A new undergraduate teaching course in geriatric medicine

The construction of a new teaching course in geriatric medicine is described. Course objectives are established, and teaching arrangements designed to meet these objectives. The course takes place late in the medical curriculum when students have some knowledge of clinical medicine, therapeutics and pathology. Particular features of the course include residential attachments in hospital departments of geriatric medicine and coordinated teaching with the departments of general practice and mental health. The attainments and methods of assessment are then discussed.     

An interdisciplinary course unit in basic pharmacology and neuroscience

Summary. A newly developed course unit for second-year medical students entitled ‘Introduction to Pharmacology and Neuroscience’ is described. Novel features of the course relate to its interdisciplinary approach to teaching of topics traditionally taught in separate departmental-based courses. An evaluation of this unit was conducted, in order to provide information to be used for decision-making and improvement and development of the ongoing programme. The evaluation involved a number of interviews with those involved in the course, including course convenors, teachers of the course, students, and members of the Medical Faculty Curriculum Review Committee. A questionnaire was also administered to students. As a result of this evaluation, a set of recommendations for future changes were made. A majority of the students interviewed were in favour of the integration of basic pharmacology and neuroscience, as in this course unit.     

Assessment of emergency medicine: a comparison of an experimental objective structured clinical examintion with a practical examination

An emergency medicine and trauma programme was implemented at Ben Gurion University Medical School in Israel. Clinical performance assessment of the first-year course in emergency medicine and trauma was done using a practical examination (PE). In the continuous process of critically reviewing the course objectives and assessment methods the objective structured clinical examination (OSCE) was chosen, for the first time in our medical school, as a tool for course development as well as evaluation of the existing PE. Seven experimental OSCE stations were designed which covered some of the course and practical examination topics. Twenty-six first-year medical students have taken both examinations concurrently. Twenty-three students answered an attitude questionnaire regarding both examinations. Results have indicated that the OSCE provided additional and crucial information on students' deficiencies in clinical performance which were not available from the PE. Those differences were probably due to realistic OSCE station content, highly simulated set-ups, and the objectivity of the examiner, all of which have contributed to a more challenging examination, as compared to the PE. The OSCE in emergency medicine and trauma seemed to have a relatively high level of acceptance by both staff and students. In our opinion it seems that the OSCE is a better tool for first-year level final assessment in emergency medicine and trauma. is a better tool for first-year level final assessment     

Palliative medicine education for medical students: a survey of British medical schools, 1992

Summary. The new specialty of palliative medicine is now recognized as making a significant contribution, not only to the practice of cancer medicine, but also to the care of terminal disease. This article reports an enquiry into the current teaching of palliative medicine in undergraduate curricula in Britain. A questionnaire concerning palliative medicine teaching was sent in December 1992 to undergraduate deans of all medical schools, colleges and faculties (hereafter referred to as schools). Replies were received from all and were analysed.
Most of the subjects represented by palliative medicine were taught in all schools by palliative medicine specialists or in sessions of other specialisms, or both. Many schools gave opportunity for students to visit local palliative care units or hospices; a few required it as part of the syllabus. The amount of time devoted to this subject in the curricula varied considerably. Eleven per cent of schools regularly asked questions on palliative medicine in final examinations; half occasionally did so, but 30% reported that there was never a question on palliative medicine in finals.
In the light of recent publications by the General Medical Council and the Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory Committee, I urge that increasing attention be paid to teaching the subjects represented by palliative medicine and to examining it. I suggest that the recently published core curriculum will enable this to be carried out more effectively.     

Teaching of medical ethics

Teaching medical ethics in Manchester within the introductory course of obstetrics and gynaecology is a joint activity with the Centre for Social Ethics and Policy. This interdisciplinary teaching has evolved through lecture sessions with small-group discussions dealing with topics of interest in human reproduction. The small-group discussion have been replaced by an open debate conducted by the students. Their own involvement and participation and an exposure to the disciplines of the humanities has broadened their approach to different ways of problem-solving of these real issues.     

Graduate evaluation of undergraduate teaching programmes in paediatrics

In a new undergraduate teaching course in child health, medical students were encouraged to prepare and present topics to their colleagues. These presentations covered major subjects in paediatric medicine and were supervised by an experienced teacher. Students were then asked to evaluate the programme at the end of their course in child health and after graduation. Evaluation scores for these presentations were high at the end of the course. Spontaneous comments suggested some disadvantages such as poor or too-detailed student presentations. However, some noted the value of personal research. After graduation, more positive comments were made and the majority felt that the course had advantages in the area of personal research, that it was better than or as good as other teaching methods, and that it should be continued in its present format.     

