibilities. Students need to be given the responsibilities and objectives toward which the course is directed. They also should know that they will be tested with a case-based evaluation instrument that requires them to integrate concepts. Oncology faculty can use case-based evaluation data to determine how well students have integrated the concepts or objectives and which of these require special reinforcement in subsequent training. Our findings suggest that students might integrate
material better if it is both taught and tested in a case-based format. We intend to modify the sophomore course so that this integration is reinforced as students continue their studies. Administrators can use the responsibilities as exit objectives for graduating students. Results of using this design in one medical school revealed that in our traditional curriculum, greater attention needs to be paid to reinforcing general clinical concepts since preclinical students seem to focus on specific facts. REFERENCES 1. Bosnian FT: Integrated Oncology course for first-year medical students. J. Cancer Educ 2:129-133, 1987. 2. Love RR: Methods for increasing active medical student participation in their own learning: Experience with a single 30-hour course for 111 preclinical students. J Cancer Educ 5:35-36, 1990. 3. Neilan BA, Westbrook KC, Riggs C, et al; Clinical oncology assistantship program for medical students. J Med Educ 30:473-77, 1985. 4. Peters AS, Schimpfhauser FT, Wright J, et al: Effect of a cancer education program on student interest and learning in cancer. J Med Educ 61:163-168, 1986. 5. Krackov S, Preston W, Rubin P: Effects of an oncology elective on first-year medical students' knowledge
Oncology course for first-year medical students
231
Downloaded by [Australian Catholic University] at 19:14 31 August 2017
and attitudes about cancer. J Cancer Educ 5:43-49, 8. Bakemeier, RF, Edwards, MH: The American Association for Cancer Education: Cancer education for 1990. medical students. J Cancer Educ 1:112-136, 1986. 6. Muller, S (Chairman). Preparing Physicians for the Twenty-First Century. The GPEP Report. Washing- 9. Rainsberry P, Grava-Gubins I, Khan SB. A study of ton, DC: Association of American Medical Colleges, the reliability/generalizability of short answer manage1984. ment on the 1989 certification examination in family medicine. Unpublished manuscript, Royal College of 7. Seegal AJ, Vanderschmidt H, Burglass R, et al. SysFamily Physicians of Canada, 1988. tematic Course Design in The Health Fields. New York: John Wiley and Sons, 1975.
