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Background and objective: The case/problem-based learning discussion method was recently introduced into the theory-based training program for residents run by the Catalan Society of Anaesthesiology. This study was designed to assess and compare its effectiveness with that of the lecture-based approach for teaching pre-anaesthetic assessment, applying an objective tool for knowledge evaluation before and after teaching. Methods: A prospective randomized study of two consecutive year groups of first year anaesthesiology residents was conducted. Twenty-nine residents attended a lecture, and 25, a case/problem-based learning discussion session. Their knowledge of pre-anaesthetic assessment was assessed before and after the teaching session with tests on four different clinical cases measuring six fields: (1) 'recognizing clinical data with anaesthetic implications'; (2) 'reasoning clinical data with anaesthetic implications'; (3) 'ASA class'; (4) 'Mallampati class'; (5) 'choice of anaesthetic technique'; (6) 'reasoning choice of anaesthetic technique'. Results: Before the teaching session, the lecture group scored significantly higher on field 1 (P = 0.006). Both teaching methods improved scores on fields 1, 2 and 4. The case/problem group also improved on fields 3 and 6. After the teaching session, the field 1 score was still significantly higher in the lecture group (P = 0.005), and the field 3 score was significantly higher in the case/problem group (P = 0.044). Conclusions: The effectiveness of lecture and case/problem-based learning discussion differed little in terms of improving participants' immediate knowledge of 'pre-anaesthetic assessment'. © 2007 Copyright European Society of Anaesthesiology.

Aim: To assess and observe the development of competence in oral surgical skills during a 3-year undergraduate programme. Method: Over a 3-year period 75 students were followed through from the beginning of their clinical course to their Bachelor of Dental Surgery graduation and their surgical experience monitored by the use of logbooks. Their development of competence was assessed objectively through structured assessments and subjectively by a single tutor responsible for each year. Assessments were made of their ability in exodontia, pre-surgical assessment and the surgical extraction of teeth/roots. Results: Seventy-three students completed the course (97%). Successful completion rates for the objective testing were 100% for both exodontia and pre-surgical assessment. The surgical assessment, (surgical extraction of a tooth or root) had a successful completion rate of only 23% and the caseload for students was low with a mean of four teeth removed surgically upon graduation. Relationships were examined between total numbers of teeth extracted, total number of minor oral surgical procedures completed and the successful completion of the surgical competence assessment, but no significant relationships were found. Conclusions: This study demonstrates that it is possible to achieve objectively measurable levels of competence in undergraduates undertaking oral surgery procedures. It is however, a labour and time intensive process and appropriate clinical and teaching resources are required. National co-operation towards agreed standardised competencies should be encouraged to allow data to be pooled and more powerful analyses to occur. © 2007 The Authors. Journal Compilation © 2007 Blackwell Munksgaard.

Background: Although medical students' use of portfolios has been studied from many angles, little is known about their motivations. Aim: This article explores medical students' motives for voluntarily compiling a learning portfolio that widely exceeded the assignments. Methods: Content analysis was performed on 22 (8%; n = 22/269) extensive portfolios, followed by a semi-structured interview with 11 medical students. Building on the theoretical work of Simons et al. (2004), interpretative analysis was used to reconstruct and understand the medical students' motives for the effort they put into the portfolios. Results: Compiling an elaborate portfolio is mainly instigated by a personal instrumentality (internally regulated instrumental motivation). These medical students reflected on what they considered important and useful. The portfolio was a tool to achieve self-set goals, yet the specific goals turned out to be very different among the students, reflecting their particular needs and experiences during clerkship. Conclusion: Motivation theory shows that students whoare internally regulated use more deep-level learning strategies and perform better. Internally regulated motivation mainly occurs when students use the portfolio to achieve their self-set goals. The formal portfolio assignments, enforced by the medical school, were more related with externally regulated motivation.

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Aims and objectives. The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. Background. Strategies for enabling continuous professional development are well established in healthcare organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. Conclusions. This study highlights important issues to be considered in developing a 'learning culture' in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work-based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. Relevance to clinical practice. The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom-based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work-based learning to be integrated into practice environments. © 2006 Blackwell Publishing Ltd.

