Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

Anatomy 1999–2000: the curriculum,who teaches it and how?

AIM: To review the impact of Tomorrow's Doctors on anatomical teaching in the UK and Ireland. To establish in particular whether a consensus has emerged on: (a) the duration and format of teaching, and (b) the impact on staffing and on the four main anatomical disciplines of gross anatomy, histology, embryology and neuroanatomy. METHOD AND RESULTS: A postal survey of 28 anatomy departments was carried out. This yielded a response rate of 75%. Twelve departments used systems-based curricula, five used problem-based curricula, and four used a traditional regional format. There were variable levels of integration between the anatomical disciplines and subjects outside anatomy. Dissection taught over the first 2 years was retained in 76% of the courses, frequently supplemented with demonstrations, with an average of 2 hours of practical work for every hour of lecture. Staff/student ratios varied with the type of curriculum: dissection room teaching and problem-based curricula were associated with higher numbers of either full or part-time clinically qualified teachers. Teaching was supported by a high proportion of part-time clinically qualified staff, giving an overall average staff/student ratio of 19.8 in a dissection class. CONCLUSIONS: There is considerable variation in duration and staffing of anatomy teaching, according to the type of curriculum. This suggests there may well be substantial variation in the level, content and depth of anatomical curricula across the country, and that this should be quantified.     

Growth of medical knowledge

BACKGROUND: Knowledge is an essential component of medical competence and a major objective of medical education. Thus, the degree of acquisition of knowledge by students is one of the measures of the effectiveness of a medical curriculum. We studied the growth in student knowledge over the course of Maastricht Medical School's 6-year problem-based curriculum. METHODS: We analysed 60 491 progress test (PT) scores of 3226 undergraduate students at Maastricht Medical School. During the 6-year curriculum a student sits 24 PTs (i.e. four PTs in each year), intended to assess knowledge at graduation level. On each test occasion all students are given the same PT, which means that in year 1 a student is expected to score considerably lower than in year 6. The PT is therefore a longitudinal, objective assessment instrument. Mean scores for overall knowledge and for clinical, basic, and behavioural/social sciences knowledge were calculated and used to estimate growth curves. FINDINGS: Overall medical knowledge and clinical sciences knowledge demonstrated a steady upward growth curve. However, the curves for behavioural/social sciences and basic sciences started to level off in years 4 and 5, respectively. The increase in knowledge was greatest for clinical sciences (43%), whereas it was 32% and 25% for basic and behavioural/social sciences, respectively. INTERPRETATION: Maastricht Medical School claims to offer a problem-based, student-centred, horizontally and vertically integrated curriculum in the first 4 years, followed by clerkships in years 5 and 6. Students learn by analysing patient problems and exploring pathophysiological explanations. Originally, it was intended that students' knowledge of behavioural/social sciences would continue to increase during their clerkships. However, the results for years 5 and 6 show diminishing growth in basic and behavioural/social sciences knowledge compared to overall and clinical sciences knowledge, which appears to suggest there are discrepancies between the actual and the planned curricula. Further research is needed to explain this.     

Eight years' experience of widening access to medical education

BACKGROUND AND STUDY AIMS: This paper reports on a 1-year, full-time widening access to medicine course that prepares mature adults for entry to selected UK medical schools. The course was developed in 1992-93 in co-operation with the University of Leicester Medical School and is restricted to adults over 21 years of age. The main subjects of the curriculum are biology, chemistry and physics. These are supported by mathematics, statistics and medical geography. METHODS: Three successive year groups were used as trial groups and nine medical schools agreed to participate in the trial. The successful trial students were monitored as they progressed through medical school. A total of 19% of successful trial students graduated from medical school with honours degrees. Evaluation of the trial years has led to changes in both the curriculum and assessment methods. FINDINGS: The longitudinal study of the course indicates that progression to medical school has increased from an average of 64% during the trial years to an average of 85% over the last 3 years. Graduate entry to the course has increased from an initial 10% of the intake to 50% over the same period. The role of the programme as a vehicle for widening access to medical school was monitored in the 4-year period 1997-2000. In these years, 41% of the student intake progressing to medical school came from socioeconomic groups IV and V, whilst 36% came from socioeconomic groups I and II. The 2001/2002 cohort numbers 45.     

