The current status of senior house officer postgraduate education in a single region

OBJECTIVE: To assess postgraduate education (PGE) for paediatric senior house officers (SHOs) in a single region. METHODS: A survey of all paediatric SHOs in the region was undertaken in the form of a questionnaire and telephone contact. The standard set by the Committee of Postgraduate Medical Deans for SHO education formed the basis for the questionnaire; there should be (i) a designated educational supervisor for each SHO, (ii) regular work appraisal and counselling and (iii) 4 h protected teaching per week. Supplementary questions were asked regarding methods of teaching and study leave. RESULTS: There was a 92% response rate from SHOs and 90% of SHOs contacted had a named educational supervisor. The mean time for protected teaching per week was 2.14 h, although this varied widely between centres. There were many different teaching methods used and 82% of SHOs had no difficulty in obtaining study leave. There was a particular problem for those who were working shifts or cross-covering. CONCLUSIONS: Our study has shown that paediatric SHOs in Wales are reasonably satisfied with their postgraduate education, although there is considerable variation between different units. Several areas have been highlighted which need to be improved if we are to provide SHOs with adequate preparation for the specialist registrar training grade.     

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education

OBJECTIVES: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training. CONCLUSIONS: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.     

Training in assessment and appraisal: who needs it?

The aim of this project was to develop a training programme to help consultants supervising postgraduate medical trainees to fulfil their role as Educational Supervisors. A training needs analysis was conducted which revealed that consultants did not appreciate the importance of some of their new duties. This was mainly because of the lack of clear perception of their new roles. Hence training needs to be provided.     

Current practice patterns and training status of selected graduates at the King Abdulaziz University College of Medicine, Saudi Arabia

Graduate doctors are the primary output of medical education programmes. It is important for institutions to identify systematically the types of medical activities in which their former students are involved in order to determine the effectiveness of the curriculum, assessing academic standards and reviewing admissions policies. Information was obtained from a survey of men and women graduates from three of the early graduation classes of King Abdulaziz University College of Medicine in Saudi Arabia about postgraduate medical training, certification, practice patterns, and other curriculum issues. Information collected from 151 graduates (90%) indicated that 96% were practising medicine in a variety of medical specialties and subspecialties. Six were not practising at the time of the study. Significant differences were found in the specialties being practised when men and women were compared. Men tended to practise in medicine, surgery, dermatology, urology, ENT, ophthalmology and orthopaedics, while women concentrated in obstetrics and gynaecology and paediatrics. Certification beyond medical school was earned by 49% with no significant difference being found comparing men to women. Men earned the majority of their postgraduate certifications outside Saudi Arabia while most women earned theirs in Saudi Arabia. Graduates indicated that departments in the basic sciences were least helpful in preparing them as doctors, while selected clinical departments were most helpful. It was concluded from the study that the curriculum goals of the College of Medicine, namely a curriculum of international standards producing graduates to take leadership roles in both teaching and medical practice, were realized in part by the graduates surveyed.     

Consulting skills training and medical students' interviewing efficiency

In more traditional medical education, medical students took a patient's medical history by asking a series of sequenced, routine questions, covering presenting medical problem(s); medical history; social and personal history; systems review; and physical examination. Following this process, the student then attempted to derive the patient's medical problems. This inductive problem-solving paradigm may not assist students to prepare for their future interviewing needs, given doctors use a hypothetico-deductive, problem-solving approach when interviewing patients and numerous researchers have developed specialized communication skills training programmes designed to enhance students' interviewing skills. Students given specific consulting skills training have tended to show significantly greater interpersonal effectiveness and improved interview behaviours compared with students who experience traditional patient clerking training. These improvements in interviewing tend to persist over the period of students' medical training. The aim of the present study was to determine whether specialized communication skills training helped students elicit greater quantity and quality of information from patients and if so, whether such information assisted students in improving their diagnostic skills. Videotaped history-taking interviews conducted by students trained in communication skills and untrained (control) students were rated for their interview efficiency. A comparison of ratings given by experimentally naive, independent observers revealed that trained students were more efficient, but took no longer than their control group counterparts to elicit fuller, more relevant information. However, the student groups did not differ in the accuracy or scope of their medical diagnoses. It is argued that students' lack of medical knowledge in this early phase of their clinical training militated against their being able to use their interviewing competence to derive more potentially accurate medical diagnoses.     

