Medical students' attitudes to psychiatric illness in primary care

Context Previous research has shown that general practitioners (GPs) hold negative attitudes towards patients with schizophrenia, which do not simply reflect the nature or chronic aspects of the illness. This study aimed to describe the attitudes and predicted behaviour of medical students towards patients with mental illness in a primary care setting and to investigate whether these were affected by the students’ level of training. Methods A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette. Results A total of 1081 (88%) students responded to the questionnaire. Students were generally less favourable in their responses to patients with either schizophrenia or depression. They would not be as happy to have them on their list, believed they would consume more time and considered they would be less likely to comply with advice and treatment. They expressed more concern about the risk of violence, the potential welfare of children and the possibility of illegal drug and excessive alcohol use. General clinical and psychiatric training had little effect on these reactions. Conclusions Patients with mental illness provoke less favourable responses in medical students, which are not altered by furthering education. Undergraduate primary care‐based mental health education should be re‐evaluated to ensure that students develop an empathetic and positive approach to mental health patients and their treatment.     

Does a brief clerkship change Hong Kong medical students’ ideas about general practice?

OBJECTIVES: This study examines the impact on students of a brief general practice clerkship, during a curriculum that is otherwise almost entirely hospital-based and in a practice environment that often does not encourage good primary care. DESIGN: 15 focus group discussions were held with a total of 110 students, as part of an action research project. Student responses were audiotaped, transcribed and then analysed for recurrent themes. SETTING: General Practice Unit, University of Hong Kong. SUBJECTS: Medical students RESULTS: There was evidence of pre-existing negative stereotypes of general practice, but in many cases these were dispelled by the relationships students developed during their attachment to general practitioners in the community. In an overcrowded curriculum, students ration their time and energy, focusing their learning pragmatically on subjects that have a high profile during examinations. CONCLUSIONS: Even in healthcare and medical school systems that are specialist-dominated, and in which the circumstances of practice do not always encourage high standards of care, the general practice clerkship can allow students to gain an understanding of the importance of primary care, and of the significance of the general practitioner's role in the healthcare system.     

Advanced training in biomedical ethics: a curriculum in clinical specialty programmes

Summary. Medical ethics play an essential role in the practice of medicine, in the care of individual patients, in the allocation of health care resources, and in the formulation of health care policy. A specific body of knowledge, ‘biomedical ethics’, has developed which applies ethical theory to biomedical practice. This has provided doctors with tools systematically to integrate rational ethical analysis into clinical decision-making. Training in the discipline of biomedical ethics is now required for all doctors in Canada. The goals, content areas, learning objectives, and learning methods considered appropriate for advanced training in this field for medical specialists are provided in this paper. Six topic areas are discussed: introduction to ethical theory, clinical ethics, professional ethics, ethics of human experimentation, ethics of health policy, and independent study. Ways this curriculum could be organized and evaluated are also offered.     

Primary care consultation skills training: implementing a new training programme for senior house officers in an accident and emergency department

Senior house officers (SHOs) in Accident and Emergency (A&E) departments see many patients who present with primary care problems. Until now, most SHOs have lacked postgraduate training in primary care skills to enable them to meet these patients' needs effectively. This paper describes an innovative training programme that has been developing at King's College Hospital, London. It identifies a new opportunity for general practitioners to contribute to the postgraduate medical education of hospital junior medical staff. The training programme was designed to give A&E SHOs protected time in which to reflect on strengths and weaknesses in relation to primary care consultations and learn from their experiences. Its aim was to improve the assessment and management of patients, and to encourage a problem solving approach within the A&E setting. The programme, established in 1992, was developed through collaboration between the departments of A&E Medicine and General Practice and Primary Care. Evaluation has been a central theme in its development, and has been used to ensure that the training meets the needs of each individual set of SHOs and of the department. It has been used in establishing agreement about the training's value and benefits. The authors discuss some of the methodological difficulties encountered in evaluating this type of educational initiative.     