Students' attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum

OBJECTIVE: To examine students' attitudes and potential behaviour with regard to whistle blowing as they progress through a modern undergraduate medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School. SUBJECTS: A cohort of students entering Glasgow University's new learner-centred, integrated medical curriculum in October 1996. METHODS: Students' pre- and post-Year 1, post-Year 3 and post-Year 5 responses to the whistle blowing vignette of the Ethics in Health Care Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes in students' reasoning behind their decisions of whether or not to whistle blow were also identified. RESULTS: There was little improvement in students' performance as they progressed through the curriculum in terms of their proposed behaviour on meeting the whistle blowing scenario. There was also no improvement in the quality of justifications provided. Students' reasoning on whether or not to whistle blow was found to change as the curriculum progressed. CONCLUSIONS: The EHCI has the potential to elicit students' attitudes towards ethical issues at entry to medical school and to measure change as they progress through the curriculum. Students should be encouraged to contemplate dilemmas from all ethical standpoints and consider relevant legal implications. Whistle blowing should be addressed as part of the wider domain of professionalism.     

Student attitudes towards anatomy teaching and learning in a multiprofessional context

CONTEXT: We carried out a survey of attitudes to learning anatomy amongst students from a range of health care disciplines in a multiprofessional context. SETTING: A joint course called the Common Foundation Programme (CFP) presented by a hospital medical school and a joint university faculty of health and social care sciences in the UK in the first term of the students' courses. PARTICIPANTS: Students following degree courses in biomedical science, medicine, nursing, physiotherapy, diagnostic radiography and therapeutic radiography. OBJECTIVES: To assess student attitudes to cadaveric work, learning anatomy and multiprofessional learning, and to compare student performance between degree courses in an anatomy assessment. DESIGN: A questionnaire was designed that requested demographic information and the students' attitudes to cadaveric work, anatomy learning and multiprofessional learning on a Likert scale. All students sat the same anatomy assessment at the end of the first term. RESULTS: The biomedical science and medical students were the most apprehensive about entering the dissecting room. The biomedical science students enjoyed working in a multidisciplinary group the most. Assessment results varied widely and the physiotherapy and medical students scored more highly than students in other disciplines, although all students had participated in the same course. CONCLUSIONS: It was possible to teach anatomy in the context of the shared learning experience of the CFP, although performance varied widely. Reasons for the differences are discussed and suggestions for the design of multiprofessional courses involving anatomy are made.     

Do students have sufficient knowledge of clinical anatomy?

INTRODUCTION: Comparisons of anatomy knowledge levels of students from various curricula show either no differences or small differences to the detriment of innovative schools. To pass judgement on the general level of students' anatomy knowledge, we need an absolute standard. The purpose of this study was to compare students' levels of anatomy knowledge as measured by a case-based anatomy test with standards set by different groups of experts. METHODS: A modified Angoff procedure was used to establish an absolute standard against which the students' results could be evaluated. Four panels of 9 anatomists, 7 clinicians, 9 recent graduates and 9 Year 4 students, respectively, judged 107 items of an anatomy test. The students' results on these items were compared with the standards obtained by the panels. RESULTS: If the standard established by the panel of Year 4 students was used, 64% of the students would fail the test. The standards established by the anatomists, clinicians and recent graduates would yield failure rates of 42%, 58% and 26%, respectively. CONCLUSION: According to the panels' standards, many students did not know enough about anatomy. The high expectations that the Year 4 students appeared to have of their peers may contribute to students' uncertainty about their level of anatomy knowledge.     

Attitude change during medical school: a cohort study

BACKGROUND: Attitudes influence behaviour. Developing and maintaining proper attitudes by medical students can impact on the quality of health care delivered to their patients as they assume the role of doctors. There is a paucity of longitudinal research reports on the extent to which students' attitude scores shift as they progress through medical school. OBJECTIVE: This study examined the change in attitude scores of a large student cohort as they progressed through medical school. Whether student gender is related to attitude change was also investigated. METHOD: Medical students from 3 consecutive classes (1999-2001) participated in this study. Students completed 2 instruments that included the Attitudes Toward Social Issues in Medicine and an in-house tool referred to as the Medical Skills Questionnaire. The instruments were administered at 3 milestones during the course of medical school training (entry, end of preclinical training and end of clerkship). RESULTS: Reliability estimates for total (0.82-0.91) and subscale (0.41-0.81) attitudinal scores were in the acceptable range. Multivariate analyses of variance of mean attitudinal scores indicated a persistent decline in several attitude scores as students progressed through the medical educational programme. Females demonstrated higher attitude scores than males. CONCLUSIONS: As students progress through medical school their attitude scores decline. The reasons for the shift in attitude scores are not clear but they may relate to a ceiling of high attitude scores at entry, loss of idealism and the impact of the unintended curriculum. Further study of the impact of medical education on student attitudes is warranted.     

Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students

OBJECTIVES: To promote safe prescribing and administration of medicines in the pre-registration house officer (PRHO) year through a programme of structured teaching and assessment for final year medical students. DESIGN: Forty final year medical students from two medical schools were randomly allocated either to participate in a pharmacist facilitated teaching session or to receive no additional teaching. Teaching comprised five practical exercises covering seven skills through which students rotated in small groups. One month later, a random sample of 16 taught and 16 non-taught students participated in a nine-station objective structured clinical examination (OSCE) to assess the impact of the teaching. SETTING: Manchester School of Medicine (MSM), and Kings College School of Medicine and Dentistry (KCSMD). PARTICIPANTS: Final year medical student volunteers. MAIN OUTCOME MEASURES: The need for teaching as indicated by student prior experience; questionnaire rating of student acceptability of teaching and assessment; self-rating of student confidence post-assessment, and student performance assessed by OSCE. RESULTS: The study demonstrated that the taught group achieved higher scores in eight OSCE stations. Four of these were statistically significant (P < or= 0.005). Taught students felt more confident performing the skills on five stations. From 0 to 47.5% students had prior experience of the skills taught. The post-teaching questionnaire evaluated exercises positively on several criteria, including provision of new information and relevance to future work. CONCLUSIONS: Structured teaching provided an effective and acceptable method of teaching the medicines management skills needed in the PRHO year. The structured approach complemented variable precourse clinical experience.     

Active learning in a Year 2 pathology curriculum

PURPOSE: Team-based learning (TBL) has been successfully used in non-medical curricula, but its effectiveness in medical education has not been studied extensively. We evaluated the impact of TBL on the academic performance of Year 2 medical students at Wright State University by comparing this active learning strategy against a traditional method of case-based group discussion (CBGD). METHODS: A prospective crossover design assigned 83 Year 2 medical students to either CBGD or TBL for 8 pathology modules in the systems-based curriculum. The effectiveness of both learning methods was assessed by performance on pathology-based examination questions contained in end-of-course examinations. The highest and lowest academic quartiles of students were evaluated separately. Students' opinions of both methods were surveyed. RESULTS: No significant differences in whole group performance on pathology-based examination questions were observed as a consequence of experiencing TBL versus CBGD. However, students in the lowest academic quartile showed better examination performance after experiencing TBL than CBGD in 4 of 8 modules (P = 0.035). Students perceived that the contributions of peers to learning were more helpful during TBL than CBGD (P = 0.003). CONCLUSION: This study demonstrates that TBL and CBGD are equally effective active learning strategies when employed in a systems-based pre-clinical pathology curriculum, but students with lower academic performance may benefit more from TBL than CBGD.     

Is it me or is it them? Factors that influence the passing of underperforming students

Context Research has found that clinical assessments do not always accurately reflect medical student performance. Barriers to failing underperformance in students have been identified in other vocational settings. Is ‘failure to fail’ an issue for medical educators in the UK, and, if so, what are its determinants? Methods We carried out a qualitative focus group study exploring the views of medical educators (general practitioners, hospital doctors and non‐clinical tutors) from two different UK medical schools. To make sense of a potential multitude of factors impacting on failure to fail, we selected the integrative model of behavioural prediction to underpin our data collection and analysis. Results Ten focus groups were carried out with 70 participants. Using both theory and data‐driven framework analysis, we identified six main themes relevant to the integrative model of behavioural prediction. These are: tutor attitudes towards an individual student; tutor attitudes towards failing a student; normative beliefs and motivation to comply; efficacy beliefs (self‐efficacy); skills and knowledge, and environmental constraints. Discussion Many different factors impact on medical educators’ failure to report underperformance in students. There are conflicts between these factors and the need to report competence accurately (i.e. duty to protect the public). Although some of the barriers identified are similar to those found in previous studies, using a theory‐based approach added value in that it facilitated a richer exploration of failure to fail. Insights offered in this study will be used to plan a questionnaire study and subsequent intervention to support medical educators in accurately reporting underperformance in students.     

Impact of a new curriculum on medical students' interpersonal and interviewing skills