Working patterns and the quality of training of medical house officers: evaluating the effect of the `new deal'

The `new deal' on junior doctors' hours of work has led to the widespread introduction of working patterns such as full shifts and partial shifts in the United Kingdom. The impact of these changes on the training of medical staff is unclear. The subjects of the current study were 36 pre-registration medical house officers working shift rotas and on-call rotas at a teaching hospital in the north of England. They were studied over a 12-month period using a self-report questionnaire seeking their views on the quality of their training experience and their satisfaction with the in-service training they received. Nursing staff, consultant and medical student opinion was also sought. Partial-shift and full-shift systems led to reduced hours of work when compared to on-call rotas (mean hours: partial shift 65·0; full shift 59·8; on-call 72·7), but they were associated with significantly lower training experience and training satisfaction scores for the house officers than were on-call systems (P < 0·01). Shift systems were unpopular among consultants and medical students but not nursing staff. Despite reducing excessive hours of work, shifts may be detrimental to the training of medical house officers. The further imposition of shift working should be suspended until such time as the impact of new working patterns on the training of medical staff has been determined.     

Views of doctors in training on the importance and availability of career advice in UK medicine

OBJECTIVES: To determine whether doctors in their first year after qualification wanted career advice, and, if so, whether they thought they had been able to obtain useful advice, and whether older doctors thought that adequate career advice had been available to them. METHODS: We carried out a postal questionnaire survey of all UK medical graduates of 1988, 1993, 1996, 1999 and 2002, and a 25% random sample of the graduates of 2000. RESULTS: The response rate was 67.4% (24 261/35 976 mailed questionnaires). Of doctors in the first postgraduate year, 95% agreed that: 'It is important to be given career advice at this stage of training.' A total of 38% disagreed with the statement: 'I have been able to obtain useful career advice since graduation.' Of more experienced doctors surveyed between 3 and 11 years after graduation, 34% agreed that: 'Making career choices has been made more difficult by inadequate career advice.' CONCLUSIONS: The great majority of junior doctors want career advice after qualification. It cannot be assumed that they are able to seek it out for themselves satisfactorily. Career advice needs to be planned into postgraduate work and training.     

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.     

Parents-as-teachers: design and establishment of a training programme for paediatric residents

OBJECTIVES: To improve the training of paediatric residents in general and to provide more meaningful insights into family functioning. DESIGN: The programme is one facet of a 1-month developmental disabilities rotation for paediatric PL2 residents. It incorporates elements of family-centred care whereby physicians learn through home and community site visits about the importance of developing partnerships with parents and service providers in order to give better care to children with chronic conditions. SETTING: Gillette Specialty Health Care Center, St Paul, Minnesota. SUBJECTS: Paediatric PL2 residents and a parent group. RESULTS: Of 18 residents, 11 completed written and 18 completed oral feedback evaluations. There were infrequent but consistent complaints relating to logistics; more positive comments were made about the programme and individuals involved. CONCLUSIONS: In the minds of all participants, the Parents-as-Teachers (PAT) programme has been highly successful, as documented by short-term objective and subjective parent and resident feedback. The PAT experience represents a unique opportunity for parents and physicians-in-training to improve their mutual understanding. While not analysed in this report, the inclusion of a complementary programme involving on-site teaching in various community agencies also appears to be of value.     

Humanizing medicine: a special study module

As medical schools begin to implement their new curricula under the guidance of Tomorrow's Doctors, the authors wish to raise some discussion on the form and content of the special study module (SSM) component. In order to do this they put forward in this paper proposals for an SSM in Medicine and Literature. This course has been designed jointly and will be run concurrently in three Scottish medical schools: Glasgow, Aberdeen and Dundee. Arguments for the course's acceptability to faculties of medicine and to students are discussed and its inclusion in the curriculum in terms of its educational impact, skills training, effect on personal development and broadening of the student's perspective are justified. The course structure, content and assessment procedures are described and a reading list proposed. The General Medical Council points out that SSMs should be seen as opportunities for innovation and this course demands a different educational approach from the standard objectives-led approach of most medical education. A process-led model is more appropriate as it stresses the way that students develop while taking the course rather than the end point reached at its finish.     