Graduate and mature entrants to medicine: changes in career intentions

Fifty-nine students who had previously taken degrees or commenced careers in subjects other than medicine entered the Cambridge Clinical Course in its first 5 years of operation, commencing in 1976. A questionnaire was used to ascertain their original career plans when entering medical education, their career plans in 1981, and the reasons for any changes. Graduates originally planning careers in general practice and teaching or research maintained their intentions, but some of those who had favoured hospital clinical work changed their minds in favour of general practice. General practice was also the most common choice amongst those students who were earlier unsure as to what branch of medicine they would enter. Of students changing their career intentions, half indicated that disenchantment with hospital medicine was a prime reason for the change.     

Content coverage in problem-based learning

Required learning of the basic medical sciences based on five clinical problems was compiled by teachers and subsequently derived as 'learning needs' by students during the problem-solving process. These lists of topics were compared in terms of number of lecture-hours and when these were taught in the traditional curriculum. The findings indicate that learning from problems is not entirely free-rein and can be largely determined by teachers; topics taught earlier in the course appeared more frequently than latter topics and there was a tremendous overlap of topics in both the traditional and problem-based list. Regardless of whether lectures have been given or not, students recalled facts better if they had encountered the related clinical problem. This study also reveals that problem-based learning can be as efficient as lectures in content coverage and concludes that the lecture method be retained provided the topics are selective and are derived and sequenced appropriately with clinical problems. Problem-solving should be adopted as a teaching strategy.     

Teaching medicine with cases: student and teacher opinion

In a second-year family medicine course taught using simulated patients the students commented most favourably on the clinical relevance of the topics, the enthusiasm of teachers, and the opportunity to interview simulated patients with their fellow students, in contrast to their basic science courses, which did not give them patient contact. They felt most confident about skills acquired in relation to diseases with a limited number of key symptoms, signs and treatments (meningitis, otitis) and less confident about diseases with many symptoms and treatments (diabetes, trauma, arrhythmias). They made few comments about alternative cases which might have been selected. Their adverse comments were about the workload. During tutor meetings over 4 years, a key concern which emerged was to find cases with a level of complexity suitable to the students. The tutors emphasized these principles of case selection: the cases should be based on real life and include most of the signs and symptoms of the disease; contain one or at most two foci; have nodal decision-making points; emphasize clinical reasoning; reinforce prior knowledge; permit the transfer of knowledge to other cases; and permit the assessment of associated technical skills.     

Undergraduate teaching of the behavioural sciences at a new medical school in Ghana

A programme of teaching in the behavioural sciences at a new medical school in Ghana is described. Students are introduced to problems in their first year and these are used as a means of working in small groups, for self-directed learning and the collection of data. The course continues for 5 years and leads on to a residential posting at a psychiatric hospital, and embodies a close association between 'clinical' medicine and psychological medicine. The programme has only been running for 2 years and so an adequate objective evaluation cannot yet be made, but judged subjectively it is enjoyed by students.     

Undergraduate teaching of geriatric medicine in the United Kingdom: changes in the years 1981-1986

A follow-up survey of undergraduate teaching of geriatric medicine was carried out in 1986. All 27 clinical medical schools responded. Geriatric medicine is taught to all medical students in 25 and to only a proportion of students in two. Fifty-nine per cent of schools have academic departments teaching for a mean of 89 hours compared with 33 hours in non-academic departments--an overall mean of 68 hours. The subject is taught by various methods with 70% of teaching time spent on bedside clinical instruction. Other aspects of institutional and community care are often covered. The subject is examined in 18 schools. New academic departments are planned at four schools, and an increase in teaching time planned in five. To meet the needs of the population of the next century, reconsideration of curricula in some of the medical schools is recommended.     

A method of evaluating opportunistic teaching in clinical medicine

Teaching in clinical medicine must often be opportunistic, using unpredicted clinical situations as they arise. To teach effectively in such settings demands considerable skill especially where tutorial-type teaching (one student to one doctor) is concerned. To develop his skills the doctor needs some method of evaluating his teaching. The present paper describes one such method which has been found to be practicable and, apparently, useful.     

