An evaluation of a course for undergraduate teaching of general practice

This paper presents an evaluation of the undergraduate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaluation justifies the time spent on clarifying the undergraduate educational objectives.     

Pre-registration posts in general practice

Though the UK Medical Act of 1978 made the creation of pre-registration house officer posts in general practice in the UK a serious proposition there have been few attempts to explore the possibility. The absence of agreed educational objectives for the year makes it impossible to conduct the properly evaluated experiments that might assuage existing doubts about the appropriateness of introducing general practice as a setting in an objective way. Experience so far shows that carefully designed schemes are both feasible and worthwhile in the opinion of those involved. The implications for general practice are explored, the need for new educational thinking is discussed and suggestions about criteria for the approval of practices are put forward.     

General practitioners, students and the objectives of general practice attachments

The objectives for undergraduate experience in general practice vary little from school to school although the timing and duration of attachment does. Students' views of the relevance and achievement of these objectives to a two-week attachment in the final year of St George's Hospital Medical School's old curriculum are shown to differ from those of their GPs. The implications of these differences for planning undergraduate learning in general practice are discussed.     

Helping general practitioners to keep up with the literature: evaluation of an RCGP initiative

The recent Report of The Medical Information Review Panel suggested that locally-produced abstracting bulletins are likely to be of great value in promoting continuing education; most notably by helping GPs to 'keep up with the literature'. The Report identified Current Medical Abstracts for Practitioners (CMAP) , a publication produced by the S.E. Scotland Faculty of the Royal College of General Practitioners (RCGP), as an example of the kind of bulletin it had in mind. It further suggested that the role and effectiveness of this publication should be investigated.
A survey of the readership of CMAP was therefore carried out. It was found that CMAP is regularly read by only 28% of those to whom it is sent (free of charge). More particularly, CMAP is read predominantly by those GPs who are already conscientious users of medical literature: they use the bulletin as a complement and supplement to their other professional reading. Those GPs who devote little time to journal reading, in general, tend to ignore CMAP. They do not seek to use it as a substitute for more extensive reading of medical journals.
It therefore appears that CMAP does little to overcome the problem of GPs who do not keep up with the literature, and it is unlikely that similar publications will be initiated in other areas. Indeed, publication of CMAP may be ceased, at least in its present form.     

Essential features of a criterion-based, integrated examination at Tromsø, Norway

With data from the first integrated examinations at Stage II in the medical curriculum at Troms0, Norway, we have found that essay-type sequential case problems may be designed according to the pattern described as 'Patient Management Problems'. In particular, a new 'standardized' morphology problem which is labour-saving and which demands from the respondents general skills of high relevance was created. We also found that the taxonomic level of this comprehensive and integrated examination could be raised by following a few simple suggestions.
The reliability of the examination is shown to be above average, when pre-accepted model answers are used throughout.
New criterion-sets describing clearly acceptable and clearly non-acceptable performances (established by finding the 99% safety limits of the chosen minimum passing level, taking the number of samples into account) were applied prospectively in 1978. Of 42 candidates 37 were classified as clearly passing, while three were classified as having failed. The validity of the sets was evaluated by using them retrospectively on the 1977 data. It was shown that they were then able to pick out as failures the same four students whom the board had failed in 1977. The format has been favourably received by both students and teachers.     

A comparison of the performance on three multiple choice question papers in obstetrics and gynaecology over a period of three years administered at five London medical schools

Four, and later five, of the medical schools in the University of London collaborated in administering one multiple choice question (MCQ) paper in Obstetrics and Gynaecology to their students at the end of the Obstetrics and Gynaecology courses. The paper was amended twice after intervals of approximately 12 months. The results showed differences in performance between the five schools on questions and alternatives within questions, which were common to all editions of the paper (the ‘short’ paper). These differences were also shown in the first two editions of the full paper (the ‘long’ paper), but were not apparent in the third. There was a significant improvement in performance from the first to the second paper edition of the long by approximately 11%, but this was reversed from the second to the third edition, where there was a significant decrease in performance by approximately 4%. We cannot here exclude the possibility that this decrease in the third edition has resulted from sample bias. The rank order of the schools may result from differences in methods of teaching. It seems that such relative performance between London medical schools is contributed to by the differences in course length and by the occurrence of a mid-course test. It appears also that student performance in any of the schools has not been uniform over the period of the study, there being a peak during the period when the second edition of the paper was used. Variations in student selection occurring between schools may effect some of these differences. There was also a marked difference in students' performance between Obstetrics and Gynaecology. The short papers appeared easier than the full papers. Whilst this may be due to the greater clarity of phrasing for the questions of the short paper, we also believe the subject matter of the short paper may be more relevant. A distinct effect could also be shown, over the period, due to improvements in the wording of the questions. It is possible that students perform better at Obstetrics than at Gynaecology.     