Teaching and assessing clinical skills: a competency-based programme in China

The objective of this study was to develop a compentency-based clinical skills teaching and assessment programme in China utilizing modern teaching techniques. Medical teachers from three schools agreed on items for inclusion in the complete physical examination of an asymptomatic adult, an outline for an adult and paediatric history, and important interviewing skills. Lesson plans, performance checklists, and written and videotape training materials were developed. Standardized patients were trained at one school to assist with the teaching at that school and with the assessment at all three schools. A national, a provincial, and a local medical school in China were used. Before beginning the new curriculum for students in their first year of clinical training, baseline data were collected on skills of students at various levels of training in the previous curriculum at all three schools. Although in the previous curriculum there was some improvement in clinical skills among advanced compared to more junior students, performance was lower than expected by staff. One year after implementation of the new curriculum, students were evaluated. These students significantly outperformed their counterparts as well as the more senior level students tested the previous year. This project has established a competency-based teaching and assessment programme in China that allows for rapid improvement in the clinical skills of students. Within a short time, a sophisticated group of medical educators has been formed, who now function as consultants to other educators in their own country. Many aspects of this programme are being adapted throughout China and are applicable to medical schools throughout the world.     

The WISDOM project: training primary care professionals in informatics in a collaborative ''virtual classroom''

OBJECTIVES: The WISDOM project applies Internet technologies to create a virtual classroom in health informatics for primary care professionals. Participants use a facilitated E-mail discussion list supported by a web site which provides on-line resources and an archive of teaching materials. DESIGN: The project took an adult-learning model in which participants identify their learning needs, emphasized using informatics skills in practice, and focused on skills likely to enhance evidence-based practice. The paper describes the project and an evaluation of the first programme which ran in 1997 with 28 participants. Pre- and post-intervention questionnaires were used to assess perceived skills in informatics and evidence-based practice. SETTING: University of Sheffield. SUBJECTS: Primary care professionals. RESULTS: Participants reported statistically significant increases in eight informatics skills. There were no significant changes in evidence-based practice skills. The web-site, seminar programme and discussion list were highly rated as useful in delivering informatics training. CONCLUSIONS: The WISDOM approach is effective for the delivery of informatics training to primary care professionals, and may be used more widely for other subjects and professional groups. There is a need for further research into facilitating virtual classrooms.     

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.     

Training for medical teachers: a UK survey, 1993†

Summary: Opportunities and resources for training of medical teachers have been criticized in recent UK reports. A survey of undergraduate and postgraduate medical deans showed that training courses were available at most institutions, though only a few were specifically designed for medical teachers. Many new and specific courses are being planned and many new appointments are being made in medical education at both medical school and postgraduate levels. While the outcome of greater resources for training of medical education cannot yet be determined, we conclude that criticisms are being speedily addressed.     

Doctor-patient communication: a study of junior house officers

This study evaluates junior house officers' perceptions of their communication skills with cancer patients; the usefulness of their undergraduate communication skills training; and their sources of emotional support. All 42 junior house officers employed at Guy's and Lewisham Hospitals in August 1994 were interviewed using a study-specific, semi-structured interview. Sixty-seven per cent of junior house officers felt they had adequate communication skills in relation to medical issues, but only 36% felt they had adequate skills in relation to psychological issues. Thirty-one per cent of doctors reported that they never, or nearly never, enquired about the emotional adjustment of dying patients. Lack of time was the most commonly reported reason for avoiding asking about psychological problems (62% of junior house officers), followed by wishing to avoid awkward questions (51%) and inadequacy of skills to deal with such issues (44%). Ninety-eight per cent of junior house officers had attended the 1-week undergraduate communication skills course at Guy's and St Thomas's Hospital Medical School (UMDS). Sixty-seven per cent of those who had attended found the course helpful and 62% felt they would benefit from further training as junior house officers. Seventy-four per cent felt they could discuss their work-related concerns with colleagues and 95% felt they could talk to friends. In contrast only about 9% felt they could, if needed, talk to a counsellor. Although the majority of the junior house officers reported benefit from their communication skills training, the course does not appear to be meeting all their communication training needs. Junior house officers require further training opportunities at the undergraduate and postgraduate levels. Traditional counselling services for junior house officers may not be meeting their support needs.     

