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By H. Kor-Shach. Northeastern State University.

The traditional way of medical school teaching has been to require students to undertake sequential courses in the pre-clinical and para-clinical sciences as a prerequisite to commencing studies in the medical sciences and clinical practice discount v gel 30g with mastercard. Such courses have been the autonomous responsibility of academic departments who have jea- lously guarded their curriculum time and their control over course content and examinations. The degree of integration, particularly in the pre-clinical disciplines, has often been limited. This structure has formed the basis of the curriculum for most medical schools since the Flexner report in 1910 but is starting to collapse in the face of the intolerable load of information that each discipline expects the student to learn. The veritable explosion of scientific knowledge relevant to medicine, and the increasing specialisation of clinical practice, has led to unmanageable requests for the inclusion of more courses and more content without agreement or action on what is to be excluded. Efforts to deal with these issues using strategies such as organ systems teaching have made little impact. An alternative approach has become necessary and PBL is one gaining increasing acceptance. Students work through these problems, under greater or lesser degree of guidance from tutors, defining what they do not know and what they need to know in order to understand (not necessarily just to solve) the problem. The justification for this is firmly based in modern psychological theories of learning which have determined that knowledge is remembered and recalled more effectively if learning is based in the context in which it is going to be used in the future. Thus, if basic science knowledge is structured around representations of cases likely to be encountered in medical practice in the future, it is more likely to be remembered. Problem-based learning is also inherently integrative with the need to understand relevant aspects of anatomy, physiology, biochemistry, pathology and so on being readily apparent in each case. There is some evidence that students do, in the long term, recall more information in the context of patient problems when taught in thePBLway when compared with students taught in the disciplinary-based way. What is strikingly apparent is that students prefer this approach and become much more motivated to learn, a prerequisite to the desirable deep approach to learning discussed in Chapter 1. Other educational objectives believed to be addressed by PBL are, according to Barrows, the development of effective clinical reasoning skills and self directed learning skills.

Freeman completed his pediatric training at Hopkins where David Clark had served as his mentor and role model purchase v gel 30g without prescription. This was followed by a child neurology fellowship at the Columbia Neurological Institute, Preface xix under the mentorship of Dr. Freeman was initially recruited by McKhann to join him at Stanford, but after enjoying sunny California for only 3 years, he repacked and returned to the East coast. It is notable that three of the four initial neurology residents, Gary Goldstein, William Logan, and Mark Molliver, were all pediatric neurology trainees. Apparently, the Osler medical residents were not informed that they were being supervised by mere pediatricians. The goal from the outset was to train academic neurologists who would advance the field, as well as train others. In starting the child neurology program, Freeman’s initial goal was to reverse the segregation policy that had been in place during his residency. He established an integrated clinic that wall open to all—black, white, rich or poor—and staffed it with residents and medical students under his supervision. Freeman also organized a com- bined service for pediatric neurology and neurosurgery patients. Clearly, the patients received better and more consistent care than if they had been on only a surgical ser- vice. Unfortunately, in later years because of house staff shortages, billing, and other issues, this unique concept had to be abandoned. The goal of the pediatric neurology training program was identical to that of adult neurology, i. During his tenure as Director of Child Neurology from 1969 to 1990, he trained 44 individuals in child neurology. Thirty-one of the 44 entered academic neurology and most went on to run their own training programs—wonderful legacy! His philosophy was to attract the best and the brightest and instill in than the joys of academia.

Before detailing the perceptions of interviewees cheap v gel 30g mastercard, I must acknowledge an important limitation of my project. Yet, by definition, this book is about change—progressive chronic conditions. About three to five years after disability begins, peo- ple typically stop talking about how it happened—“it’s a moot point” (Olkin 1999, 60). People’s perceptions evolve, although research suggests that atti- tudes are unrelated to the extent of physical impairments. The value that peo- ple place on their physical abilities shifts over time, as they become used to progressive impairments (Eklund and MacDonald 1991; Kutner et al. While others may perceive persons as having “poor” health, they themselves may prize their health “since they have adjusted their life styles and expectations to take account of their condition” (Dolan 1996, 559). These shifts in self-perceptions and expectations become especially apparent when someone finally decides to use a wheelchair (chapter 12). Ostensibly the quintessential symbol of defeat and despair, wheelchairs often restore inde- pendence to people who have long felt “stuck” in place (Scherer 1996, 2000). Experts have studied how people “adjust” to impairments, the “stages” they pass through to reconcile themselves to physical limitations. But peo- ple do not proceed, lock step, through neat stages, instead varying widely in their responses (Olkin 1999, 47). In chronic illness especially, physical abil- ities and sensations continuously shift, unlike for injured people (where deficits are fixed, although functioning can alter with secondary condi- tions). One large challenge is learning “to live with ongoing and perma- nent uncertainty” (Toombs 1995, 20). Rhonda Olkin, a psychotherapist who uses a scooter because of polio, became increasingly uncomfortable as she read articles on rehabilitation. Rather, it continues to wend its way, often up, sometimes downward, through- out the life-span in a continuous process. Two coping styles emerge: “problem-focused,” con- fronting the difficulty, seeking relevant information, and devising manage- ment strategies; and “emotion-focused,” denial, escape, avoidance, or recon- figuring the problem to appear more positive. Sometimes clinicians pressure people “not only to cope but to cope correctly,” thus implicitly criticizing those “who are doing the best they know how under trying circumstances” (Olkin 1999, 124).