The introduction of problem-based learning projects into a clinical correlation course in the first year of the Edinburgh medical curriculum

Thirty hours were allotted to problem-based learning projects in the first year of a new medical curriculum in Edinburgh. Those projects have been very successful in encouraging student initiative and in satisfying the students'desire for contact with patients, relatives and medical staff early in the curriculum. The difficulties involved in this form of teaching and the shortcomings of the exercise are discussed.     

Interprofessional education in medical school

The opinions of entering medical students regarding interprofessional education (IPE), and their reasons, are described in this article. More female than male students favour IPE, 49 as compared to 25%. Students who endorse IPE give different reasons for their position than students who oppose it. The former group refer to increased communication and respect among health professionals, increased knowledge about mutual roles and function, greater equality among members of the health team and improved patient care. The opposing group fear that IPE would lower the quality of education by increasing class size and slow the pace of instruction to accommodate students with limited scientific backgrounds. Students also protest against having to study irrelevant subjects and acquire irrelevant skills. The opposing group is concerned primarily with IPE's effect on medical students; the group in favour is concerned more with the effect on patients and interprofessional relations. It seems that opinions about IPE are part of a basic attitudinal structure that medical students bring with them when they enter medical school. The implications for IPE in medical school are discussed.     

Establishing a psychiatry clerkship in a clinical teaching unit

Difficulties arising during the establishment of a clinical unit students' clerkship programme are presented. These are reviewed to establish general principles important for the successful introduction of such clerkships. Particular emphasis is laid on continual evaluation, and the results of one such evaluation are discussed.     

Objective measure of incidental learning in oncology

The learning experience of 150 third-year medical students in the specific area of paediatric oncology during a 6-week required paediatric clerkship, was assessed.
The clerkship, during which emphasis is placed on patient contact, was based at each of two institutions (A and B). Institution A, with a large relevant patient population and more teaching staff in the field of paediatric oncology, relies primarily on incidental learning relative to this area during the clerkship. Institution B, with smaller related patient groups and teaching staff, employs didactic instruction in this field. Results of pre- and post-testing at both institutions revealed comparable and significant gain in information relative to paediatric oncology in both student groups. Pre-test scores did not increase during the course of the school year, suggesting that the influence of specific prior clerkships was negligible. Differences in the amount learned between individual student rotational groups were less marked in institution A, where opportunities to contact patients and teaching staff concerned with this specific area, was more consistent.     

The British contribution to sponsored postgraduate training for overseas doctors

More effective use could be made of the resources devoted to the sponsored postgraduate training of overseas doctors in Britain. There is need for careful selection and planning of training programmes. More attention should be given to providing skills in communication, management and education. Clinical training requires the better provision of posts carrying responsibility. Training of leaders in the basic medical sciences should be based to a greater extent on courses leading to M.Sc. and less upon pure research degrees (there is also a major need for a broadly based M.Sc. for non-medical science graduates who will teach the basic sciences). A major recommendation is that a central office should be established which would plan programmes for and supervise all sponsored trainees, under contract with the sponsoring body.     

Comparison of didactic lecture, self-reading and self-instruction as learning methods in medical students of western India

A controlled study was conduced on a batch of fifty-four medical students in the paraclinical period of study, to compare the relative effectiveness of self-reading of books, didactic lecture and use of self-instruction kits as teaching-learning experiences. The assessment was done by an immediate and delayed objective type examination as well as questionnaire.
The results indicate self-reading to be relatively ineffective. Didactic lectures and use of self-instruction kits have a similar rating in objective assessment while, subjectively, the students expressed a marginal preference for self-instruction kits.
Comparison of the performance of the students grouped according to merit reveals that there is no significant difference between the three methods of learning in the lower group while the upper group did perceptibly better with self-instruction kits than with didactic lecture.     