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 clinical learning environments in medicine, paediatrics and surgery clerkships

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.     

The use as a learning resource of the community in which the medical school is situated: the Medical School, Southampton

Southampton University Medical School was established in 1971 and now takes 130 students each year for the 5-year course, and fifteen students for the premedical year. The school uses facilities within the whole Wessex region, population 2.5 million, for teaching. During the first year of the course, community-based learning is a feature of the 'Man, Medicine and Society' course and of Early Medical Contact (EMC). Each student has four half-day EMC visits to patients in their homes and these visits are followed by discussion with medical staff. Sociology, or the social context of health care, together with an epidemiology course are the main contacts with the community in the second year. In the third year, all students visit a general practice surgery for half a day per week for 40 weeks; this enables them to appreciate the natural history of common conditions in primary care and their management. There is also a course in occupational medicine in the third year. At the beginning of the fourth year, many students spend an elective in an underdeveloped country, but much of the year is concerned with a study in depth, in some cases involving the community. The fifth year of the course is a major clinical year, often spent in regional hospitals away from Southampton. Three weeks are spent in general practice somewhere in the Wessex region.     

Teaching skills improvement programmes in US internal medicine residencies†

Summary. The prevalence and nature of resident teaching skills improvement programmes (TSIP) are unknown. Although residents perceive themselves as important teachers of students, there is little information on how programme directors (PDs) view residents as teachers. A comprehensive questionnaire was sent to all 428 US internal medicine PDs in December 1990, of which 60% (n= 259 ) responded. Of the 259 responding programmes, only 20% (n= 51 ) had TSIPs. Characteristics of TSIPs were not uniform. Mean instructional time was 9 hours (range, 1–24 hours). The teacher most frequently utilized to develop and facilitate the TSIP was the PD. PDs from residencies with a TSIP indicated more strongly than PDs without a TSIP that residents contributed to students' learning. Fifty-one per cent of TSIPs required residents to attend. Evaluation/feedback as a teaching method was the most common topic covered in TSIPs. Long-term assessment of teaching skills after programme participation was done in 15% of TSIPs. Although PDs value the resident's role as teacher, current TSIPs in internal medicine residencies are few in number and lack standardization. PDs' attitudes probably influence whether residents are taught teaching skills and whether teaching skills are evaluated. Further investigation of appropiate curriculum for TSIPs and assessment of long-term effectiveness of TSIPs are needed.     

The organization of a postgraduate training course for medical advisers in the pharmaceutical industry

A postgraduate training and education course for physicians working in the field of pharmaceutical medicine is described. The course proved welcome and acceptable to the participants and provided valuable experience for the organizers. The scientific content and information gained in organizing the course have been incorporated in the planning of a postgraduate diploma course in pharmaceutical medicine.     

The evolution of a course in human sexuality University of Edinburgh, 1972–1978

A short undergraduate course in human sexuality has been developed over a period of 7 years. The objectives, initially concerned with cognitive learning, shifted to affective aspects of the topic, introduced through a format of sexually explicit films and small-group discussions. Continuing evaluation of successive courses by students has been particularly valuable in identifying helpful and unhelpful behaviour in group leaders, and has been used in their training. The evaluations also demonstrated that students saw a need to develop their interviewing skills. The course, therefore, now seeks to combine affective learning with other topics of direct relevance to clinical practice.     

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.     

A comprehensive clerkship in family medicine

A 6-week family medicine clerkship that is comprehensive in its approach to the academic base of family medicine and in its integration of clinical and didactic experiences is discussed. The goals of the clerkship are to enable students to: acquire knowledge of common illnesses in ambulatory care; integrate compassion, concern and empathy in the delivery of comprehensive and personalized care; and to experience the medical and social issues of family medicine. The curriculum includes 50 hours of didactic preparation in the family life cycle, common illnesses, patient interviewing, problem-oriented medical records, genograms. compliance, and clinical problem-solving. Clinical experiences include placement in a family practice centre, an experience in a drug-abuse treatment centre and a brief rotation in geriatric medicine. Students are evaluated on their performance in clinical settings and in an objective test of primary care concepts. Test performance shows significant growth from student pre- to post-test scores. Student evaluations have been very favourable toward the clerkship, and self-reports reveal growth in knowledge of common illnesses, problems of the elderly, problems of drug abuse and the role of the family doctor.