Curriculum factors influencing knowledge of communication skills among medical students

Background  

Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students.     

The impact of needs-based education on the change of knowledge and attitudes towards medical genetics in medical students

In this research we aimed to (1) develop and validate a new questionnaire examining attitudes and knowledge towards medical genetics, (2) examine the knowledge and attitudes towards medical genetics in students of the Medical Faculty in Rijeka, Croatia and (3) evaluate the impact of education from the mandatory course Medical Genetics on the change of knowledge and attitudes. The study was conducted on 191 fifth- and sixth-year students of the Integrated Undergraduate and Graduate University Study of Medicine in the academic year 2019/2020. Students completed the validated online questionnaire anonymously and voluntarily. Fifth-year students completed the questionnaire twice (beginning/end of the course), while sixth-year students completed the questionnaire once, 3 months after completing the course. The education was carefully designed for medical students according to the CoreCompetences in Genetics for Health Professionals in Europe issued by the European Society of Human Genetics. Using the Kruskal–Wallis test, a statistically significant difference was found between fifth year before and after education and between the fifth year before education and sixth year for (a) total knowledge (P < 0.001), (b) total attitudes (P < 0.001) and (c) personal assessment of knowledge in medical genetics (P < 0.001). Moreover, positive attitudes were associated with higher levels of knowledge. In conclusion, our results emphasise the importance of needs-based education in medical genetics for medical students, which is indispensable for the increase in the level of knowledge and development of positive attitudes in order to provide better health care for patients with genetic disorders.Subject terms: Genetics research, Human behaviour     

Deficient knowledge of genetics relevant for daily practice among medical students nearing graduation.

PURPOSE: The objective of this study was to investigate whether the knowledge of genetics relevant for daily practice among medical students nearing graduation in the Netherlands was sufficient to react appropriately to the change of relevance of genetics in medicine. METHODS: A computer examination validated in a group of clinical geneticists, medical students nearing graduation, and nonmedical students. The examination consisted of 215 genetic questions classified by the designers into three categories of relevance: "essential" knowledge (requirement: > 95% correct answers), "desirable" knowledge (requirement: > 60% correct answers), and "too specialized" knowledge (no requirement). To set an independent standard, the questions were also judged by clinical geneticists and nongenetic health care providers in an Angoff procedure. In total, 291 medical students nearing graduation from seven out of the eight medical schools in the Netherlands participated. RESULTS: As expected, the mean score for "essential" knowledge (71.63%, 95% CI 70.74-72.52) was higher than for "desirable" knowledge (55.99%, 95% CI 55.08-56.90); the mean score for "too specialized" knowledge (44.40%, 95% CI 43.19-45.62) was the lowest. According to passing scores set for "essential" knowledge as defined by the designers, the clinical geneticists, and the nongenetic health care providers, only 0%, 26%, and 3%, respectively, of the participants would have passed. CONCLUSIONS: Medical students nearing graduation lack genetic knowledge that is essential for daily practice. Therefore, changes should be made in the medical curricula.     

The procedural skills of medical students: expectations and experiences

The procedural skills that medical students should learn were identified by a survey of faculty and residents at the University of North Carolina at Chapel Hill School of Medicine in 1985. Those who responded indicated that it was important for students to have exposure to all 52 procedures listed on the questionnaire. Only a small number of procedures were identified by 75% or more of those who responded as being important for students to perform with proficiency (11 procedures identified by the faculty, nine by the residents). On another questionnaire, the graduating medical students indicated that, for the most part, they had experience performing these important procedures. To ensure clinical competency, expectations regarding these skills should be communicated to students, faculty, and residents and, ideally, a system should be established to assess these skills.     

医学生临床沟通技能课程设置及效果自评

目的 有效提高医学生的医患沟通技能.方法 北京协和医学院2009年3月至2011年10月期间对165名八年制高年级医学生教授临床沟通课程,使用学生自评问卷的方式对教学效果进行评估.结果 医学生在课后大部分临床沟通技能高于课前,大部分医患沟通能力评分高于课前,以患者为中心的理念得到强化.课程整体满意度为96.2％.结论 临床沟通技能课程达到了提高沟通技能的目的,沟通技能的客观考核方式需要进一步探索.     

