Student Evaluation of an Integrated, Spiral Model of Epidemiology Education at the Ege University

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1 O R I G I N A L R E S E A R C H P A P E R Student Evaluation of an Integrated, Spiral Model of Epidemiology Education at the Ege University ZA Ocek, S Taner Gursoy, M Ciceklioglu, F Aksu, Turk Soyer M Ege University, Faculty of Medicine, Department of Public Health, Bornova, Izmir Turkey Published: 12 September 2008 Ocek ZA, Taner Gursoy S, Ciceklioglu M, Aksu F, M Turk Soyer Student Evaluation of an Integrated, Spiral Model of Epidemiology Education at the Ege University Education for Health, Volume 21, Issue 2, 2008 Available from: A B S T R A C T Objectives: The Ege University Faculty of Medicine (EUMF) introduced a community-oriented undergraduate curriculum in In developing the epidemiology portion of the new curriculum, learning objectives were written for their relevance to different learner stages within the general curriculum and to Turkey s public health problems. Key learning objectives were that students should be able to comprehend the moral values of scientific research, principles of study design and evidence appraisal, and the role of epidemiology in clinical practice. The curriculum included didactic lectures and group activities. The aim of the present study was to explore third-year students perceptions of the epidemiology curriculum. Methods: The program was evaluated at the end of our students third year through written evaluations using quantitative and qualitative methods. Two hundred fifty-five students (92.7%) of all third-year medical students participated in the evaluation. Quantitative methods were based on student ratings, whereas qualitative method assessments involved content analysis of the students open-ended statements. Findings: Based on responses to fixed response items, more than seven out of every 10 students appreciated the value of epidemiology to the work of physicians. More than six out of 10 students evaluated the curriculum favorably, but only a third indicated that they became more interested in epidemiology with time, and one-quarter found epidemiology challenging. In students open-ended responses, the most frequent positive statements referred to students heightened interest in research and Health: 1

2 appreciation of the curriculum s interactive teaching. Some students criticized the content as difficult and felt that there were too many didactic lectures. Conclusion: Based on their evaluations, students found our new epidemiology curriculum acceptable, and regarded it as relevant and valuable to their future practice. Key words: Epidemiology education, medical students, public health curriculum, critical appraisal, scientific research Context There is increasing recognition of the importance of learning epidemiology for future physicians (Marantz et al., 2003). Widely regarded as the basic science of public health (Stone, 1998; Marantz et al., 2003), epidemiology also provides a foundation for such important competencies as critical thinking, clinical judgment and the practice of evidence-based medicine (Waters, 1984; Stone, 1998; Marantz et al., 2003; Khan et al., 2006). However, since medical students do not always perceive the need to study epidemiology (Novick et al., 1985), teaching epidemiology to them can be a challenging task (Waters, 1984; Novick et al., 1985; Dannenberg et al., 2002; Marantz et al., 2003). Many innovative methods, such as analysis of current community health problems (Novick et al., 1985), case discussions (Marantz et al., 2003), and critical appraisal of the literature (Astin et al., 2002) have been used to make epidemiology more attractive to medical students. The introduction of clinical epidemiology ward rounds in a pediatrics rotation is one successful example of how to teach the relevance of epidemiology in clinical practice (Stone, 1998); however this strategy is not appropriate for early students still completing basic science courses. The experience of Aberdeen University showed that epidemiology could be integrated with primary care training by general practice-based tutors (Moffat et al., 2004). Another approach puts epidemiological concepts into a public health context and integrates epidemiology and public health with other subjects within the first years of medical education. The British Committee of the General Medical Council also emphasized interdisciplinary integration in public health teaching and noted that the assessment of population needs and the influence of environmental and social factors are relevant to many parts of the curriculum (General Medical Council, 1993). Objective The aim of the present study was to examine students perceptions of the epidemiology teaching they receive in the first three years of the undergraduate curriculum at Turkey s Ege University. Description of Epidemiology Education in Ege University Medical Faculty Ege University, with its half-century history, is the focus of educational and cultural life of Izmir, the third largest city in Turkey. There are two medical faculties in Izmir; the Ege University Medical Faculty (EUMF) is the older. EUMF introduced a new community-oriented curriculum in The content and overall structure of the new curriculum were based on the spiral curriculum concept. According to this concept, students revisit topics, themes and subjects at several stages of the curriculum in order to help reinforce and deepen knowledge as it fits with other topics being learned at each stage (Harden & Health: 2