The reform of medical education: a Canadian model †

The Flexner reforms of the early 20th century were successful in correcting a mismatch between medical education and the newly available knowledge from the laboratory sciences. At the same time, they set in motion changes which have resulted in another mismatch, this time between medical education and society's needs. Five major corrective changes are described, with particular reference to the role of family medicine (general practice) in attaining them: (1) a change in the environment of learning, (2) a reawakening of concern with the subjective aspects of medicine, (3) a shift of emphasis from content to process, (4) a change in our concept of health and (5) a rapprochement between personal and population medicine. New medical schools have had an important influence on the reform of medical education. However, it is important also to study examples of successful adaptive change in older institutions. Changes at the University of Western Ontario are described as an example of successful adaptation. Some reasons are given for the failure of many institutions to adapt. Five conditions are necessary if a medical school is to adapt successfully to change: (1) the school should penetrate the entire health care system, (2) all sections of the profession should be represented on the faculty, (3) the school should be strongly rooted in its region, (4) it should have a flow of information from the ‘grass roots’ and (5) society should have some means of ensuring that its needs are met.     

Audiotape and booklet self-instructional materials in physiology: an evaluation of their effectiveness and acceptability in the pre-clinical curriculum

Audiotape and booklet self-instructional materials in physiology have been evaluated for their effectiveness and acceptability in the pre-clinical course. Learning effectiveness was determined by comparison of pre-test and post-test scores on multiple choice tests, and acceptability was determined by scores on a specially constructed and validated Likert type questionnaire. It is concluded that in three out of the four physiology topics studied, audiotape and booklet was a significantly more effective method of study than the conventional method of text books and lecture notes. Self-instructional material in the form of audiotape and booklet is acceptable to students both in absolute terms and when compared with other methods of learning. Use of the self-instructional material enabled students to achieve the required learning objectives.     

Teaching the teachers — a needs assessment of tutors for a new clinical skills course

There is an increasing trend in undergraduate education towards teaching clinical skills from a community base. A new clinical curriculum was introduced in Newcastle upon Tyne in 1995, beginning with an integrated clinical skills course. Although the attitudes and views of general practitioners (GPs) towards community-based clinical teaching have previously been reported, their perceived training needs have not been formally identified. The aims of this study were to identify the competencies needed by GPs for community-based clinical skills teaching, to compare and contrast these needs with their hospital colleagues, and to use the results to develop a teaching programme for the clinical tutors involved in the new course. In order of priority, the GPs and hospital tutors expressed similar needs: small-group teaching skills, assessing student needs, giving effective feedback and assessment of student performance, with a preference for the teaching to be organized within local teaching units. Most GPs and hospital tutors (73 and 69%, respectively) requested a distance-learning pack to complement the teaching. General practitioners rated resources for improving their individual clinical skills more highly than their hospital colleagues: for example, videotapes demonstrating examination techniques. Forty-six per cent of GP tutors had received some formal training in teaching methods compared to 29% of hospital tutors. The implications of the results for developing a 'Teaching the Teachers' course for clinical tutors are discussed.     

Student expectations and personal perceptions as an approach to course evaluation

Evaluation of courses tends to emphasize individual teacher behaviour and/or student reaction to the course. To avoid this approach a technique to determine student expectations and the degree to which the expectations were or were not met by the course was used. In addition, student perceptions of laboratory teaching/learning objectives of teachers were obtained.     

Student perceptions of a new integrated course in clinical methods for medical undergraduates

CONTEXT: In line with recent General Medical Council recommendations a new, 8-week integrated course in clinical methods has been introduced into the undergraduate curriculum at Leicester University. OBJECTIVES: To describe student perceptions of the course and to identify areas for improvement. DESIGN: A questionnaire survey. SETTINGS: These were 50 general practices, three teaching hospitals and the academic Department of General Practice and Primary Health Care. SUBJECTS: A total of 180 third- and fourth-year medical students. RESULTS: The questionnaires were completed by 93% of students. The latter expressed higher satisfaction with practice teaching compared with hospital teaching, on a 5-point scale, with regard to questions on 'teaching content' (4.0 vs. 2.7, P < 0.0001) and 'teaching process' (4.1 vs. 2.7 P < 0.0001), which was reinforced by free text comments. Of the respondents, 92% agreed that their teaching practice had satisfied the required teaching timetable and 87% of students found their departmental tutor enthusiastic and stimulating. CONCLUSION: It is possible to deliver an integrated course in clinical methods, teaching generic clinical skills, in a mix of hospital and practice settings. Nevertheless there were substantial differences in student perceptions of the relative quality and impact of teaching in the two settings. This may be related to the more detailed programme of preparation of practice teachers and the greater extent to which practice teachers were required, and able, to create protected time for the teaching task. These differences should be minimized if hospital teachers undergo similar preparation for the teaching task and have similar levels of protected teaching time.     