The effect of a domestic violence interclerkship on the knowledge, attitudes, and skills of third-year medical students.

PURPOSE: To determine whether participation in an intensive domestic violence interclerkship (DVI) improved the knowledge, attitudes, and skills of two successive cohorts of students at the University of Massachusetts Medical School. METHOD: The authors measured the knowledge, attitudes, and skills pertaining to domestic violence of third-year students in the classes of 1997 and 1998 using a validated written examination administered before, immediately after, and six months after participation in a 3.5-day or two-day DVI, respectively; they compared the scores using paired t-tests. Nine months after the DVI, the students' domestic violence screening skills were measured by a performance-based assessment (OSCE); using unpaired t-tests, the authors compared the OSCE scores with those of a previous third-year class that had not participated in a DVI. Immediately after the OSCE, the students reported their levels of confidence in domestic violence screening and their satisfaction with the domestic violence curriculum; using chi-square analysis, those self-reports were compared with those of the class with no DVI. RESULTS: The students who participated in the DVIs immediately and significantly improved their knowledge, attitudes, and skills (p < .001), and fully or partially sustained those improvements six months later (p < .001). Nine months after the DVI, the students performed domestic violence screening more effectively (p < .001), expressed greater comfort with domestic violence screening (p < .001), and felt better-prepared by the curriculum to address domestic violence issues (p < .001) than did the students with no DVI. CONCLUSION: Participation in a short, focused DVI curriculum produced sustainable improvements in knowledge, attitudes, and skills that were successfully applied by third-year medical students to effective domestic violence screening. Interclerkships are an effective way to fit into the clinical curriculum those subjects that transcend the traditional biomedical domain and intersect all areas of medical practice.     

Milestones for medical students completing a clinical genetics elective

PurposeWe are not aware of any competency-based evaluation method that is specifically designed for a genetics elective for medical students. Here, we aimed to create a milestone template to improve evaluation and to use the feedback from the template to improve the elective.MethodsThrough an iterative process using feedback from eight medical students and eight attendings, we crafted a milestone template for the medical student genetics rotation. A “scavenger hunt” of activities was developed to address several gaps discovered through this process.ResultsAll participants felt that the milestone template was complete for the student level and that it improved evaluation. In response to faculty feedback, we modified the evaluation process such that several evaluators rated students in only selected domains. Scavenger hunt activities were designed to address five domains that the students reported to be inadequately covered.ConclusionDeveloping a milestone template has taken us a step closer to meaningful assessment of students completing the genetics elective and simultaneously allowed us to strengthen the elective. Meaningful elective experiences in genetics that provide individual feedback within a learner-centered assessment of progress and flexible out-of-classroom activities may contribute to lifelong learning and interest in genetics and genomics.     

Retention of basic sciences knowledge at clinical years of medical curriculum

Aim

To explore the association between the knowledge of basic (physiology and biochemistry) and clinical sciences (internal medicine) among medical students, and determine the level of retained basic science knowledge at the fifth year of medical studies.

Methods

Medical students attending the second (n = 145, response rate 60%) or the fifth year (n = 176, response rate 73%) of medical studies at the Zagreb University School of Medicine in Croatia were given an anonymous knowledge test with 15 pairs of questions developed specifically for this purpose. Each pair consisted of a basic and clinical question, with the correct answer to the basic question explaining the physiological or biochemical background of the clinical question. Three pairs of questions were excluded from the analysis due to poor psychometric characteristics.

Results

We found statistically significant correlation between basic and clinical tests scores for both groups of students (r = 0.47, P<0.001 for the second year and r = 0.45, P<0.001 for the fifth year). 2 × 2 within-between measures ANOVA revealed a significant interaction effect for knowledge test and study year (Wilks λ = 0.55, F_{1, 319} = 262.7, P<0.001; effect size = 0.45), showing that fifth year students scored lower on the basic test than second year students but obtained higher scores on the clinical test.

