A method of teaching counselling

The major part of one section of a teaching-methods course for general practitioner teachers (Harris et al. , 1976) was concerned with teaching counselling skills. This paper describes the methods used to do so, in the setting of a residential course lasting for only a few days.
The functions and objectives of counselling are defined, and the counselling process is divided into six stages which are reflected in the organization of the teaching. Five specific skills required are isolated, to clarify the teaching and to permit assessment of the members' learning. Three roles in a counselling interview are described, and members work in trios where they experience each of these roles. The problems at which the members work have to be real and unresolved problems in their own lives.
Some conclusions are offered, drawn from the writers' experience and from the evaluation and assessment techniques employed.     

Comparison of septal and fornical lesioned rats performance on the maier three table reasoning task

Neither septal nor fornix lesioned rats were able to successfully perform the Maier 3 table reasoning task. Detailed analysis of the performance patterns of both groups reveal a common feature of primary dependence on directional responses at the choice point. This response strategy, as opposed to the spatial strategy attributed to normal animals, does differentiate between the two lesion groups. Septal lesioned subject show a dependence on a preferred or dominant direction of turning at the choice point both within and over trials. Fornical lesioned animal demonstrate the same pattern but only over trials. In addition, fornical lesioned rats tend to continue responding even though they had successfully reached the goal table. It is argued that fornical lesioned rats may not be able to use spatial information while septal rats who evidence repetitive errors, made by alternating between environmental locations, may attempt to acquire and unsuccessfully use spatial information.     

Pilot study on use of PMPs

Patient management problems (PMPs) have been used for many years in an attempt to design tests capable of measuring clinical problem-solving ability. Problems have arisen particularly related to criterion validity, though some studies have suggested that content and construct validity are satisfactory. One of the major problems has been that a common definition of problem-solving ability has not been developed yet. In addition, various formats have been used with considerable variety in construction, possibly influencing outcomes, and scoring procedures have not been standardized. A serious charge has been that PMPs are content specific and therefore are unreliable and not valid for measuring any general characteristic such as problem-solving ability (assuming this exists).     

A factor analytic study of branching patient management problems

This study was undertaken to determine the factor analytic structure of patient management problems (PMPs) and to determine whether such factors are stable for different groups taking the same examination and for the same group over time. Two examinations were administered to a group of medical students, the first during their junior year and the second during their senior year. The second examination was also administered to a second class of students during their junior year. Factor analyses results indicated there are two components to medical problem-solving as measured by PMPs-data gathering and management. Both factors were stable over groups and over time.     

A scoring technique for computerized patient management problems

A scoring technique was developed for computerized patient management problems, based on an external criterion group of practising paediatricians. The technique was used successfully to score the 1974 computerized patient management problems examination, taken by paediatric candidates as part of the certification process required by the Royal College of Physicians and Surgeons of Canada. Statistical analysis indicated there was significant agreement between practising paediatricians' and candidates' responses. Comparison of responses of both groups suggested that differences between candidates and practising paediatricians were due to different approaches to the content of the problem, rather than a defect of scoring. The technique will be revised as computerized examinations are increasingly adopted by other medical specialties.     

Problem solving cases in teaching of applied pathology

A 'problem solving case' method of teaching practical pathology is described, illustrated and compared with more traditional teaching methods. This method offers many advantages-the most important being that it shows the effect of pathological lesions in an actual patient, thus emphasizing the relevance of pathology to clinical medicine. Other advantages are that self-assessment is encouraged; guidance is given on the depth of knowledge expected from a student; student response is favourable; no elaborate or expensive equipment is required; the method is economic in the use of staff time, and it is very flexible in use in terms both of time and place.     

An indication for a process dimension in medical problem-solving

Several recent studies have concluded that medical problem-solving, as evidenced in a written simulation, is heavily influenced by the medical content of the particular case. The method employed in these studies did not allow process and content aspects to be separated, so the contribution of each could not be independently assessed. The present study employed a method that allowed such a separation.
Medical students were required to write problem lists, to order laboratory tests and to choose a final diagnosis for each of five casts. They were given corrective feedback after each part (e.g. after writing problem lists they were given the correct problem list) so that all students were working with the same information as they began each section of the case. The results on factor analysis showed more similarity in performance on the same aspect of problemsolving across different clinical cases than on the different processes within a given case. The present study clarifies some issues, but more work is needed to define further the specific processes in problemsolving.     

Clinical problem solving and clinical knowledge

Videotape and simulated patients were used for evaluating third year medical students' performances in solving familiar and unfamiliar clinical problems. To assist the doctor to rate the students' performances by the review of videotapes, criteria were set up for students' behaviours that could be construed as evidence that the students recognized cues obtained by interviewing the patient and the information content of such cues. Criteria for data use by the students were also set. A mean of 90% of the pertinent medical history data was collected by the students. The amount of pertinent historical data collected was found to correlate very closely with student-patient interaction analysis score for the familiar and unfamiliar problems (r = 0.89 and r = 0.92, respectively). Significant differences in mean scores for data generation (P less than 0.001) and for data use (P less than 0.01) were found between those students who solved and those who failed to solve the familiar problem. With the unfamiliar problem a significant difference was found between the mean scores for data generation (P less than 0.01), but not for data use. The implications of these findings in medical education are discussed.