Learning in primary care--a report

A symposium on Learning in Primary Care was held in Cape Town, South Africa, as a pre-conference workshop to the 9th International Ottawa Conference on Medical Education. The aim of this report is to inform medical educationalists of important issues in learning in primary care and to stimulate further debate. Four international speakers gave presentations on their experiences in teaching and learning in primary care. Objective positive outcome measures include acquiring clinical skills equally well in general practice as in hospital, and improved history taking, physical examination and communication skills learning. Students regard the course as an essential requirement for learning and are appreciative of the wider aspect to learning provided by the community, giving a more holistic view of health. A SWOT analysis (strengths, weaknesses, opportunities and threats) of teaching and learning in primary care identified that learning in primary care is of a generalist nature and reality based, but is hampered by a lack of resources. The increased professionalization of teaching in primary care results in better training, cost containment, and improved quality of health care at community level. It is important to focus on turning threats into opportunities. Academic credibility needs to be established by conducting research on learning in primary care and developing the conceptual basis of primary care.     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

Ethical reasoning and decision-making in the clinical setting: assessing the process

Clinical ethical reasoning and analysis are skills as central to good patient care as the efficient application of biomedical knowledge to diagnosis and prognosis. However, experience in teaching clinical ethics to senior medical students has indicated that simply trying to ‘apply’ the knowledge learnt about ethical theories, principles, concepts and rules in the clinical setting does not ensure ethical competence in clinical decision-making. In 1992, we developed and piloted a three-session programme that focused on a more systematic approach to the way students identified and attempted to manage ethical issues in their clinical practice. This programme was modified and improved in 1993 and further expanded in 1994. Our experience suggests that many students are now better able to bridge what has been called the ‘gap’ between the possession of ethical knowledge and its actual use in clinical decision-making. The remaining problem was assessment. How do you assess clinical ethical reasoning and decision-making? In the preclinical years of medical education, knowledge-based assessment tools, like the modified essay question (MEQ), provide a means for assessing the sensitivity of students to ethical issues. However, such tools permit neither an appraisal of how students actually make clinical ethical decisions, nor which factors students perceive as important in making an actual clinical decision. In order to make this type of appraisal, we developed a format for a written case report that facilitated our assessing the process as well as the end-product, the decision. The results obtained from the use of the written case report in the annual assessment of our senior medical students in 1993, while encouraging, also identified a number of unexpected problems.     

Ethics and animal issues in US medical education

Increasing public and regulatory agency concern about a variety of animal protection issues that affect the field of medicine have made these issues increasingly relevant to medical school curricula. The purpose of this study was to assess the availability and forms of medical school training relating to ethical, conceptual, and societal concerns in the use of animals within the field of medicine and the perceived need for such training.
Questionnaire surveys were mailed to the Deans of the 125 accredited US medical schools, and completed by Deans or their designees within the same medical institution. Questionnaire recipients were informed that results would be compiled in a fashion that did not identify specific individuals or institutions.
Survey responses were obtained from 84 medical institutions (67% response). Sixty respondents (71%) indicated that their medical school offered or sponsored some type of activity related to ethical and conceptual concerns in the use of animals in medical research and training. Most schools (43) offered informal discussions/seminars relating to these issues, but nine schools offered full formal courses with up to 15 lectures on these topics. Programme content and perceived need for additional instruction varied greatly amongst respondents.
The results suggest a wide diversity amongst US medical schools in the availability and perceived importance of medical school training relating to ethical and conceptual concerns in the uses of animals in medicine. It is proposed that instruction in these areas be pursued with more concerted efforts to address the growing body of knowledge about non-human beings and the ethical implications of such knowledge.     

Attitudes towards the doctor-patient relationship: a prospective study in an Asian medical school

Context Patient‐centredness is an accepted guiding principle for health system reform, patient care and medical education. Although these attitudes are strongly linked with cultural values, few studies have examined attitudes towards patient‐centredness in a cross‐cultural setting. Objectives This prospective study evaluated attitudes towards patient‐centredness in a cohort of Asian medical students and examined changes in these attitudes in the same students on completion of their junior clinical clerkships. Methods The study was conducted in a cohort of 228 medical students entering Year 3 in medical school. The Patient–Practitioner Orientation Scale (PPOS), a validated instrument which scores an individual’s level of patient‐centredness, was used. Results Being female and having personal experience of continuing care were significantly associated with higher scores. Students in the USA were previously reported to have similar ‘caring’ but higher ‘sharing’ scores on the same scale. At the end of the junior clinical clerkship, there were improvements in the ‘caring’ subscale, but no change or a reduction in ‘sharing’. Students who did not have previous personal experience with continuing care experienced a greater increase in overall PPOS score. Conclusions When compared with students in the USA, the students in our study appear to have a lower propensity to view the doctor–patient relationship as a partnership. This may be a reflection of differences in cultural norms and expectations of doctor–patient interaction in different societies. Our finding that attitudes towards patient‐centredness did not decline over the course of the year, which contrasts with findings of other studies, may be attributed to various factors and warrants further study.     