OBJECTIVES: In 1998 we reported on the rise and fall of medical student communication skills during the 4 years of medical school. Since then, the University of Connecticut School of Medicine has completed a major curriculum renewal project with an emphasis on early clinical work, lifelong learning and more ambulatory training. The goals of this study were to compare students' interviewing and interpersonal skills in standardised patient (SP) assessments in the old and new curricula and to assess the success of the new curriculum in preventing a decline in student skills in this domain. METHODS: The clinical skills of 202 students were measured longitudinally during encounters with SPs in each of their 4 years of medical school. Students in this study and the earlier study were evaluated using the Arizona Clinical Interviewing Rating (ACIR) Scale. RESULTS: Compared with students from the previous curriculum, students on the new curriculum in this study showed an improvement in ACIR scores. Year 1 mean ACIR scores (1 = poor to 5 = excellent) were, respectively, 3.6 for the old curriculum cohort and 4.0 for the new curriculum group. In Year 4 the mean score for the old curriculum cohort was 3.7 and that for the new curriculum group was 3.8. Students on the new curriculum still showed a decline in ACIR scores from Years 1 to 4, but it was not as severe a decline as it had been previously. CONCLUSIONS: Pre-clinical medical students perform better on measures of interpersonal communication than their clinical counterparts. The students who participated in the new curriculum demonstrated an earlier acquisition of and a less steep decline in interviewing and interpersonal skills during the course of medical school.     

The first batch of graduates of a new medical curriculum in Asia: how their teachers see them

OBJECTIVE: To examine teachers' views of the first batch of graduates of a revised medical curriculum in Asia. METHODS: A cross-sectional study using a structured questionnaire was carried out to obtain the views of all the clinical teachers involved in teaching final year students of the old curriculum in 2000-01 and the new curriculum in 2001-02 at the University of Hong Kong, which commenced curricular reform in 1997. RESULTS: Nearly 62% of respondents felt that better graduates were being produced with the new curriculum. The majority of them rated the new curriculum students better in nearly all the major goals of the new curriculum, such as self-directed learning initiative, problem solving skills, interpersonal skills and clinical performance in patient care. However, the core knowledge of the new curriculum students was of concern to some teachers. CONCLUSION: This study focused on the first complete cycle of a revised medical curriculum in Asia. Teachers' views of the new curriculum students were highly positive and they felt that better graduates were being produced.     

The influence of tutoring competencies on problems, group functioning and student achievement in problem-based learning

CONTEXT: Prominent factors in problem-based learning (PBL) are the problems to be solved, tutorial group functioning and tutors' competencies. These factors mutually affect one another and largely determine whether a powerful learning environment will be created. It is a tutor's task to stimulate active, self-directed, contextual and collaborative learning and display interpersonal behaviour that is conducive to students' learning. We investigated the effects of tutors' competencies on students' learning and on other variables, such as group functioning and student achievement. OBJECTIVES: We investigated whether tutors who stimulate active, self-directed, contextual and collaborative learning make better use of problems and meaningful contexts in PBL and also enhance group functioning. We also investigated whether the quality of problems has a positive impact on group functioning and whether group functioning advanced student achievements. METHODS: Questionnaires were used to collect data from students at the end of 11 modules in Years 1 and 2 of a PBL undergraduate medical curriculum. We used structural equation modelling to test the fit of a theoretical model representing the factors of interest and their relationships. RESULTS: Stimulation of active and constructive learning, self-directed learning and collaborative learning by tutors enhanced the quality of the problems and group functioning. The quality of the problems promoted group functioning, which was found to have a positive effect on student achievement. CONCLUSIONS: Tutors' competencies had a positive effect on the learning of students. This suggests that it would be worthwhile including these competencies in staff development.     

Student perceptions of effective small group teaching

PURPOSE: The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation. METHODS: Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data. RESULTS: Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve. CONCLUSION: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.     

Factors affecting the probability of first year medical student dropout in the UK: a logistic analysis for the intake cohorts of 1980-92

BACKGROUND: In the context of the 1997 Report of the Medical Workforce Standing Advisory Committee, it is important that we develop an understanding of the factors influencing medical school retention rates. AIMS: To analyse the determinants of the probability that an individual medical student will drop out of medical school during their first year of study. METHOD: Binomial and multinomial logistic regression analysis of individual-level administrative data on 51 810 students in 21 medical schools in the UK for the intake cohorts of 1980-92 was performed. RESULTS: The overall average first year dropout rate over the period 1980-92 was calculated to be 3.8%. We found that the probability that a student would drop out of medical school during their first year of study was influenced significantly by both the subjects studied at A-level and by the scores achieved. For example, achieving 1 grade higher in biology, chemistry or physics reduced the dropout probability by 0.38% points, equivalent to a fall of 10%. We also found that males were about 8% more likely to drop out than females. The medical school attended also had a significant effect on the estimated dropout probability. Indicators of both the social class and the previous school background of the student were largely insignificant. CONCLUSIONS: Policies aimed at increasing the size of the medical student intake in the UK and of widening access to students from non-traditional backgrounds should be informed by evidence that student dropout probabilities are sensitive to measures of A-level attainment, such as subject studied and scores achieved. If traditional entry requirements or standards are relaxed, then this is likely to have detrimental effects on medical schools' retention rates unless accompanied by appropriate measures such as focussed student support.     