Conclusion

The core basic science knowledge is lost during the clinical years of medical studies. Although remembering and understanding basic science concepts as a background of clinical statements at the clinical years does not directly affect clinical knowledge, there is a positive correlation between retained basic science concepts and clinical knowledge.Plato (1) wrote, “Right opinion, being incapable of giving a reason, is not knowledge (for how can knowledge be devoid of reason? nor again, ignorance, for neither can ignorance attain the truth), but is clearly something which is a mean between ignorance and wisdom.”Medical students build their clinical knowledge on the ground of previously obtained basic knowledge. Nevertheless, many senior undergraduate students indicate informally that they do not remember much from their basic science medical courses and that the content of those courses does not seem relevant to their later clinical work or studies (2).The portion of knowledge retained by the students seems to be the central question for medical education (3). If students are unable to use the knowledge they had once been taught, if that knowledge becomes inert and inaccessible, then teaching such knowledge becomes questionable (4-6).A loss of knowledge among senior medical students was confirmed by all the studies conducted. Watt (7) found a 21.5% decline in pre-clinical knowledge of oral biology when the same test was administered 20 months later to dental students. Krebs (8) discovered that medical students retained only 65% of the simple basic science knowledge. D’Eon (2) found a considerable knowledge loss among medical students in the three basic science courses tested and this loss was not uniform across courses (relative knowledge loss over the ten months was 18% of immunology, 52% of neuroanatomy, and 19% of physiology). Knowledge loss does not seem to be related to the marks on the final examination or the assessment of course quality by the students (2).However, longitudinal data from five medical schools across the USA confirm the strong associations between levels of performance in medical school and clinical competence in residency (9). Failure rates on certifying examinations and board certification status were significantly associated with the assessment of basic sciences knowledge during medical school education. These findings strongly refute the pessimistic view which claims that what is learned in medical school is irrelevant to the practice of medicine (9).The aim of the study was to explore the level of basic knowledge of physiology and biochemistry and how it influenced the knowledge of clinical medicine among second and fifth year medical students. Tested clinical concepts were supposed to be known to second year students as well, since they were taught as examples of applied basic science in medicine in the second year courses. Comparison of basic medical knowledge between second and fifth year medical students can illustrate whether basic science concepts are retained at the fifth year of medical studies and ascertain if senior students accept clinical knowledge with sufficient insight into causality of the processes learned.     

A survey of basic technical skills of medical students.

PURPOSE: In 1998, the Medical Schools Objectives Project (MSOP) Report listed the minimum routine technical procedures that graduating medical students should be proficient to perform. The authors conducted a survey to determine to what extent basic technical skills are being taught formally and how student competence in these skills is being evaluated in U.S. medical schools. METHOD: A questionnaire of five items, designed to supplement existing information in CurrMIT, the national curriculum database for medical schools, was transmitted electronically via the AAMC listserv to associate deans for academic affairs. RESULTS: Sixty-two of the 126 medical schools (52%) responded to the survey. Most agreed that graduating medical students should be proficient to perform basic technical skills. Fifty-five percent of the respondents required students to keep logs of procedures performed. A majority responded that their students were proficient to perform venipuncture, IV placement, suturing lacerations, Foley catheter placement, and arterial puncture. The responding schools stated that few students are proficient in thoracentesis and intubation of children and neonates. CONCLUSIONS: It is likely that half of the medical schools are not attaining the MSOP objective of rigorously teaching and evaluating technical procedures. Currently, more measures and more sophisticated measures of physicians' performance are being implemented in medical practice. The authors' findings call attention to this educational need and act as a stimulus to improve this aspect of medical education.     

The associations between reflective ability and communication skills among medical students

ObjectivesAssess associations between medical students’ reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions.MethodsWe analyzed 66 medical students’ reflective ability, using ‘REFLECT’ rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. ‘BAS’ and ‘SPIKES’ questionnaires measured students’ communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills.ResultsSignificant positive correlations between students’ reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients’ needs and address emotions.ConclusionsHigh reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically.Practice implicationsEncourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients’ reactions to them. This process may help students develop competency to share and tailor difficult information sensitively—a critical skill when communicating bad news.     