The content of the medical curriculum at McMaster University: graduates'' evaluation of their preparation for postgraduate training

This paper describes McMaster University medical graduates' perceptions of how well their medical curriculum prepared them for postgraduate training. The graduates view their overall preparation for postgraduate work as sound. These perceptions were compared with independent assessments by internship supervisors for one graduated class. The graduates suggest their preparation for postgraduate work differs somewhat from fellow interns. Graduates reported feeling very well prepared compared to fellow postgraduate trainees in independent learning, self-evaluation and problem solving skills. They also judge their preparation in data gathering skills, behavioural science knowledge, ability to deal with social and emotional problems of patients, medical record keeping skills, preventive, follow-up and in-patient care as very good compared to peers. They identified two content areas, pharmacology and the basic medical sciences, as requiring more attention in the curriculum. These findings are discussed and related to the approach to medical education at McMaster University.     

Assessment of undergraduate general practice teaching

Final-year medical students at the University of Bristol were asked to outline a plan of management for an elderly female patient who presented with several problems. These problems were presented in the form of a 'patient management questionnaire'. This questionnaire was completed before and again after a 9-week course that included a 3-week attachment to two general practitioners. The patterns of answers were compared to look for modifications in the plan of management that could be attributed to the teaching. The results indicate a broader plan of management after the course with more students considering the physical, social and family needs of the patient, rather than the clinical problems alone. Nevertheless, further experience of this method of assessment is needed before the technique can be considered a useful tool in the evaluation of general practice teaching.     

Improving communication: a practical programme for teaching trainees about communication issues in the general practice consultation

This paper describes a teaching programme, for use in general practice vocational training, which provides a theoretical and practical framework for exploring key aspects of the consultation with trainees. A particular emphasis is on the educational or 'cognitive' outcomes of the consultation and skills for improving them. The five stages of the programme are described and an example of experience of each stage is given. The paper concludes with an evaluation of the programme by the trainers, trainees and social scientist involved.     

Review of undergraduate small group teaching with television in general practice

To help new part-time lecturers to develop skill in undergraduate small group teaching, videorecorded seminars conducted by each lecturer were reviewed at a series of staff meetings using analyses produced by experienced full-time staff. One year later a second series of comparable seminars was recorded and, using a simple method of communication analysis, the lecturers were found to be less opinionated and more non-directive towards students.     

Constructing a new course for undergraduate teaching of general practice

This paper outlines in Part I the method used to analyse and re-define a set of educational objectives on which a new course of teaching of general practice in the later clinical years is based. Part II describes the course, the learning methods, behavioural attainments and the techniques of evaluation to be implemented. A year was spent on the exercise by a group which comprised the professorial head, consultant senior lecturer and a senior registrar tutor from the Department of General Practice, Queen's University, Belfast, and a consultant educationalist, a senior lecturer, Department of Education, of the same University.     

Integrating general practice tutors into an undergraduate programme

Eighteen tutors appointed to the Department of General Practice at Dundee were visited. They provided information for a study to determine the degree of their involvement in the Department. A structured questionnaire standardized the interview and the results are described. The study showed a considerable level of success in integrating this group of practitioners into the teaching activities of the Department. Results also suggested that some educational objectives were not clearly defined, and surprisingly there appeared to be an underuse of this group of motivated teachers.     

Objectives and Students' learning in general practice

Student views of objectives and learning, during 4 weeks spent in general practice in the fifth year, are compared to those of the GPs to whom they were attached. Relationships between these views are discussed, together with their implications, for the wider contributions made by general practitioners to the undergraduate curriculum.     

A new integrated course in preventive and community medicine

An integrated course in Preventive and Community Medicine was introduced at the Christchurch Clinical School, New Zealand in 1974. Details of the fourth and fifth clinical years as well as the elective studies in the trainee intern (sixth) year are presented. The implications of the topic studies, rotating attachments, preventive medical examinations, preventive medical ward rounds, problem-orientated record studies, simulated disabilities and Clinico-Pathological Conferences are discussed. Some preliminary conclusions are drawn from the evaluation of this course.     

A course on collaboration between social workers and general practitioners during their vocational training

The educational programme reported was an experiment in the vocational training scheme of the Department of General Practice, Erasmus University, Rotterdam, Holland, and is now part of the course. The programme focused on the training in team function (co-operation) given to trainee GPs and social workers. It became clear that both groups during their professional training develop markedly different attitudes and views about patient (client) care. These differences form a fundamental handicap in any discussion about teamwork.
During the programme the students were made aware of this divergence of viewpoint and were taught how to handle these resulting handicaps and, if possible, to eliminate them.     

Teaching teachers in general practice

A short, intensive, teacher training course for general practitioners is described. The assessment techniques used indicate that it went some way towards achieving predetermined goals. Set alongside the limited time available to practitioners for attending training courses, and the logistic problems of training an adequate supply of teachers, this experience suggests that short intensive courses may have an important role in professional education.     

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.