3 Stamper, 1999; Moffat, 2004). The new curriculum was organized into four stages within the first three years. Stage one is an introduction to medical sciences, and stage two covers normal human structure, function and behavior. Stage two includes four blocks: respiratory/circulatory, excretory/lymphatic systems, digestive system/metabolism, and musculoskeletal/nervous systems and human life stage. Stage three is an introduction to the pathological sciences, and stage four addresses pathology of each of the four system blocks of stage two (Figure 1). Within this curricular framework, subjects that could not be horizontally integrated into other topics were covered under three domains. The educational committee called these domains vertical corridors ; they included Community Health and Field Implementations (CHFI), Interpersonal and Clinical Skills, and Medical Ethics and Medico-legal Responsibilities. The Public Health Department, an academic unit within the EUMF, is responsible for the CHFI, which spans the first three years of the curriculum. CHFI aims to improve students awareness of its topics and develop positive attitudes towards the social dimensions of medicine. It covers a broad range of public health topics, including epidemiology. Affective Cognitive Skills VI Internship V Clinical Sciences Vertical corridor IV System Pathologies III Introduction to pathologies and clinics II Normal structure and function I Introduction to medical sciences Figure 1: Spiral Curriculum of Ege University Faculty of Medicine Health: 3

4 Marantz, P.R., Burton, W., & Steiner-Grossman, P. (2003). Using the case discussion method to teach epidemiology and biostatistics. Academic Medicine, 78(4), Marusic, A., & Marusic, M. (2003). Teaching students how to read and write science: A mandatory course on scientific research and communication in medicine. Academic Medicine, 78(12), Mays, N., & Pope, C. (1996). Rigour and qualitative research. In N. Mays & C. Pope, (Eds.), Qualitative research in health care. (pp ) London: BMJ Publishing Group. Moffat, M., Sinclair, H.K., Cleland, J.A., Smith, W.C.S. & Taylor, R.J. (2004). Epidemiology teaching: student and tutor perceptions. Medical Teacher, 26(8), Novick, L.F., Greene, C., & Vogt, R. (1985). Teaching medical students epidemiology: Utilizing a State Health Department. Public Health Reports, July-August 100(4), Preston-Whyte, E., & Fraser, R. (1997). Student attitudes to small group teaching. Educational for General Practice, 8, Rosenthal, J., & Ogden, J. (1998). Changes in medical education: the beliefs of medical students. Medical Education, 32, Stone, D.H. (1998). The clinical epidemiology ward round: can we teach public health medicine at the bedside? Journal of Public Health Medicine, 20(4), Waters, W.E. (1984). Teaching epidemiology to the medical students. Annals Academy of Medicine Singapore, 13, Appendix 1: Question form of Critical Appraisal 1 Category 1: Title Is it in accordance with the study? Is it stated clearly enough? If not, how should it be stated? Category 2: Abstract Is it explanatory in terms of its aims, methods, findings and conclusions? Is it structured? If not, how it should be structured? Category 3: Introduction Is there enough information about the topic s importance, risk groups and the frequency of the problem? Is there the rationale for the research? Health: 14

5 Category 4: Aim of the study Is it stated clearly enough? Is it in accordance with the method and the dependent variable? Category 5: Study population Is the risk group chosen as study population? Is there an explanation of how the sample size was calculated? What is the response rate? Category 6: Variables Which variables are taken into account? What else should be covered as variables? Are there any variables included in the analyses that were not introduced in the methods? Category 7: Classification Which variables findings are classified? Are the criteria of classification clearly explained? Category 8: Data collection method What data collection techniques were used? Are these techniques relevant for evaluating the study s variables? If not, what other techniques should be used? Is there enough information about the techniques used? Category 9: Findings Are findings presented for all variables? Are the titles of the tables relevant? If not, please indicate why. Are the findings presented in the tables adequate? Are the classifications of the data relevant? Category 10: Discussion Is the interpretation of causal relationships correct? Are all of the findings discussed? Are the study s limitations presented? Category 11: Ethics Is the method of the study acceptable ethically? Health: 15