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  • Title: An evaluation of teaching methods utilized during an HIV miniresidency course for Thai physicians.
    Author: Zell SC.
    Journal: AIDS Educ Prev; 1997 Feb; 9(1):70-82. PubMed ID: 9083592.
    Abstract:
    This study examines the efficacy of medical education methods in improving the knowledge base and clinical skills of participants attending a 2-day miniresidency course in HIV infection. Instructional methods included: a didactic lecture format, diagnostic algorithm presentation, color slide photographic demonstration, bedside teaching rounds, and "meet-the-professor" sessions. Questions to assess the various instructional formats were administered and teaching methods were evaluated. Fifty-seven Thai physicians, highly exposed to HIV patient care duties, completed both precourse and postcourse tests. Overall, significant improvement was noted in participant's final global test score. However, discrepancies existed among the efficacy of instructional methods. Recognizing physical signs of HIV infection, as taught by slide photographs, revealed a high baseline level of expertise. Statistically significant postcourse gains were made in physician's diagnostic decision-making ability and basic knowledge of HIV and AIDS taught respectively by the methods of a teaching algorithm and didactic lecture. Despite the latter, participation performed poorly regarding HIV case management. This observation may be related to test design and cultural differences but likely underscores the difficulty in imparting clinical HIV management skills to course participants over a short period of time. Future continuing medical education (CME) courses intended to enhance physician care for the HIV infected must strive to refine evaluation methods for assessing case management skills while exploring innovative instructional techniques when current methods are ineffective. To improve the skills of Thai physicians in the ambulatory care of patients with HIV and AIDS, a 2-day miniresidency was designed and tested in Bangkok in 1994. Course content included a photographic demonstration, didactic presentations, diagnostic algorithms, bedside teaching rounds, and questions and answers. Of the 57 physicians who completed the 2-day training, 88% reported HIV patient care duties and 44% estimated that over 20 such patients were currently in their care. Before the course, the mean strength of agreement with the statement, "I feel that I need to know more about HIV disease," was 4.10 out of a maximum of 5.00. Pre-test scores (0-100) were 80.3 for recognition of the physical signs of HIV/AIDS, 67.1 for diagnostic decision making, 61.4 for basic knowledge, and 40.0 for case study management. Post-test scores were 84.0, 80.5, 79.7, and 45.2, respectively, with an overall knowledge gain of 11.2 points (17.9% increase). Despite improvements in knowledge base and diagnostic ability, case management skills remained unsatisfactory. The inherent complexity of the written case scenarios presented to physicians in the test may have masked gains achieved in clinical management skills. However, future courses intended to enhance physician care in this area should seek to refine methods for assessing case management skills and to identify innovative alternative instructional techniques.
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