Evaluating family counselling skills training for family practice

Educational programmes for family practice should develop family counselling skills of students to moderate levels of competence. Few specific training programmes are part of the regular curriculum and of these few are evaluated. Twenty-three residents enrolled in a 2-year family practice programme in Toronto, Canada participated in a non-randomized control intervention study to assess a specific training programme. Pre-training counselling skills, and ability were assessed using two types of generally recognized measurement instruments, the Carkhuff Stems of Communication Skills and the Carkhuff Discrimination Index. The treatment group entered the training programme which involved supervised family counselling 8 half-days each week for one month as part of their usual rotations. They completed a second set of instruments following this course to assess immediate within-group change and then both they and the control group completed a set about one year later to measure differences. Initial scores for all residents showed a less than 'minimally facilitative' level of counselling response on both empathy and warmth dimensions. Following the course, the treatment group scored above this level and significantly better than the control group. Furthermore, the former showed a 20% improvement in ability to discriminate between effective and ineffective helping responses which was sustained over one year, while the control group's scores became worse. Teaching of counselling skills can be effective.     

Educational intervention in pharmacy students' attitudes to HIV/AIDS and drug misuse

Summary: By providing injecting equipment to drug misusers, community pharmacists in the UK may become involved in preventing the spread of HIV via the intravenous route. Over 60% of pharmacy graduates from the School of Pharmacy enter community pharmacy and, as part of their undergraduate course, attend a series of lectures and seminars on HIV/AIDS and drug misuse. The aim of this research was to:

• (1) 

  investigate students' attitudes to these subjects;
• 2 

  assess the students' knowledge of HIV/AIDS;
• 3 

  evaluate any change in level of knowledge or of attitude after attending the course; and
• 4 

  investigate students' attitudes towards the teaching of these subjects.

A questionnaire was administered to students before and after their undergraduate course. The level of knowledge increased significantly after attending the course. Students were asked their opinion on the teaching of HIV/AIDS and drug misuse at the School of Pharmacy. After the course, significantly more responded 'good' or 'very good' with regard to teaching on social issues in drug misuse, rehabilitation and treatment of drug misusers, and health education on HIV/AIDS. There was no significant change in attitude, after the course. Attitude to HIV/AIDS and drug misuse was found to be unassociated with previous experience of working in pharmacies supplying injecting equipment and prescribed methadone. Both attitude and pre-course assessed knowledge were significantly associated with race and religion. These results indicate that attending the course had the effect of increasing knowledge of HIV/AIDS and increasing confidence in counselling clients. The perception of the teaching was also seen to be more positive.     

Teaching interviewing skills to paediatric junior clerks using simulated mothers

In this article a training programme is described for improving interviewing skills of students in the fifth year (junior clerkship) of the medical curriculum. Two interviews with a 'simulated mother' form the core of the programme. The interviews are immediately followed by a feedback session in which the simulated mother discusses the strong and the weak points of the interview. In the feedback she makes use of a checklist with relevant points concerning the content and the process of the interview. Where required the comments are substantiated with fragments of the videotaped interview. In a 2-hour theoretical session, students are told how to prepare themselves for the interview. The learning effects of the training programme using simulated mothers were evaluated in order to determine: (1) the subsequent improvement in interviewing skills; and (2) the effect of the feedback session. It was found that students' interviewing skills improved significantly on the content and the process aspects after one or two interviews. In addition the feedback sessions proved very helpful, although no significant differences were revealed, when comparing the mean group scores for students who had had feedback sessions with the scores for those who had not. The results also revealed that two interviews were insufficient and that the training should include at least three interviews. This was borne out by the large number of students who asked for more interviews with simulated mothers. In the training programme the simulated mothers perform two functions: (1) playing the role of the mother of a sick child; and (2) giving feedback to students regarding their interviewing skills.(ABSTRACT TRUNCATED AT 250 WORDS)     

Introducing training in primary health care programme management into the curriculum

A short account of the objectives and strategies of Gezira Medical School in relation to community medicine and primary health care is given. The introduction of primary health care programme management into the curriculum is described. Preliminary evaluation of the first course reflected positive results for students' achievement and acceptance. The experience proved the feasibility of integrating health care programme management into the undergraduate curriculum.     

Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education

OBJECTIVE: To compare alcohol-related intervention and general interactional skills performance of medical students from a traditional (Sydney) and a non-traditional (Newcastle) medical school, before and after participation in an alcohol education programme about brief intervention. DESIGN: In two controlled trials, students received either a didactic alcohol education programme or didactic input plus skills-based training. Prior to and after training, all students completed videotaped interviews with simulated patients. SETTING: The Faculties of Medicine at the University of Newcastle and the University of Sydney, Australia. SUBJECTS: Fifth-year medical students (n=154). RESULTS: Both alcohol-related intervention and general interactional skills scores of the Newcastle students were significantly higher than those of the Sydney students at pre-test but not after training. Although alcohol-related interactional skills scores improved after training at both universities, they did not reach a satisfactory level. The educational approach used had no effect on post-test scores at either university. CONCLUSIONS: Significant baseline differences in interactional skills scores favouring non-traditional over traditional students were no longer evident after both groups had been involved in an alcohol education programme. Further research is required to develop more effective alcohol intervention training methods.     

Teaching brief motivational interviewing to Year three medical students

OBJECTIVES: In 2005, the authors developed and tested a curriculum to teach Year 3 Yale University medical students a behaviour change counselling approach called 'brief motivational interviewing' (BMI). Brief motivational interviewing is a patient-centred approach designed to promote changes in patient behaviour within the time constraints imposed by a busy medical practice. METHODS: Standardised patients/instructors delivered the curriculum within a single 2-hour training episode using a teaching acronym called 'CHANGE' to promote the students' learning. The authors used a pretest, post-test and 4-week follow-up design to assess students' BMI skills (as measured by the Helpful Response Questionnaire), knowledge and attitudes toward the approach. RESULTS: Students successfully increased their use of BMI-consistent behaviours, primarily by increasing the frequency and depth of their reflections and by reducing the frequency with which they incorporated communication roadblocks and closed questions into their responses (all P-values < or = 0.05). Students also showed increases in BMI knowledge, interest in the approach, confidence in their ability to use BMI, and commitment to incorporating BMI skills into their future medical practice (all P-values < or = 0.05). CONCLUSIONS: The findings suggest that Year 3 medical students can learn basic BMI skills and knowledge and develop positive attitudes toward the approach within a relatively short period of time. The authors discuss the study's limitations and future directions for teaching students BMI.     

Learning human anatomy: does learning occur during a lecture?

Information uptake during a formal lecture was evaluated using a sample of 43 second-year medical students to whom a topic on human developmental anatomy was presented. The sample was divided into two groups: Blue (group B) (21 students) and Red (group R) (22 students). Prior to the lecture, a pre-test of 20 multiple choice questions was administered to each group. The lecture was then delivered over 50 minutes. Both in its preparation and presentation, the lecture conformed to the principles of programmed instruction. After a 10-minute students' question-and-answer session, a post-test was served. For group B, this was group R's pretest while group R, in turn, received group B's pretest. No question in the pre-test was repeated in the post-test. Intergroup comparisons of pre-test scores and of post-test scores revealed non-significant differences (P greater than 0.05), thus confirming that the pre- and the post-tests were of comparable difficulty. In each group, the mean post-test score was significantly higher than the pre-test score (P less than 0.001). The pooled scores indicated that the percentage mastery of material presented during the lecture increased from -1.8% to 58.4%. These results demonstrate that significant learning can occur during a lecture prepared and delivered in accordance with sound pedagogical principles.     

Attitude towards computer-based learning: determinants as revealed by a controlled interventional study

BACKGROUND: Curriculum-wide implementation of computer-based learning (CBL) in undergraduate medical education remains elusive. Unlike many pilot tests of singular learning programmes, dropout rates are high and acceptance seems low in the long run. We studied the effect of a new CBL programme, suitable for curriculum-wide implementation, on Year 3 medical students' attitudes towards CBL. METHODS: Students from 2 universities participating in a mandatory pharmacology course were given access to a CBL programme covering cardiovascular drug therapy in a controlled randomised study (n = 167). Learner properties and attitude towards CBL were measured using psychometric scales, and knowledge by multiple-choice questions (pre- and post-test). RESULTS: Attitude towards CBL worsened in the CBL group (n = 70). Individual learners' properties did not explain this effect. The perceived programme quality was rated only 'average', which may contribute to the lower post-test values of attitude towards CBL. Learning outcomes were similar between the control group (n = 97) and students using CBL (n = 44). Learning efforts were shifted from self-study towards CBL. CONCLUSION: The initial enthusiasm of students was not maintained when using a programme designed to complement or even replace traditional teaching. Curriculum-wide implementation of CBL might be hampered by the discouragement of users.     