Child health surveillance: development of a multicentre course and its evaluation

With increasing numbers of general practitioners wishing to provide child health surveillance during the 1980s and the expected further increase with the 1990 General Practice Contract, a course in child health surveillance was developed. The content of the course was determined by a needs assessment of Welsh general practitioners in combination with the expectations of paediatricians already involved in educating doctors in community child health. A multicentre course with prepared materials was developed. Teaching methods reflected adult learning needs, included practical clinical competencies and was centred in small groups each led by local tutors. The course was held annually on three occasions, with 220 participants in total. The materials and teaching methods were highly acceptable to the participants, and evaluation demonstrated a significant increase in knowledge and confidence. All participants reached the required clinical competence, six after further teaching. The content, teaching methods, and evaluation methods were altered in the light of feedback, resulting in a 'stand alone' course with built-in evaluation, which is now being provided by local tutors. This study has demonstrated the feasibility of providing a course for large numbers of doctors, using predominantly small-group teaching and discussion with local tutors. We are grateful to all the participants and especially the tutors.     

When students learn numbers: evaluation of a course in clinical decision-making

This paper describes the evaluation of an innovative course in clinical decision-making (CDM). A traditional course in neurology taught concurrently to the same group of students by the same teacher was used for comparison. The aim of the course was to introduce students to the basic concepts of CDM as an aid to rational decision-making. The end-point of the evaluation was their perception of the immediate clinical relevance of CDM. It was postulated that by seeing this relevance they would be more likely to change their decision-making behaviour than by simply learning factual content or principles. The evaluation used an ongoing formative approach, including ethnographic analysis, questionnaires, small group discussion and supportive feedback for the teacher. The ongoing evaluation of the course resulted in revisions with increasing relevance within the students' level of experience, changes in sequence of presentations and encouragement of active student participation. A pre-test showed that students had difficulty in the correct assessment of the validity of data and in the correct revision of opinion. Results of the evaluation indicated that the CDM course did not achieve its objective of making students aware of the immediate clinical relevance of CDM. Possible reasons for this include the lack of reinforcement from clinicians suitable for modelling and the context specific nature of the learning of thinking processes. For a CDM course to be successful, it may need to be taught within the context of specific clinical topics. It is suggested that the evaluation approach used here is a cost-effective method when considering innovations in the curriculum and useful for generating further questions for study.     

Early diagnosis of substance abuse: evaluation of a course of computer-assisted instruction

A computer-assisted, experiential course of instruction on early diagnosis of substance abuse was developed and compared to three existing substance abuse curricula for third-year medical students on family medicine clerkships. The experimental course, requiring 2 hours of teacher contact, consisted of three computer-assisted instruction modules, active discussion, role play, opportunities for applying new knowledge and clinical skills, and modelling of clinical interest by a family doctor. The three comparison educational programmes were a one-week immersion experience on a substance abuse in-patient unit, 1-4 hours of lecture, and no formal teaching. For 6 months, all third-year medical students at Jefferson Medical College were exposed to one of these courses, and to the same required readings on substance abuse, on their required family medicine rotations at different clerkship sites. They completed end-of-rotation questionnaires assessing their knowledge, satisfaction with substance abuse teaching, and motivation for continued learning. Groups were similar with regard to demographic variables, academic performance, and previous curricular and extra-curricular exposure to substance abuse. Despite a possible selection bias favouring the immersion experience, the computer-assisted course resulted in higher levels of knowledge on early diagnosis, but similar attitudes and satisfaction. The computer-assisted and immersion courses produced more favourable outcomes than lecture-based teaching and no formal teaching. Compared to no formal teaching, lecture did not produce measurable effect. The results suggest that a computer-assisted, experiential substance abuse course, based on relevant and practical goals, can efficiently augment knowledge and motivation for further learning of third-year medical students.     