不同阶段临床学生外科基本技能的训练教学方法探索

北京协和医院外科学教研室对外科教学进行了适当优化,提出了全阶段、整体性、系统性教学方案,针对不同阶段临床学生制定了不同的外科基本技能训练方法,并针对相应的学习阶段制定相应的学习要求和考核标准,取得了很好的教学效果。     

An innovative approach to developing the reflective skills of medical students

Background  

Development of the reflective skills of medical students is an acknowledged objective of medical education.     

Loss of international medical experiences: knowledge,attitudes and skills at risk

Background  

Despite the great influence International Medical Experiences (IMs) can have on young physicians and their impact on patients and communities, they are not offered in all training programs and are at risk of being reduced in some due to stringent guidelines for funding of graduate medical education.     

Third year medical students perceptions towards learning communication skills: implications for medical education

Objective

To analyze students’ perceptions towards learning communication skills pre-and-post training in a Communication and Clinical Skills Course (CCSC) at a Portuguese Medical School.

Methods

Content analysis was used to describe and systematically analyze the content written by students (n = 215 from a total of 229) in an open-ended survey. In addition, content analysis association rules were used to identify meaning units.

Results

Students’ pre-training definitions of communication skills were not specific; their post-training definitions were more precise and elaborated. Students perceived communications skills in Medicine as important (61%), but recommended that teaching methodologies (52%) be restructured. There appeared to be no connection between criticism of teaching skills performance and perceptions of the other aspects of the course.

Conclusion

Students’ experiences at CCSC are associated with their perceptions of communications skills learning. Content analysis associations indicated that these perceptions are influenced by context.

Practice implications

Improvement of curricula, teaching and assessment methods, and investment in faculty development are likely to foster positive perceptions towards learning communication skills in these students.     

A model for assessing information retrieval and application skills of medical students.

PURPOSE: To develop and evaluate a model for assessing information retrieval and application skills, and to compare the performances on the assessment exercises of students who were and were not instructed in these skills. METHOD: The authors developed a set of four examination stations, each with multiple subtasks, and administered the exams to students at two medical schools. Students at one school had intensive instruction in literature searching and filtering skills for information quality (instructed group), and those at the other school had minimal instruction in these areas (uninstructed group). The stations addressed pediatrics content and the skills of searching Medline and the World Wide Web, evaluating research articles, evaluating the accuracy of information from the Web, and using the information to make recommendations to patients. The authors determined the psychometric characteristics of the stations and compared the performances of the two groups of students. RESULTS: Students in the instructed group performed significantly better and with less variability than the uninstructed group on four tasks and no differently on seven tasks. There was no task on which the uninstructed group performed significantly better than the instructed group. CONCLUSION: The prototype stations showed predictable differences across curricula, indicating that they have promise as assessment tools for the essential skills of information retrieval and application.     

The impact of perceived gender bias on obstetrics and gynecology skills acquisition by third-year medical students.

PURPOSE: To investigate the perceptions of third-year medical students about how their acquisition of skills during their obstetrics and gynecology clerkship may be affected by their gender. METHOD: From January 1999 to December 2001, all third-year students at one school completing their obstetrics and gynecology rotation were given an anonymous questionnaire addressing whether gender had a positive, negative, or neutral effect on their learning experience. Students were also asked to enumerate procedures they had performed (e.g., deliveries and speculum examinations) and to rate their ability to counsel women on several clinical problems. To further investigate the perceptions of gender discrimination, a focus group of 12 fourth-year students was held. RESULTS: A total of 263 questionnaires (95%) were returned. Of the respondents, 78% of the men felt their gender adversely affected their experience, and 67% of women felt gender had a positive affect. All but five of the remaining students were in the neutral group. Those students who reported a positive gender effect performed significantly more speculum examinations (15.5 versus 12.3), labor coaching (8.7 versus 6.2), and independent deliveries (3.4 versus 2.7) than did the negative gender-effect group. The positive gender-effect group felt more confident of counseling skills. The neutral group did not differ from the negative group. The overall numerical differences among groups were small, and all groups, on average, performed adequate numbers of skills to meet clerkship objectives. CONCLUSIONS: There is a strong perception among medical students that gender influences experience on their obstetrics and gynecology clerkship, but the differences are actually small. Possible reasons for such strong feelings are addressed and related to the history of sexism in reproductive health care and to the ethics of patients' preferences.