Objective-structured teaching of undergraduate neurology

Medical students at two teaching institutions were given an objective list containing information thought to be of maximum neurological teaching value. The usefulness of the objective list was assessed by giving the students pre- and post-tests containing questions that were derived from the objective list. Irrespective of the disparity in the clinical teaching programme, there was no significant difference between test scores of students who rotated at the two institutions. Comparison of pre- and post-test scores showed a highly significant improvement (P less than 0.005) in test scores. An objective list should be part of an effective undergraduate teaching programme in neurology.     

A skills programme for preclinical medical students

An education programme in which preclinical medical students are introduced to common procedural skills is described. This programme is presented by a multidisciplinary health care team using short lectures, demonstrations, mannequin practice, and, in selected instances, practice on class-mate volunteers. The programme was evaluated by the students immediately following the presentation and for one class during their clinical activities one year later. The students' support for this programme was generally enthusiastic and remained undiminished upon reflection 12 months later.     

A life-cycle conference series: education for general practice

An all round educational programme for general practice trainees involving a conference and seminar curriculum was developed, based on a life-cycle concept. In addition to emphasizing the study of usual life stresses and crises for individuals and families, the programme encouraged the contribution of resource people from many related medical disciplines and also from the non-health sciences. Detailed planning allowed the structuring of the conference over an academic year. Clearly defining the objectives for each meeting led to effective evaluation and enhanced the educational process.     

Teaching medical students alcohol intervention skills: results of a controlled trial

OBJECTIVE: To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills. DESIGN: In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experimental students made a 20-min videotape and participated in a 1.5-h small group feedback session. Prior to and after training, all students completed questionnaires and videotaped interviews with simulated patients. SETTING: Faculty of Medicine and Health Sciences of the University of Newcastle, Australia. SUBJECTS: Final-year medical students. RESULTS: Levels of alcohol-related knowledge, attitudes and interactional skills as well as general interactional skills were significantly improved after teaching. Alcohol-related interactional skills that were unsatisfactory at pretest reached satisfactory standards at post-test. An intergroup comparison of the improvement between pre- and post-teaching scores indicated that there was no significant difference in the effectiveness of the two methods. CONCLUSIONS: Training can improve medical student performance in alcohol intervention. Further research is required to examine the relative effectiveness of different teaching methods.     

Trialling a new way to learn clinical skills: systematic clinical appraisal and learning

AIM: To describe and evaluate the effectiveness of a new method of teaching clinical skills designed to increase students' active and self-directed learning as well as tutor feedback. METHODS: A total of 22 consenting Year 4 medical students undertaking general practice and general surgery clinical experience were involved in a pre- and post-test research design. In the initial period of the study, students were taught clinical skills in a traditional manner. In the second phase a clinical teaching strategy called systematic clinical appraisal and learning (SCAL) was utilised. This learning strategy involved active and self-directed learning, holistic care and immediate feedback. Students independently saw a patient and were asked to make judgements about the patient's potential diagnosis, tests required, management, psychosocial needs, preventive health requirements, and any ethical problems. These judgements were then compared with those of the clinical supervisor, who saw the same patient independently. Students recorded details for each consultation. Comparisons were made of the two study periods to examine whether the use of SCAL increased the number of students' independent judgements, perceived student learning, tutor feedback and self-directed learning. RESULTS: During the SCAL learning period, students reported making a greater number of statistically significant independent judgements, and receiving significantly increased tutor feedback in both general practice and general surgery. The number of learning goals set by students was not found to differ between the two periods in surgery but significantly increased in general practice in the SCAL period. Students' perceptions of their learning significantly increased in the SCAL period in surgery but not in general practice. During the traditional learning period in both settings, there was limited student decision-making about most aspects of care, but particularly those relating to prevention, psychosocial issues and ethics. CONCLUSIONS: The SCAL approach appears to offer some advantages over traditional clinical skills teaching. It appears to encourage active and independent decision-making, and to increase tutor feedback. Further exploration of the approach appears warranted.     

