BackgroundMajor changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy. Little guidance exists for medical educators designing anatomy courses that account for factors that positively influence medical student confidence in their own anatomy knowledge. We sought to determine what factors are associated with medical students’ self-reported confidence in their anatomy knowledge in preparation for clinical practice.MethodsCross-sectional national survey of Australian medical students distributed using social media. We performed univariate and multivariable ordinal regression to determine the factors in anatomy learning and teaching that influence medical student self-reported confidence to have sufficient anatomy knowledge by the time of graduation, for practice as a junior doctor.ResultsOf 1309 surveyed, 1101 (84%) responded, representing 6.5% of the Australian medical student population. Mean age was 23.9 years (SD 4.8 years), a majority were female (644, 58.5%), and students in all years of both undergraduate (52%, 575) and graduate entry courses (48%, 529) were represented. Items associated with increased self-reported confidence in anatomy knowledge included adequate assessment of anatomy (Odds Ratio 2.17 [95% CI 1.69–2.81]), integration of anatomy with other basic sciences (OR 1.97 [1.52–2.56]) and clinical teaching (OR 1.90 [1.46–2.48]), male gender (OR 1.89 [1.48–2.42]), anatomy education prior to medical school (OR 1.46 [1.14–1.87]) and exposure to dissection (OR 1.39 [1.08–1.78]). Medical students in their clinical years reported lower confidence in their anatomy knowledge (OR 0.6 [0.47–0.77], p < 0.0001). Age and career intention were not significant predictors of confidence.ConclusionsMedical educators can enhance student confidence in their own anatomy knowledge by developing curricula that vertically integrating anatomy learning and teaching, integrate anatomy teaching with other basic sciences, and providing consistent assessment through both the pre-clinical and clinical stages of medical training. Anatomy education should also incorporate dissection as a teaching method, and students could benefit from completion of anatomy education prior to medical school. Consideration should also be given to further investigate the confidence of female students in their anatomy knowledge.
University faculty members, district and school administrators, and teams of teachers from seven rural schools worked together for 18 months, seeking to accomplish clearly identified school improvement goals using a collaborative inquiry approach. Five of seven school teams demonstrated increases in collaborative behavior that, in turn, enhanced their ability to accomplish their goals. Four schools showed improvements in student achievement on external exams that were identified as measures related to their goals. Two schools showed minimal improvement on any measures. Lack of improvement was mostly related to changes in team membership, changes in leadership, unresolved conflict, or an inability to sustain focus on a goal. Improvement in student learning was observed and documented in writing and reading skills, numeracy, assignment completion, and classroom behavior. The most apparent aspects of teacher growth were pronounced increases in professional reading, enhanced knowledge of curriculum, improved assessment practices, and shared leadership. However, involvement in the project failed to encourage a majority of teachers to share aspects of their teaching practice with their colleagues. Principals of successful projects were seen to be effective in sharing responsibility, managing conflict, communicating clearly, and ensuring task completion. Less effective principals were seen as more controlling. less willing to delegaie, and not skilful in managing conflict.SPRING 2008 53
The aim of this study is to identify the role of incomplete suppression during the first months of highly active antiretroviral treatment (HAART) to predict virologic failure in patients with high levels of HIV replication. In a retrospective, longitudinal, and multicenter study, response to HAART was assessed in treatment-naive adults with HIV RNA >100 000 copies/mL, and factors predicting failure were analyzed through regression analyses. A total of 118 patients were included. Virologic failure occurred more often in patients with >500 copies/mL at week 12 (Cox regression: Exp (B) 3.22; P = .02). HIV RNA >500 copies/mL at week 12 predicted incomplete virologic response (odds ratio [OR] = 9.33; P = .002] but not viral rebound. Major antiretroviral resistant mutations were present in 11 of 14 patients. HIV RNA >500 copies/mL at week 12 of first HAART predicts incomplete virologic response in patients with high levels of replication at baseline. Most patients carried resistance mutations at the time of failure.
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