Use of a general medical setting to teach medical students about neurosis

A new way of teaching medical students about minor psychiatric illnesses is described. Psychiatric morbidity on general medical wards was identified, using medical students to administer the screening instrument to all routine admissions and interview possible cases. This was linked to a weekly teaching round in the same setting conducted by a psychiatrist. Advantages of this method of teaching were (1) it increased the overall numbers of patients clerked by our students during their psychiatric clerkship; (2) it increased the number of cases of neurosis seen by students as compared with psychotic illnesses; and (3) it related teaching on psychiatric conditions to settings where most students would eventually practise. The aim was both to increase the students' factual knowledge about minor psychiatric illnesses as encountered in these settings, and to improve their skills at identifying and treating such illnesses. An attempt was made to measure the effectiveness of this teaching method. All students showed an improvement in test scores, whether taught under the new regime or not, but it proved impossible to distinguish those taught on medical wards from those taught primarily in psychiatric wards. The implications of this finding are discussed. There was uniformly positive feedback from the students who took part in the study.     

Teaching psychiatric interview skills to medical students

A teaching package is described for teaching interview skills to large blocks of medical students whilst on their psychiatric attachment. The aims of this package are to reduce students' concerns about interviewing psychiatric patients, to reinforce students' knowledge of basic interviewing skills and to introduce students to the particular skills required in taking a psychiatric history and mental state examination. The package emphasizes the following teaching methods: 'hands-on' experience of interviewing a patient in front of small groups of peers; peer feedback using check-lists which focus on three major aspects of interviewing; elicitation of facts, elicitation of feelings and control of the interview; facilitation of small-group discussions in the presence of senior psychiatrist. The active involvement of all students in interviewing psychiatric patients engages them in the learning process. Peer involvement increases motivation and was deemed by students as a supportive and constructive exercise. The presence of a senior psychiatrist ensures that discussion is focused on the process of interviewing rather than on patient pathology. Ideally this package would precede focused training throughout the subsequent psychiatric placement.     

A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Summary. Teaching preclinical medical students about doctor-patient communication gives them an opportunity to develop their interviewing skills prior to their having to elicit lists of symptoms in their clinical years. General practitioners should be among the more efficient interviewers in clinical medicine and therefore able to make important contributions to the teaching of interviewing skills. This paper describes the aims, objectives and methods of the preclinical communications skills course at St George's Hospital Medical School. The contribution of the Division of General Practice and Primary Care to the teaching of interviewing skills in the preclinical course has been evaluated using rapid group methods. Students were asked to identify examples of specific interviewing behaviours in videotaped general practice consultations, and to judge whether the behaviours were helpful or unhelpful in eliciting relevant information from the patient. Students who had been given experience in interviewing patients in small groups led by general practitioners identified significantly more helpful and unhelpful interviewing behaviours in the taped consultations than students who had not received the small-group teaching. Students rated the teaching as relevant and effective in terms of giving insights into the interviewing skills they needed to develop. Group methods of evaluation such as these might prove useful to other medical schools with class sizes of 150 students or more.     

Clinical exposure during clinical method attachments in general practice

BACKGROUND: There has been a significant decline in medical students' clinical experience in hospitals. Hospital-based teaching is struggling to provide medical students with sufficient experience of the common health problems of our industrialized ageing society. Hence, general practice has become an important locus for medical education. Published evidence, however, that students can access appropriate clinical experience in general practice is sparse. OBJECTIVE: To determine students' clinical exposure during clinical and method attachments based in general practice at two medical schools. EDUCATIONAL INITIATIVE: Students were attached to general practice tutors to learn clinical method in internal medicine. METHOD: General practice tutors from two medical schools collected data on age, gender, diagnoses, symptoms and signs of the patients they invited to teaching sessions. RESULTS: The frequency of diagnoses, symptoms and signs seen by medical students are recorded. Students mostly saw patients with chronic illnesses; the commonest diagnoses were ischaemic heart disease and angina. DISCUSSION: Our study has recorded the largest published database of clinical diagnoses, symptoms and signs encountered by students learning clinical method in general practice. It shows that students obtained a wealth of experience with patients with common chronic diseases. Students must also learn in the hospital setting, to experience the presentation of acute illness. The combination of teaching in these two settings is likely to provide the most effective technique to ensure that students encounter the common, acute and chronic conditions that affect patients in the 21st century.     

The patient is the expert: a technique for teaching interviewing skills

Aspects of a teaching development intended to encourage patient-centredness in medical interviewing is discussed. Patients are asked by their local general practitioner to volunteer their time in order to be interviewed by medical students and then to stay on afterwards to discuss their impressions of the students' behaviour. It is argued that this approach to teaching interviewing skills enables students to examine the assumptions they make about the patient and to become aware of their difficulties in discussing sensitive issues.     

The teaching of professional attitudes within UK medical schools: Reported difficulties and good practice

INTRODUCTION: The demonstration of appropriate attitudinal behaviour is crucial in the professional development of doctors. This study explores the experiences of UK medical schools in developing and assessing the behaviour associated with the attitudes of undergraduate medical students. METHODS: A qualitative in-depth interview study was based on a questionnaire survey of all UK medical schools. Six heads of medical schools or their nominated representatives were interviewed. Outcome measures were the perceptions and experiences of developing and assessing appropriate attitudes and behaviour in their undergraduate students. RESULTS: Aspects of the hidden curriculum, especially the negative role modelling encountered during clinical practice, were seen to undermine the attitudinal messages of the formal curriculum. Some participants believed that students could still qualify as doctors despite having inappropriate attitudes or behaviour. Others felt certain that this was now unlikely in their school, and this confidence seemed to be backed up with the knowledge that strategies, systems and structures were in place to detect and act upon poor behaviour. DISCUSSION: The conviction that it is right to assess students on their attitudinal behaviour does not yet appear to be held consistently across all schools and we suggest that this may reflect some fundamental tensions arising from differing views about the essential elements of good medical practice, tensions that are also shaping the hidden curriculum.     