An infusion of twenty-first century skills into American public education necessitates a plan for research and development to further such reform. While the nation agrees that students must obtain critical thinking, problem-solving, and communication skills to succeed in the current global marketplace, this chapter puts forth a long-term, proactive agenda to invest in targeted research to propel and sustain this shift in education. The authors examine the impact such an R&D agenda would have on pedagogy and assessment and the implications for institutions of higher education. As the United States struggles to maintain dominance in the international economy, it faces a great challenge in keeping up with European and Asian competitors' strategies for preparing youth for the global marketplace. The authors hope the global reality will help contextualize the debate around American education--the current trend toward basics and accountability needs to be broadened. Building on frameworks created by the Partnership for 21st Century Skills, this chapter proposes questions to guide research around teaching, professional development, and assessment significant to twenty-first century skills. Knowing that educational change depends on providing teachers with the tools, support, and training to make fundamental changes in their practice, the authors argue for extensive research around best practices. In addition, if assessments are created to measure the desired outcomes, such measuring tools can drive reform. Furthermore, large-scale changes in teacher preparation programs must take place to allow teachers to adequately employ twenty-first century teaching and assessment strategies.

Background. Research on individual learning approaches (or learning styles) is split in two traditions, one of which is biased towards academic learning, and the other towards learning from direct experience. Aims. In the reported study, the two traditions are linked by investigating the relationships between school-based (academic) and work-based (experiential) learning approaches of students in vocational education programs. Samples. Participants were 899 students of a Dutch school for secondary vocational education; 758 provided data on school-based learning, and 407 provided data on work-based learning, resulting in an overlap of 266 students from whom data were obtained on learning in both settings. Methods. Learning approaches in school and work settings were measured with questionnaires. Using factor analysis and cluster analysis, items and students were grouped, both with respect to school- and work-based learning. Results. The study identified two academic learning dimensions (constructive learning and reproductive learning), and three experiential learning dimensions (analysis, initiative, and immersion). Construction and analysis were correlated positively, and reproduction and initiative negatively. Cluster analysis resulted in the identification of three school-based learning orientations and three work-based learning orientations. The relation between the two types of learning orientations, expressed in Cramér's V, appeared to be weak. Conclusions. It is concluded that learning approaches are relatively context specific, which implies that neither theoretical tradition can claim general applicability. © 2006 The British Psychological Society.

INTRODUCTION: In 1988, the New South Wales (NSW) Department of Health developed the NSW Rural Resident Medical Officer Cadetship Program (Cadetship Program) to help overcome a junior doctor workforce shortage in rural hospitals. A second aim was to increase recruitment to the rural medical workforce on the basis that positive exposure to rural medicine increases the likelihood of choosing to practice in a rural location. The Cadetship Program offers bonded scholarships which provide financial support for residents of NSW studying medicine during the final 2 years of their medical degree. In return, cadets are contracted to complete 2 of their first 3 postgraduate years in the NSW rural hospital network. NSW Rural Doctors Network has managed the Cadetship Program for the NSW Department of Health since 1993, and carried out an evaluation in 2004. The purpose of this evaluation was to track the career choice and practice location of medical students entering the Cadetship Program before 1999, and to comment on the impact of the Program on the rural medical workforce in NSW to date, and its implications for the future workforce. METHODS: The career choice and practice locations of 107 medical students who received cadetships between 1989 and 1998 were tracked. Students who did not graduate from medical school (n = 3) or who did not complete their rural service (13) were excluded from the analysis. Career choice was not available for a further nine former cadets and they were also excluded from the analysis. The NSW Rural Doctors Network was the major source of data on career choice and practice location due to its role in administering the Cadetship Program on behalf of the NSW Department of Health. Two brief questionnaires targeting specific groups of cadets were used to fill knowledge gaps about where cadets grew up, what vocational training they undertook, and where they were working in 2004. Where this information was not obtained from cadets first hand, it was sourced from the CD-ROM version of the Medical Directory of Australia. RESULTS: Forty-three percent of cadets entering the Program before 1999 were working in rural locations in 2004 (compared with 20.5% of medical practitioners nationally), 46% had attended primary school in a rural location and 44% chose to specialize in general practice. Career choice was the major determinant of practice location. Having a rural background did not appear to influence practice location; whereas, those specialising in general practice made up 70% of this cohort of cadets working in rural areas. All general practice trainees were in rural locations compared with only two of the 25 trainee specialists, which reflects the availability of accredited training places in rural Australia. CONCLUSIONS: The Cadetship Program, which ensures junior doctors work for 2 of their first 3 postgraduate years in a rural allocation centre, is an effective link between medical school and rural practice, particularly rural general practice. Providing vocational training opportunities in rural locations is central to this success, and needs to be considered in efforts to expand the rural specialist workforce, and in ensuring rural health capitalises on the increasing number of medical students moving through the education and training system in the next 4-10 years.

Aim: Published studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners. Materials and methods: This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication. Results: (1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs. Conclusion: Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified. © British Dental Journal 2006.