medline training for medical students integrated into the clinical curriculum†

This study was initiated in response to the availability of unlimited access to medline via the PaperChase interface at the host institution. The goal of the study was to analyse the usage of medline by medical students during their third-year clinical clerkship in paediatrics. This was achieved by first giving them a formal demonstration of medline and then longitudinally administering a structured questionnaire at several points during their paediatric clerkship. Since medical students were required to write a thesis for this clerkship, which included an analysis of the primary literature, there was an identified need for using the system. This study analyses the students' perceptions and searching activities after formal training and upon having unlimited access to medline .     

Evaluating primary care as a base for medical education: the report of the Cambridge Community-based Clinical Course

BACKGROUND: Medical students receive increasing amounts of their clinical education in a primary care setting. The educational possibilities of such attachments are still being explored. AIM: To report the evaluation of a small, radical innovation to provide students with a long-term community attachment which integrated with hospital-based education. METHOD: Between 1993 and 1998, 13 medical students completed 15-month attachments with a single general practice in England. The course offered them experience in the major clinical specialties throughout this period. Students were exposed to specialist as well as generalist education in the context of patients with whom they could establish a continuing relationship. The innovation was evaluated by its feasibility, by students' examination results, by analysis of clinical experience, through formal student feedback and by cost. RESULTS: The course was practicable in a particular setting with academic leadership. The students all passed their exams. They had wide, appropriate clinical experience even though the attachment was to a single practice. When they returned to the hospital environment, students did not feel themselves at a disadvantage compared with traditional students. The costs of the course are controversial: placement costs were higher than in the hospital, but those for facilities were lower. CONCLUSION: It is possible to run a course like this successfully. It remains the most radical attempt to share clinical education in the UK between primary and secondary/tertiary care. Further research is required into providing long-term clinical attachments in NHS primary care settings.     

Specialty choice and understanding of primary care among Japanese medical students

To assess specialty choice and understanding of primary care among Japanese medical students, all students from seven Japanese medical schools (three public and four private) were surveyed, using a written questionnaire. A total of 3377 students provided data for the study. Of the students surveyed, 89.8% wanted to become clinicians, and 79.3% wanted to have general clinical ability. About half of the respondents, 54.9%, replied that they had some, or great, interest in primary care, but it was found that their understanding of primary care was inadequate. Almost half (56.3%) of the students answered that they had some idea of what a general practitioner did. This proportion was nearly the same through all years of medical school. While 1245 (36.9%) students (most of them in the fifth or sixth year) replied that they had received some clinical training while working in hospitals, only 203 (6.0%) students had worked in private clinics (the sites where most primary care is still provided), and 129 (3.8%) students had experience in providing home visits and home care. An even greater number, 64.3%, replied that they had inadequate information about the career options available to them. The study found that although many Japanese medical students want to obtain broad clinical competence, their understanding of primary care is insufficient. In order to increase the number of primary care providers the system of medical education in Japan must provide primary care doctors to act as role models, and must make available information about postgraduate primary care programmes. These programmes need to be increased, as do rewarding positions for programme graduates.     

Writing a scientific paper as part of the medical curriculum

Summary. The curriculum at the Medical School, University of Tromsø reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979–89) from Tromsø 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.     

Computer awareness among medical students: a survey

The objective of the study was to assess the attitude of Edinburgh University medical students towards computers and to evaluate the effects of changes in the curriculum and intercalated BSc towards computer knowledge. During March to November 1995 a questionnaire was distributed in lectures, seminars and tutorials to all Edinburgh University medical students. Overall, 65% of students returned the questionnaire, divided equally between both genders. Only 2% of students had not used a computer in the previous year. The most frequent application used was E-mail and the most frequent site, the Greenfield suite micro lab, within the medical school. The average score for self-perceived computer knowledge on a scale of 0–10 was 4.19. This score was significantly higher for the students who own a computer and who have an intercalated BSc honours degree as well as the pre-clinical students compared to the clinical students. There is also a strong correlation between computer use and doing a second year special option module. With regards to attitude towards computers, 86% of students agreed that computer skills will be beneficial to them in their future career and 62% of all students wanted a structured course in computer use as part of the MB ChB course. There has been a general increase in computer literacy amongst the medical students in Edinburgh. This is specially so for the pre-clinical students who have had the brunt of the changes in the curriculum. The tendency for both the lower knowledge and use by the clinical students can, in part, be due to the accessibility of computers to these students.     

