General competencies of problem-based learning (PBL) and non-PBL graduates

INTRODUCTION: Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies. METHOD: We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation. RESULTS: Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school. DISCUSSION: Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education.     

The first batch of graduates of a new medical curriculum in Asia: how their teachers see them

OBJECTIVE: To examine teachers' views of the first batch of graduates of a revised medical curriculum in Asia. METHODS: A cross-sectional study using a structured questionnaire was carried out to obtain the views of all the clinical teachers involved in teaching final year students of the old curriculum in 2000-01 and the new curriculum in 2001-02 at the University of Hong Kong, which commenced curricular reform in 1997. RESULTS: Nearly 62% of respondents felt that better graduates were being produced with the new curriculum. The majority of them rated the new curriculum students better in nearly all the major goals of the new curriculum, such as self-directed learning initiative, problem solving skills, interpersonal skills and clinical performance in patient care. However, the core knowledge of the new curriculum students was of concern to some teachers. CONCLUSION: This study focused on the first complete cycle of a revised medical curriculum in Asia. Teachers' views of the new curriculum students were highly positive and they felt that better graduates were being produced.     

Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum

INTRODUCTION: Most medical schools in the UK have been engaged in major curriculum reform based on their premises of what might improve undergraduate medical education. In 1994 the course at the medical school of the University of Manchester changed to an integrated course using problem-based learning throughout and with increased emphasis on community-based medical education. This study explores whether the new curriculum has produced any differences in perceptions of how well graduates are prepared for the role of pre-registration house officer. METHODS: A postal questionnaire was used to survey 1998 Manchester graduates (traditional course) and 1999 Manchester graduates (new course), three months into their first pre-registration house officer placement. A similar questionnaire was sent to the educational supervisors who were supervising the graduates. The questionnaire was designed to measure perceptions of levels of preparedness for the role of pre-registration house officer, using a list of broad areas of competence and specific skills listed in the General Medical Council's 'The New Doctor'. RESULTS: Graduates rated the new course significantly more effective for 12 of the 19 broad competences and eight of the 13 specific skills that were listed. The 'new' graduates rated their understanding of disease processes lower than the 'traditional' graduates, but there was no difference in the ratings given by the educational supervisors for this. Overall the educational supervisors rated the new course as better preparing graduates in five of the competences. CONCLUSIONS: Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.     

Medical graduates evaluate the effectiveness of their education

Summary. In response to the General Medical Council's 1991 Consultative Document proposing changes to medical curricula, the King's College School of Medicine and Dentistry, London, established a steering group to plan a new curriculum. As part of this process a postal survey was undertaken of five cohorts of King's graduates to ascertain how well the medical course they had undertaken had equipped them for practice. The questionnaire explored the level of factual content, the adequacy of their skills training, and the development of personal attributes during the course. A total of 371 graduates replied, a response rate of 78%. Over 70% indicated that their education had satisfactorily equipped them for their medical practice. Significant differences were found, however, between those now practising in primary care and those in hospital medicine regarding the importance attached to different subjects within the curriculum, and also with respect to the personal attributes the graduates felt they had acquired. Both groups identified deficiencies in virtually all aspects of their skills training: clinical, analytical, communication, management and technical.
This feedback from some of the 'consumers' of medical education is now being used to assist the planning of the new King's curriculum.     

In search of criteria for the assessment of medical education

This paper describes results of a study to asses whether an undergraduate educational curriculum is 'relevant'. The people surveyed comprised 290 individuals involved in medical education or health service administration. They were asked to suggest five major criteria for judging whether a medical undergraduate programme is relevant or not and to say whether they felt current curricula meet these criteria. Of those sampled, 40 % replied.
An analysis of the data from respondents showed that medical school professors and senior administrators of health services in Australia have roughly similar expectations of the outcome of medical education. Both groups were concerned that graduates be conscious of health care requirements and costs, that they have adequate clinical skills, knowledge in medical school subjects and skill in interacting with patients and managing their continuing education. On the various dimensions examined there were frequently strong expressions of dissatisfaction with current achievements.     

Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post? A qualitative study of the views of pre‐registration house officers using critical incidents

INTRODUCTION: In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as 'critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. METHOD: We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. RESULTS: We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. CONCLUSIONS: Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO.     

Predicting doctor performance outcomes of curriculum interventions: problem-based learning and continuing competence

Context  Problem-based learning (PBL) is an educational strategy designed to enhance self-assessment, self-directed learning and lifelong learning. The present study examines a peer review programme to determine whether the impact of PBL on continuing competence can be detected in practice.
Objectives  This study aimed to establish whether McMaster graduates who graduated between 1972 and 1991 were any less likely to be identified as having issues of competence by a systematic peer review programme than graduates of other Ontario medical schools.
Methods  We identified a total of 1166 doctors who had graduated after 1972 and had completed a mandated peer review programme. Of these, 108 had graduated from McMaster and 857 from other Canadian schools. School of graduation was cross-tabulated against peer rating. A secondary analysis examined predictors of ratings using multiple regression.
Results  We found that 4% of McMaster graduates and 5% of other graduates were deemed to demonstrate cause for concern or serious concern, and that 24% of McMaster doctors and 28% of other doctors were rated as excellent. These differences were not significant. Multiple regression indicated that certification by family medicine or a specialty, female gender and younger age were all predictors of practice outcomes, but school of graduation was not.
Conclusions  There is no evidence from this study that PBL graduates are better able to maintain competence than graduates of conventional schools. The study highlights potential problems in attempting to link undergraduate educational interventions to doctor performance outcomes.     

Simulation in undergraduate medical education: bridging the gap between theory and practice

OBJECTIVE: To evaluate the use of simulation-based teaching in the medical undergraduate curriculum in the context of management of medical emergencies, using a medium fidelity simulator. DESIGN: Small groups of medical students attended a simulation workshop on management of medical emergencies. The workshop was evaluated in a post-course questionnaire. SUBJECTS: All Year 4 medical students allocated to the resuscitation rotation during the first half of 2002. MAIN OUTCOME MEASURES: Student perceptions of learning outcomes, the value of the simulation in the undergraduate curriculum and their self-assessed improved mastery of workshop material. RESULTS: A total of 33 students attended the workshop and all completed questionnaires. Students rated the workshop highly and found it a valuable learning experience. In all, 21 (64%) students identified teamwork skills as key learning points; 11 (33%) felt they had learnt how to approach a problem better, particularly in terms of using a systematic approach, and 12 (36%) felt they had learnt how to apply their theoretical knowledge in a clinical setting better. All 33 students were positive about the use of simulation in their training; 14 students wrote that simulation should be used more or should be mandatory in training; 5 students commented positively on the realism of the learning experience and a further 5 said they valued the opportunity to learn new skills in a safe environment. CONCLUSION: This study demonstrates that medical students value simulation-based learning highly. In particular, they value the opportunity to apply their theoretical knowledge in a safe and realistic setting, to develop teamwork skills and to develop a systematic approach to a problem. A medium fidelity simulator is a valuable educational tool in medical undergraduate education.     

Graduate evaluation of undergraduate teaching programmes in paediatrics

In a new undergraduate teaching course in child health, medical students were encouraged to prepare and present topics to their colleagues. These presentations covered major subjects in paediatric medicine and were supervised by an experienced teacher. Students were then asked to evaluate the programme at the end of their course in child health and after graduation. Evaluation scores for these presentations were high at the end of the course. Spontaneous comments suggested some disadvantages such as poor or too-detailed student presentations. However, some noted the value of personal research. After graduation, more positive comments were made and the majority felt that the course had advantages in the area of personal research, that it was better than or as good as other teaching methods, and that it should be continued in its present format.     