The new Dundee medical curriculum: a whole that is greater than the sum of the parts

The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.     

Mentorship in postgraduate training programmes: views of Canadian programme directors

Objectives  Many academic training programmes have developed mentorship programmes for postgraduate doctors in training, but little is known about the factors that influence their establishment.
Methods  Canadian postgraduate training directors were surveyed to determine views on mentorship and factors associated with the establishment of these programmes.
Results  A total of 199 of 344 (58%) programme directors completed an online survey. Overall, 65% of respondents reported that their training programmes had a mentorship programme and 40% felt there was a need for more structured mentorship in training programmes. Univariate analysis showed that mentorship programmes were present significantly more often in larger programmes, internal medicine-based training programmes, and in programmes where the acting programme director had either been part of a mentorship programme during his or her own training or felt that mentorship had played an important role in his or her professional development. In adjusting for covariates using a logistic regression analysis, only those factors directly attributable to a programme director's personal mentoring experiences remained significantly associated with having a mentorship programme. Those who felt that mentorship had played a role in their own careers ( P  = 0.008, odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.7–6.6) or who had been part of a mentorship programme during their own training ( P  = 0.01, OR = 6.6, 95% CI 1.4–30.1) were more likely to have an active mentorship programme at their institution.
Conclusions  A need for more structured mentorship was identified for many training programmes. Overall, programme directors' previous mentoring experiences were independently associated with having a mentorship programme.     

Academic careers in general practice and primary care

In the past 10 years, significant developments in general practice teaching and research have led to the considerable growth of academic general practice as a discipline. This paper reviews issues relating to these developments, particularly career pathways and training aspects. The need to extend these advances to the broadening arena of primary health care has given further impetus for the development of academic careers. General practice will need to work closely with secondary care, community health, and social services to develop primary health care in its broadest sense, and an evidence base, generated by relevant research and evaluation, must underpin all of this. Structural and funding changes to undergraduate education, postgraduate training and primary care research have created a range of opportunities for general practice clinicians to define career pathways, not formerly available, within multiprofessional and multidisciplinary departments and groups. Education for future general practice and primary care must underpin developments as much as a research base. Relevant masters' degrees and diplomas are now widely available, and extended vocational training and higher professional education will enable general practitioners in their formative years to consider academic opportunities.     

Back to the future — the history and philosophy of medicine experiment at Sydney University

History and Philosophy of Medicine has been a compulsory unit in the first year of the medical curriculum at Sydney University for the past decade. Volunteer tutors are drawn from most clinical and basic science departments, and each year the programme is organized on a theme of current importance in medical practice. This course began as an experiment because no resources were available for specialist staff, but has proved outstandingly successful in generating both student and teaching staff interest and support for the programme. Students present short tutorial papers to their peer group followed by submission of an essay which takes into account the tutorial discussion. The open book examination includes analysis of an unseen piece of primary source material as well as questions derived from the classwork. The Faculties of Arts and Science encouraged this educational experiment and several medical students have now opted to undertake a year of historical research during the intercalated B Sci(Med) programme, and a number of the tutors have enrolled in postgraduate historial or ethical programmes. We suggest that this model may permit introduction of novel courses in times of financial cutback within the Universities, and even allow a foundation to be laid for future development.     

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 Study

Summary. The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the 'Junior Physician 88' study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977–1986 in Finland (   n = 5208  ). After randomization, a postal questionnaire was sent to one half (   n = 2631  ) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team-work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.