The use as a learning resource of the community in which the medical school is situated: the Medical School, Southampton

Southampton University Medical School was established in 1971 and now takes 130 students each year for the 5-year course, and fifteen students for the premedical year. The school uses facilities within the whole Wessex region, population 2.5 million, for teaching. During the first year of the course, community-based learning is a feature of the 'Man, Medicine and Society' course and of Early Medical Contact (EMC). Each student has four half-day EMC visits to patients in their homes and these visits are followed by discussion with medical staff. Sociology, or the social context of health care, together with an epidemiology course are the main contacts with the community in the second year. In the third year, all students visit a general practice surgery for half a day per week for 40 weeks; this enables them to appreciate the natural history of common conditions in primary care and their management. There is also a course in occupational medicine in the third year. At the beginning of the fourth year, many students spend an elective in an underdeveloped country, but much of the year is concerned with a study in depth, in some cases involving the community. The fifth year of the course is a major clinical year, often spent in regional hospitals away from Southampton. Three weeks are spent in general practice somewhere in the Wessex region.     

Effect of legislative changes in drug promotion on medical students: questionnaire survey

Objective The aim of this follow‐up study was to examine whether the legislative changes that took place in Finland in 2004 had an impact on the interactions between pharmaceutical companies and medical students. According to a previous survey, information provided by pharmaceutical companies represented one of the most important sources of information on pharmaceutical products for medical students and students frequently attended promotional events. Methods The authors collected the survey data using questionnaires distributed to medical students in Finland’s five medical departments in spring 2005. A total of 1523 students (44% of all medical students in Finland) responded to the questionnaire. Results were compared with the findings of a previous study conducted in 2000. Results We found a dramatic drop in how often students attended promotions given by pharmaceutical company representatives (PCRs), with 17% versus 68% of students in the clinical phase of study attending at least twice a month (P < 0.001). Other educational events organised by pharmaceutical companies were attended by 3% versus 22% of clinical students (P < 0.001). In addition, presentations by PCRs and industry‐sponsored educational events were not regarded as such important sources of information as they had been earlier and the perceived influence of promotion on future prescribing habits had decreased (12% versus 25% indicated that promotion influences prescribing; P < 0.001). Almost two‐thirds of the students indicated that basic medical education should provide them with more efficient tools for critical assessment of the claims made by pharmaceutical marketing departments. Conclusions Legislative reform has decreased the amount of contact between the pharmaceutical industry and medical students and diminished the role of industry‐sponsored promotion as a source of information on pharmaceutical products.     

Indian student doctors'' attitudes towards primary health care, poverty and related issues

An attempt is made to study the attitudes of student physicians towards primary health care, poverty, and related social issues in India. The sample consisted of 464 men and 228 women final-year medical students (a total of 692) from 11 medical colleges in India. An open-ended questionnaire was used. Content analysis was performed on the responses. There were no statistically significant differences between the responses of the students belonging to different socio-economic groups. There were some differences in the responses of the men and women students, especially on the question of poverty and related social issues. The data presented here show that the student physicians do not have a clear understanding of the primary health care approach, or about the social issues that influence health. This study underlines the need for exposing student physicians to the essential aspects of poverty and its impact on health and the importance of the primary health care approach for providing health care to disadvantaged groups.     

Cultural diversity in Australian medical education

The present study sought to explore the relevance of cultural dimensions and cultural diversity among overseas and local medical students. The main comparison among the fourth year medical students studied was between Asian origin and Anglophone background students. The measures used included cultural variation, reasons for studying medicine, learning approaches and strategies, patient interaction confidence, and medical practices anxieties. Results indicated cultural differences between the two groups, and relationships between cultural variables and, in particular, reasons for studying medicine, learning approaches and strategies, and patient interaction confidence. Results were interpreted according to Hofstede's(1980, 1986) theory of cultural dimensions as they may apply in the educational setting.