Evaluation of undergraduate medical education in Finnish community-oriented and traditional medical faculties: a 10-year follow-up

OBJECTIVES: This study focused on Finnish physicians' views of their undergraduate medical education. Differences between traditional and community-oriented medical faculties were examined and changes which had taken place during a 10-year follow-up period were also assessed. METHODS: The study was based on data retrieved from a postal survey made among Finnish physicians in 1998. The study population consisted of all doctors who graduated between 1987 and 1996 (n=4926); those born on odd-numbered days were selected for this study (n=2492). A postal questionnaire and two reminders were sent to those selected, and 1822 questionnaires were returned, giving a response rate of 73.1%. RESULTS: Physicians who graduated from the community-oriented faculties were more satisfied with their undergraduate medical education when compared with their colleagues graduating from traditional faculties. There were some differences between the universities with respect to education for hospital work. The teaching of primary health care, however, was clearly more effective in community-oriented faculties. The proportion of graduates who were satisfied with their primary care education was over 70% in community-oriented faculties, whereas in the traditional faculties it was only 35-45%. CONCLUSIONS: According to graduates, the community-oriented medical school curriculum better meets the needs of practising physicians than that in traditional faculties. In curriculum reforms, more emphasis should be placed on comprehensive medical education, which includes both primary and secondary health care.     

Pre-registration house officers' views on studying under a reformed medical curriculum in the UK

In 1996 the University of Liverpool introduced a new curriculum based on the recommendations published in Tomorrow's Doctors. This work examines how graduates of that course view their undergraduate curriculum and whether they consider it prepared them well for the pre-registration year. Five focus groups were arranged with a selection of graduates from the first cohort to graduate from the reformed curriculum in order to ascertain their views on the course and how it had prepared them to work as pre-registration house officers (PRHOs). The focus groups were tape-recorded, transcribed and analysed. The PRHOs felt they had been well prepared for the PRHO year, citing the clinical experience of the final year, communication skills classes and the Clinical Skills Resource Centre as having been particularly beneficial. There were concerns about their basic science knowledge base although this had not affected their ability to work as PRHOs. They had criticisms of the way part of their course had been structured but overall they were happy with the content of the course. A reformed medical curriculum in the UK can prepare graduates well to work as junior doctors and can take away some of the anxiety associated with graduation; therefore, to that extent curriculum reform has worked. However, anxiety about undertaking the role of junior doctor seems to have been replaced by anxiety about knowledge base, despite having adequate knowledge to work as PRHOs. Students undertaking a reformed curriculum are wary about being the first people to use their training in the workplace. This factor may need to be considered when further reforms are introduced.     

A web-based presentation of an undergraduate clinical skills curriculum

AIMS: The aim of this study was to use information and communications technology to present a curriculum of clinical skills in a user-friendly format. SETTING: A UK undergraduate medical school with a problem-based curriculum and a strong emphasis on proficiency in clinical skills. STUDY DESIGN: Case study describing the qualitative analysis of users' requirements and development of a web-based learning portfolio. EVALUATION: The study involved direct observation of users during a 'think-aloud' protocol, a validated software users' measurement inventory and a 17-item questionnaire designed to test whether 'SkillsBase' met its users' requirements. RESULTS: Students wanted a clear and flexible presentation of their skills curriculum that was easy to navigate, offered instructional material and standards for self- and peer assessment, offered useful Internet links, allowed them to compare their progress with school standards and peer norms, and could be used as a learning portfolio. During the think-aloud protocol, students made very few errors in data interpretation or navigation, and found SkillsBase easy to learn and aesthetically pleasing to use. They rated it higher on all measures of usability than standard commercial software. The questionnaire showed that it met most aspects of its design specification, although many students were doubtful that they would use its reflective function. It is available for inspection at http://www.skillsbase.man.ac.uk/. CONCLUSIONS: SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.     

Interns'' evaluation of their preparation for general practice: a comparison between the University of Tromsø and the University of Bergen

A total of 168 interns who have graduated from the Medical Schools of Bergen and Tromsø were asked about various aspects of the medical curriculum. In Bergen the curriculum has a traditional structure with a pre-clinical and a clinical part, but in Tromsø the pre-clinical and clinical subjects are integrated. In addition, the students in Tromsø spend long periods in municipal hospitals and in the primary health care service. We were interested in how the interns from the two universities evaluated their respective curricula and how prepared they felt for their current work. There was a response rate of 86% to the questionnaire. The results showed that the interns from Tromsø are more satisfied with their education and feel more confident in their practical skills than the interns from Bergen. They are also more motivated for future work in general practice. In our opinion the main reason for these results is the difference in curricula in the two medical schools. Other possible reasons are also discussed.     