A new course in basic therapeutic skills for medical and dental students at the College of Medicine, University of Lagos: student evaluation

A new course in basic therapeutic skills for first-year students at the College of Medicine, University of Lagos began in July 1980. The course is designed to teach basic medical procedures in nursing, first aid, medicine, surgery, paediatrics and dentistry. It also introduces the students, early in their medical or dental training, to the role in treatment and rehabilitation of dietetics, physiotherapy, prosthetics and orthotics, occupational therapy and medical social work.
The course is in its second year of implementation with 152 students participating in the inception year and 166 in the second year. The former group of students had a pre-test and post-test consisting of fifty multiple choice questions. The latter group were also examined in the performance of the skills taught them using check lists and rating scales of the Objective Structured Clinical Examination (OSCE) type.
At the end of the course the students completed an evaluation questionnaire. As a result, the organization of the course in its second year took account of many of the findings from student evaluation in the first year. The particular learning needs of dentistry students were included, hence the second class of dental students found the courses more relevant than the previous class. The teachers were encouraged to develop audiovisual presentations of their subjects and the increased use of simulators permitted greater opportunity for students to practise skills.
The study indicates that student evaluation of course organization and management can be of great value in providing the feedback required to progressively improve the learning environment.     

Occupational medicine: student evaluation of a postgraduate course

Postgraduate students attending a ten-week course in occupational medicine have evaluated all contributions to this course on the basis of value, interest and presentation. Assessments given for the standards of presentation of items of the teaching vary more than the assessments given for interest. Interest in those parts of the course with a direct clinical content is greater than in other sections of the course. Methodological problems necessitate certain assumptions in this form of audit. The results nevertheless provide worthwhile feedback to contributors and co-ordinators that can be used to maintain and improve the quality of courses.     

Teaching in medicine: an elective course for third-year students

An elective course titled 'Teaching in Medicine' was given to eight third-year medical students in response to the policy of the University of British Columbia medical school to expand its elective offerings. Course objectives focused on the skills that doctors need to fulfil their role of teacher of patients, students or colleagues. Instructional methods included directed reading, group discussions, microteaching, evaluation of videotaped samples of teacher behaviour, role play, demonstration and practice in developing and using audiovisual materials, and analysis of research in teaching and learning in medicine. The course culminated in each student presenting a major teaching session which was videotaped and assessed by the student and course teachers. All students rated the course as excellent. This paper describes the course and the teacher and student perceptions of it. The experience of this medical school is that a course of this nature is extremely worthwhile.     

Crafting cases for problem-based learning: experience in a neuroscience course

Clinical cases for problem-based learning should capture the relevance of patient encounters, and not serve merely as a 'take-off' point for scientific study. As a vehicle of learning, the case should drive the science and the science should drive the case. Decision points elicit intellectual commitment, and help to raise the level of inquiry. Our cases are focused, avoiding clinical complexity and reliance on pattern recognition. We emphasize formulation of evidence-based mechanistic hypotheses. The case does not stand alone, but must suit its position in the course and curriculum.     

Literature and medicine: a short course for medical students

A course on literature and medicine for medical students is described. A wide range of books, plays and poems were used with medical and non-medical themes. Students enjoyed the course and particularly welcomed the non-medical components. The staff learned at least as much as the students. Several book lists were developed with input from the students. Such a course might have a part to play in several parts of the medical course, such as in the teaching of ethics.     

Ongoing evaluation of a behavioural sciences course for medical students: uses, methods, limitations

This paper describes a system of ongoing student evaluation of a behavioral sciences course for medical students. Student opinion about all aspects of the course is tapped, using a variety of methods including formal and informal discussion between staff and students; and written evaluations of lectures, tutorials, textbooks, assignments, and methods of assessing students' performance. The evolution of the evaluation programme into its present form is described, together with the way in which student evaluations are used, and the limitations of these methods of evaluating a course.