Medical students’ opinions on professional behaviours: The Professionalism of Medical Students’ (PoMS) study

Abstract

Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students’ opinions and experience with professionalism dilemmas.

Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations.

Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students’ opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions – particularly male gender and being a student in the latter stages of the course.

Discussion: Medical students’ professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students’ approaches to professionalism.     

Development and alignment of undergraduate medical curricula in a web-based,dynamic Learning Opportunities,Objectives and Outcome Platform (LOOOP)

Introduction: This study presents a web-based method and its interface ensuring alignment of all parts of a curriculum map including competencies, objectives, teaching and assessment methods, workload and patient availability. Needs, acceptance and effectiveness are shown through a nine-year study.

Methods: After a comprehensive needs assessment, the curriculum map and a web-based interface “Learning Opportunities, Objectives and Outcome Platform” (LOOOP) were developed according to Harden’s conceptual framework of 10-steps for curriculum mapping. The outcome was measured by surveys and results of interdisciplinary MCQ-assessments. The usage rates and functionalities were analysed.

Results: The implementation of LOOOP was significantly associated with improved perception of the curriculum structure by teachers and students, quality of defined objectives and their alignment with teaching and assessment, usage by students to prepare examinations and their scores in interdisciplinary MCQ-assessment. Additionally, LOOOP improved the curriculum coordination by faculty, and assisted departments for identifying patient availability for clinical training.

Conclusion: LOOOP is well accepted among students and teachers, has positive effect on curriculum development, facilitates effective utilisation of educational resources and improves student’s outcomes. Currently, LOOOP is used in five undergraduate medical curricula including 85,000 mapped learning opportunities (lectures, seminars), 5000 registered users (students, teachers) and 380,000 yearly page-visits.     

'Team observation': a six-year study of the development and use of multi-source feedback (360-degree assessment) in obstetrics and gynaecology training in the UK

Multi-source feedback, or 360-degree assessment, is an important part of the assessment of people in the workplace, in both health and industry. Almost all published work concentrates on content validity and generalizability. However, an assessment system needs construct validity, and has to have practicability and acceptability, without sacrificing fitness for purpose, content validity or inter-rater reliability. This was a six-year study of the first UK-wide hospital-based multi-source feedback system, in the specialty of obstetrics and gynaecology. This paper describes the development of the assessment tool, its use and the analyses of the results in several areas. These are picking up poor performance, congratulating good behaviour, construct validity, the number of domains to be measured, and the minimum number of raters. The study demonstrated that the Team Observation system in reality only measured a very limited number of attributes, and that the main construct under scrutiny is interpersonal behaviour. The system can identify those who may have a problem, using less than 10 raters, and yet the process can be a positive experience for the large majority of people who have been assessed.     

The Dundee Ready Education Environment Measure (DREEM): A review of its adoption and use

Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a tool to evaluate educational environments of medical schools and other health training settings and a recent review concluded that it was the most suitable such instrument. Aims: This study aimed to review the settings and purposes to which the DREEM has been applied and the approaches used to analyse and report it, with a view to guiding future users towards appropriate methodology. Method: A systematic literature review was conducted using the Web of Knowledge databases of all articles reporting DREEM data between 1997 and 4 January 2011. Results: The review found 40 publications, using data from 20 countries. DREEM is used in evaluation for diagnostic purposes, comparison between different groups and comparison with ideal/expected scores. A variety of non-parametric and parametric statistical methods have been applied, but their use is inconsistent. Conclusions: DREEM has been used internationally for different purposes and is regarded as a useful tool by users. However, reporting and analysis differs between publications. This lack of uniformity makes comparison between institutions difficult. Most users of DREEM are not statisticians and there is a need for informed guidelines on its reporting and statistical analysis.     

The medical teacher's job: "Working together to zero in on patient safety, and zero out preventable errors" (Clinton 1999)

The role of a medical teacher proposed 25 years ago is still recommended. Some teachers are born to greatness, but more careful and more thoughtful attention, rather than less, should be given to preparation for that role for those not born to greatness. In addition the penury of blueprint of the expected relevant professional profile makes it difficult to construct certifying exams of an acceptable level of validity in order to protect the population from incompetent doctors.     

Scoring standardized patient examinations: lessons learned from the development and administration of the ECFMG Clinical Skills Assessment (CSA)

Throughout the 40 year history of standardized patient assessments and OSCEs, there have been numerous advancements, including many that involve scoring the simulated clinical encounters. While there is no clear agreement on how examinees' performance should be documented or scored in an encounter, there is a consensus that several well-chosen SP encounters are required to produce reliable examinee scores. There also continues to be some debate as to who should do the scoring on an SP-based assessment. While logistics and cost will certainly play a role, it is probably best to use the person who is most familiar with the domain being assessed. In some instances this will be the SP; in others, an outside observer or content expert. Finally, with the growing use of OSCEs for summative purposes (e.g. certification, licensure), special attention must be paid to fairness issues. Since the same test form cannot be used day after day, examinee scores must be 'equated', taking into account the psychometric properties of scores from individual cases and individual SPs. To date, the CSA has been one of the highest-volume, high-stakes, standardized patient assessments to be developed and successfully administered. In 2003 alone, over 11 500 IMGs were tested. The early conceptual framework for this assessment was synthesized from the research endeavours of several notable individuals, including, amongst many others, Harden et al. 1975, Swanson & Stillman, 1990, Newble & Swanson, 1988, Vu et al. 1992 and Colliver, 1995. The early prototype administrations of the CSA, including many operational research studies, were supported and guided by Dr Friedman Ben-David, Friedman et al. 1991, 1993, Stillman et al. 1992, and Sutnick et al. 1993, 1995.     

(See symbol in text) in early modern discussions of the passions: Stoicism, Christianity and natural history

This paper examines the reception of the Stoic theory of the passions in the early modern period, highlighting various differences between the way notions such as (see symbol in text) (complete freedom from passions) and(see symbol in text) (pre-passions) were handled and interpreted by Continental and English authors. Both groups were concerned about the compatibility of Stoicism with Christianity, but came to opposing conclusions; and while the Continental scholars drew primarily on ancient philosophical texts, the English ones relied, in addition, on experience and observation, developing a natural history of the passions.     

The holistic claims of the biopsychosocial conception of WHO's International Classification of Functioning, Disability, and Health (ICF): a conceptual analysis on the basis of a pluralistic-holistic ontology and multidimensional view of the human being

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF's claim to holism. The following components of the ICF's complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic-holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b).