The teaching of professional attitudes within UK medical schools: Reported difficulties and good practice

INTRODUCTION: The demonstration of appropriate attitudinal behaviour is crucial in the professional development of doctors. This study explores the experiences of UK medical schools in developing and assessing the behaviour associated with the attitudes of undergraduate medical students. METHODS: A qualitative in-depth interview study was based on a questionnaire survey of all UK medical schools. Six heads of medical schools or their nominated representatives were interviewed. Outcome measures were the perceptions and experiences of developing and assessing appropriate attitudes and behaviour in their undergraduate students. RESULTS: Aspects of the hidden curriculum, especially the negative role modelling encountered during clinical practice, were seen to undermine the attitudinal messages of the formal curriculum. Some participants believed that students could still qualify as doctors despite having inappropriate attitudes or behaviour. Others felt certain that this was now unlikely in their school, and this confidence seemed to be backed up with the knowledge that strategies, systems and structures were in place to detect and act upon poor behaviour. DISCUSSION: The conviction that it is right to assess students on their attitudinal behaviour does not yet appear to be held consistently across all schools and we suggest that this may reflect some fundamental tensions arising from differing views about the essential elements of good medical practice, tensions that are also shaping the hidden curriculum.     

Characteristics of doctors and nurses as perceived by students entering medical school: implications for shared teaching

INTRODUCTION: Debate continues with respect to when to introduce interprofessional education for maximal potential benefit. One perspective is that interprofessional education should be introduced early in the undergraduate curriculum before students develop stereotyped impressions of other professional groups. However, it may be that students at entry to medical school have already developed these stereotypical impressions. This study examines perceived professional characteristics of doctors and nurses by students entering medical school. METHODOLOGY: Year 1 medical students in 4 consecutive years completed a questionnaire on their perceptions of the characteristics and backgrounds of nurses and doctors and on their attitudes to shared teaching. RESULTS: Year 1 medical students were found to perceive the characteristics of doctors and nurses differently. They considered nurses to be more caring and doctors to be more arrogant. They considered nurses to have lower academic ability, competence and status, although comparable life experience. They were generally very positive about beginning shared learning at an early stage of training. DISCUSSION: Whilst it is encouraging that medical students are positive about shared teaching, it is of concern that they have a poor perception of the academic ability, status in society and professional competence of the nurse at entry to medical school. These perceived impressions, which may reflect societal misconceptions regarding the roles and responsibilities of nurses within a modern health care system, may have an impact on the success of early interprofessional teaching initiatives in undergraduate curricula.     

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

Validating the Readiness for Interprofessional Learning Scale (RIPLS) in the postgraduate context: are health care professionals ready for IPL?

AIMS: This paper describes the process of validating the Readiness for Interprofessional Learning Scale (RIPLS) for use with postgraduate health care professionals. CONTEXT: The RIPLS questionnaire has proved useful in the undergraduate context, enabling tutors to assess the readiness of students to engage in interprofessional learning (IPL). With the drive in the National Health Service (NHS) to deliver health care in interprofessional teams, it seems logical to ask whether postgraduate education should, or could, be delivered successfully in interprofessional contexts. As a preliminary to undertaking an extended IPL project, the researchers tested the validity of the RIPLS tool in the postgraduate health care context. METHOD: A modified version of the RIPLS questionnaire was administered to all general practitioners, nurses, pharmacists and allied health professionals in the Dundee Local Health Care Cooperative (LHCC) (n = 799). A total of 546 staff responded (68%). RESULTS: Three factors, comprising 23 statements, emerged from the statistical analysis of the survey data, namely, teamwork and collaboration, sense of professional identity and patient-centredness. The internal consistency measure was 0.76. Analysis of variance suggested some key differences between the different professions in respect of the factors. CONCLUSIONS: The RIPLS questionnaire was validated for use in the postgraduate context, thus providing researchers with a tool for assessing health professionals' attitudes towards interprofessional learning at practice level, community health partnership level or at a national level of education and training. Significant differences between professional groups should be taken into account in designing any interprofessional learning programme.