Developing teaching skills for medical educators in Russia: a cross-cultural faculty development project

CONTEXT: Faculty development programmes have proved successful for improving teaching skills. We investigated whether or not a successful US-based faculty development programme for improving the teaching skills of medical faculty could be transported to Russia. METHODS: Five seminars, based on the 7 categories of the Stanford Faculty Development Program model, were presented to 48 teachers at Kazan State Medical University in Kazan, Russia. The seminars were comprised of mini-lectures, reviews of actual videotaped teaching scenario re-enactments, interactive role plays of teaching situations, and personalised goal setting for future teaching performance. Evaluation was performed through participants' self-reported ratings of teaching ability based on a retrospective pretest/post-test questionnaire and fulfilment of commitment of change (CTC) statements written by workshop participants. Outcomes were measured at both 1 and 12 months post-intervention. RESULTS: Survey response rates were 98% (47/48) at 1 month and 81% (39/48) at 12 months. Global teaching performance improved (pretest = 38.4, 1 month post-test = 43.7, 12 months post-test = 42.5; P < 0.001) as did ratings of specific teaching behaviours (pretest = 100.2, 1 month post-test = 121.3, 12 months post-test = 116.8; P < 0.001). A total of 127 CTC statements were made and 90 (71%) were successfully instituted. CONCLUSIONS: Our faculty development intervention demonstrated a positive, lasting effect on the teaching skills of Russian faculty members. This suggests that our efforts in transporting this intervention across the 2 cultures were successful.     

Assessing the development of communication skills in undergraduate medical students

CONTEXT: The teaching of clinical communication skills' teaching has become an important part of medical school curricula. Many undergraduate medical courses include communication skills training at various points in their curriculum. Very few reports have been published on the development of communication skills over the duration of a medical undergraduate training. AIMS: To determine the change in communication skills between early and mid-stages of the students' 5-year curriculum, and to investigate the predictive and theoretical significance of knowledge and understanding of communication skills in relation to observed performance. PARTICIPANTS: Students entering as the first cohort to the new medical curriculum at Liverpool Medical School (n=207). Nine students withdrew leaving 198 students who completed two summative assessments in June 1997 (level 1) and November 1998 (level 2). STATISTICAL ANALYSIS: Repeated measures multivariate ANOVAS were applied to the main study data to detect any change in performance between levels 1 and 2. RESULTS AND CONCLUSIONS: An improvement in communication skills was found in medical students over 17 months of their undergraduate teaching: that is from the level 1 to the level 2 assessment. Knowledge and understanding of communication skills at initial assessment did not show the predicted association with performance at level 2.     

Clinical epidemiology: an experiment in student-directed learning in Western Australia

This paper describes an experiment at the University of Western Australia (UWA) medical curriculum, in which the focus of the 1 week of face-to-face teaching in public health in the 3-year clinical rotation was changed from important health problems affecting whole communities to one emphasizing the use of epidemiological principles to enhance doctors' decision-making. The students are now left to choose the clinical subject matter, and instead of being presented with predetermined readings selected by the teaching staff, the students have assumed responsibility for discovering the latest relevant information on the topics they choose and of presenting this to the class. The teacher now spends much less time in front of the class, providing only mini-tutorials each day on presenting to small groups, and on the skills required to understand the published literature on the aspects of the diagnosis, investigation, management and prognosis of individual patients.
The topics chosen by students for exploration differ little, either in terms of the nature of the health problems concerned or the epidemiological principles at issue, from those covered previously when the programme was set entirely by the staff. However, attendance at the course has improved sharply, the short time between mini-tutorials and application of the material they cover has increased the perceived relevance of the teaching, and feedback collected systematically from successive classes of students has been very positive. Any anxiety on the part of the staff at relinquishing control of the curriculum has proved unfounded while the new programme has much to recommend it as a model of self-directed learning.     