The determination of the relevance of basic sciences learning objectives to clinical practice using a questionnaire survey

OBJECTIVES: Facilitating sufficient understanding of the basic sciences to underpin clinical practice is important in producing the good doctor. However, the inclusion of irrelevant material in the curriculum not only wastes valuable learning time, but may also hinder learning. The aim of this study was to determine how relevant staff and students thought respiratory basic science learning objectives were to medical practice. DESIGN: The study involved a survey using an anonymous questionnaire to determine whether the respiratory learning objectives stated in Year 1 were perceived as relevant to clinical practice. Each learning objective was rated as being 'relevant', 'not relevant' or of 'uncertain relevance'. SETTING: Dundee Medical School, UK. SUBJECTS: Junior and senior students and staff. RESULTS: Year 1 students considered the majority of the learning objectives to be relevant to clinical practice. Staff and senior students identified some respiratory learning objectives as not relevant to clinical practice, most of which were related to biochemistry. CONCLUSIONS: The identification of learning objectives with questionable relevance to clinical practice requires careful consideration to determine whether these should be removed from the course. Attention needs to be given to both the presentation and process by which material is delivered to students. Strategies to emphasise the clinical relevance of the basic sciences to students are discussed. Further research needs to be conducted to evaluate what knowledge is essential for producing good doctors.     

Research governance: impeding both research and teaching? A survey of impact on undergraduate research opportunities

OBJECTIVE: To explore the impact of research governance on medical students' ability to gain an understanding of research methodology, as required by the General Medical Council. METHODS: We carried out a qualitative study based on semi-structured interviews, in 3 medical schools in the UK, with 12 interviewees including academic supervisors and administrative staff. RESULTS: Research governance has the potential to facilitate medical undergraduates to experience better quality research but, unfortunately, the inhibitory effects of the current framework overwhelm this. Participants highlighted the bureaucracy of the process, particularly the complexity of securing ethical approval and the length of application forms. In addition, there is widespread confusion and uncertainty about the process at a variety of levels. For medical teachers, confusion exists around the practicalities of the current process, the boundaries between core clinical experience, audit and research, and how the process may change in the future. Academic supervisors have adopted several strategies, including amending existing research projects, and in some cases have withdrawn from student supervision altogether. CONCLUSIONS: The present research governance requirements, especially for ethical approval, are too unwieldy to facilitate medical students' assimilation of research experience as a required learning outcome. Precise and clear definitions of the types of projects that necessitate ethical approval and the development of a shortened, simplified ethical approval application form are recommended.     

Teaching sexual history taking to medical students and examining it: experience in one medical school and a national survey

OBJECTIVES: To assess the feasibility and acceptability of training and examining medical students in taking a sexual history and to compare practice with other medical schools in the UK. DESIGN: A training programme involving group work, role play and clinical attachments was developed and applied to 131 students at the University of Bristol Medical School. They then underwent an objective structured clinical assessment using simulated patients. The practice of other medical schools was surveyed by postal questionnaire. RESULT: The students felt that the examination was a good test of their knowledge and skills. One student failed. Sexual history taking is taught in 17 of 22 medical schools but examined in only six. CONCLUSION: Both teaching and examining of sexual history taking skills are possible and are likely to occur increasingly in UK medical schools.     

Student perceptions of medico-legal autopsy demonstrations in a student-centred curriculum

Objectives  Teaching autopsies in undergraduate medicine, although traditionally considered valuable by both educators and students, have been marginalised in modern curricula. This study explored medical students' experiences of the medico-legal autopsy demonstrations which formed part of their training in forensic medicine.
Methods  In this phenomenological study, qualitative data obtained by interviewing 10 Year 4 medical students from various socio-cultural backgrounds were interpretively examined. One-to-one, semi-structured interviews were tape-recorded and transcribed. The data were thematically organised and then analysed using a theoretical framework of three dimensions of learning, namely, cognitive, emotional and societal.
Results  Students still perceive autopsies as essential even in the context of self-directed learning. They identified a better understanding of anatomy and traumatology as the main cognitive benefits. At an emotional level students felt they had developed a degree of clinical detachment and would be better equipped to deal with issues surrounding death. Although socialisation influenced students' feelings about the autopsy, it did not detract from their appreciation of the educational value of the experience.
Conclusions  The results support previous findings from both students, prior to curriculum reform, and medical educators who were canvassed for their opinions in relation to a modern curriculum. Besides the obvious cognitive advantages, educators should be mindful of the hidden curriculum that emanates from autopsies because it impacts on the development of professionalism and ethical behaviours of future medical practitioners.