The effect of professional skills training on patient-centredness and confidence in communicating with patients

OBJECTIVES: The effect of introducing professional skills training on students' patient-centred attitudes and perceptions of ability to communicate was examined. The professional skills training included weekly training in communication skills, ethics and law, and clinical skills. METHODS: Consecutive cohorts of medical students receiving a traditional pre-clinical curriculum (n = 199) and a new curriculum including professional skills training (n = 255) were compared. Students completed the Doctor-Patient Scale to assess patient-centred attitudes and an 11-item scale to assess confidence in their ability to communicate with patients. Students completed the measures at the start of Year 1 and the end of Year 2. RESULTS: Students receiving the professional skills training showed increased confidence in communicating with patients and increases in 2 dimensions of patient-centredness ('holistic care' and 'patient decision making'). Students receiving the traditional curriculum showed increased nervousness in talking to patients. Gender and ethnic differences were found in patient-centredness and confidence in communicating, which were maintained over time. CONCLUSIONS: The introduction of professional skills training was successful in improving students' confidence in their ability to perform specific communicative behaviours and increasing patient-centredness relative to a traditional curriculum.     

Evaluation of an AIDS education programme for young adults.

STUDY OBJECTIVES--To evaluate the impact of an AIDS education programme designed for young adults. DESIGN--A randomised trial with a pre-post test design. SETTING--Participants were drawn from six youth training centres in the city of Nottingham, England. STUDY POPULATION--All trainees aged 16-19 years attending the six centres were included in the sample and centres were randomly allocated to experimental (n = 173) and control (n = 164) groups. The response rate to both questionnaires was high (71%). MEASUREMENTS AND MAIN RESULTS--Data on sexual behaviour, knowledge, and attitudes towards HIV/AIDS were obtained by confidential questionnaire. Two thirds of the sample were sexually active. There were no differences between groups at pre-test and no differences by sex. The experimental group had a significantly higher level of knowledge than the control group post-test. Significantly more experimental than control trainees knew post-test that HIV could be transmitted via anal sex and through broken skin. In addition, twice as many experimental (53%) as control trainees (25%; p < 0.001) were aware that a cure for AIDS was unlikely in the near future. There were no observed effects on sexual behaviour, intentions, or attitudes. CONCLUSIONS--The Streetwize UK educational programme had a significant impact on young adults' knowledge of HIV/AIDS transmission and prevention in the short term. If community based AIDS education is to do more than merely inform, however, resources must be made available for peer led interventions and skills training.     

A comparison of computer-assisted instruction and small-group teaching of cardiac auscultation to medical students

Cardiac auscultation is suffering from declining interest, caused by competing diagnostic technology and inadequate training of doctors. Computer-assisted instruction (CAI) supporting graphics and digitized sound could be ideally suited for teaching and sharpening this skill. To evaluate this premise we randomized 35 third-year medical students to 3 hours of seminar teaching plus the use of audiotapes (group 1), the self-use of a MacIntosh-based CAI (group 2), or both (group 3). All students took a pre- and post-test consisting of eight pre-recorded cardiac events and were also assessed for computer anxiety. Although there were no significant differences between pre- and post-tests for each group and among groups, group 1 had a 4.5% deterioration in its diagnostic score compared to the 7.2% and 3.2% improvements of groups 2 and 3 respectively. Group 2 used the CAI significantly more than group 3. We conclude that CAI is at least as effective as seminars in teaching cardiac auscultation to third-year medical students.     

Elective modules in the behavioural sciences

An elective modules programme in the behavioural sciences was designed for the undergraduate medical curriculum at The Ohio State University College of Medicine. The programme provides a mechanism by which a broad range of behavioural science content can be introduced into the curriculum without increased allocation of teaching staff or budget. Student preference data indicate some clear differences with the more popular modules being those which focus on skills or behaviours that students perceive to be useful in the immediate practice of medicine. The elective aspect of the programme was part of its initial appeal, both to students and teaching staff. Two years of course evaluation data from the students indicate that most individual modules and the programmes as a total have been successful in achieving their intentions. The programme has now been included as a permanent component of the curricula.