Formative assessment: a student perspective

Summary. An educator's view would be that formative assessment has an important role in the learning process. This study was carried out to obtain a student perspective of the place of formative assessment in the curriculum. Final-year medical students at Royal Prince Alfred Hospital took part in four teaching sessions, each structured to integrate teaching with assessment. Three assessment methods were used; the group objective structured clinical examination (G-OSCE), structured short answer (SSA) questions and a pre/post-test multiple choice questionnaire (MCQ). Teaching sessions were conducted on the subject areas of traumatology, the 'acute abdomen', arterial disorders and cancer. Fifty-five students, representing 83% of those who took part in the programme, responded to a questionnaire where they were asked to rate (on a 5-point Likert scale) their response to general questions about formative assessment and 13 specific questions concerning the comparative value of the three assessment modalities. Eighty-nine per cent of respondents felt that formative assessment should be incorporated into the teaching process. The SSA assessment was regarded as the preferred modality to reinforce previous teaching and test problem-solving skills. The MCQ was the least favoured assessment method. The effect size variable between the total scores for the SSA and MCQ was 0.64. The variable between G-OSCE and SSA/MCQ was 0.26 and 0.33 respectively. Formative assessment is a potentially powerful method to direct learning behaviour. Students should have input into the methods used.     

Attitudes to and knowledge about elderly people: a comparative analysis of students of Medicine, English and Computer Science and their teachers

Attitudes to and knowledge about elderly people were assessed in 1091 students and lecturers from the London Hospital Medical College (LHMC), London, UK and the English and Computer Science departments of Queen Mary and Westfield College (QMW), London, UK. General knowledge about elderly people was measured by the Palmore 'Facts about Aging Quiz 1'. Attitudes towards elderly people were measured by the Rosencranz and McNevin Semantic Differential scale.
A higher level of knowledge about elderly people was found both in medical students and in medical lecturers compared to their counterparts in the English and Computer Science departments (   P < 0.001  ). The cross-sectional data indicated that medical students developed a significantly increasing knowledge about elderly people as they progressed through their training, in contrast to students of English and Computer Science.
Scores on the Rosencranz & McNevin scale indicated that attitudes towards elderly people across all three groups of students and lecturers were similar. The scores obtained for all groups indicated that they held approximately neutral attitudes towards elderly people.
A significant correlation (   P < 0.001  ) was found between high levels of knowledge about elderly people, and positive attitudes towards them.
The necessity of interventions to improve general attitudes towards and knowledge of elderly people among medical students is questioned. It is suggested that future research should look beyond surveys of general attitudes towards elderly people for the causes of the current lack of interest in geriatric medicine.     

The perceptions of attending doctors of the role of residents as teachers of undergraduate clinical students

INTRODUCTION: Much of undergraduate clinical teaching is provided by residents. An earlier study showed the attitude of residents towards teaching to be generally positive. Little is known, however, about attending doctors' views on their own and residents' roles as teachers of medical students. OBJECTIVES: To examine attending doctors' perceptions of the (dis)advantages of resident teaching, their own teaching abilities and the need for a teacher training programme for residents. METHOD: A questionnaire survey of 76 attending doctors was carried out in the Departments of Obstetrics & Gynaecology and Paediatrics at the teaching hospitals of the Universities of Maastricht and Amsterdam, the Netherlands. RESULTS: Attending doctors perceive teaching by residents to be beneficial for students and residents alike. Although they consider themselves to be better suited than residents to teach medical students, they see teaching as an integral part of residency training and feel it should be recognised as such by departments and medical schools. Attending doctors are in favour of a teacher training programme for residents, which should include communication, clinical and teaching skills as well as skills such as time management and (self-) assessment. DISCUSSION: Despite the uneven distribution of participants between the departments, no significant differences were found between departments. It is interesting that attending doctors perceive teacher training as beneficial to residents' teaching skills, but provide more feedback on residents' attitudes than on their teaching. The results show that, in general, attending doctors share residents' views that teaching is an important component of residency and that a teacher training programme for residents is to be recommended.     

Criterion-based open book examinations in physiology

Analysed data from ten consecutive physiology examinations for medical students at Aarhus University are presented. Each examination comprised one MCQ test and one short-answer test. For both written aids were allowed; both were dominated by items above the recall level.
The mean test scores of both the MCQ and the short answer tests were slightly above their mean pass levels with coefficients of variation around seven. Large but similar pass rate fluctuations in both tests were found, and about half of the non-passing students failed both tests. The MCQ minimum pass level, established by the Nedelsky principle, was more stable than the essay pass level. The Nedelsky values seem to compensate for a large part of the fluctuations in the difficulty level of various MCQ sets. Due to lack of comparable data it cannot be settled whether the pass rate fluctuations are excessive, nor whether standards fluctuate more than those at other institutes.     

Audit: teaching medical students in general practice

Summary. Audit is being seen as an increasingly important topic for medical students. Many departments of general practice in the UK now incorporate audit as part of their course work. It remains controversial as to whether this is perceived to be worthwhile by the students. Following an introductory seminar final-year medical students at the University of Glasgow were asked to perform a case-note review of 10 randomly chosen diabetic patients for a number of process and outcome measures during their practice attachments. Feedback was given in their final teaching session. 128/153 (84%) students completed an evaluation of the course on their knowledge and attitudes to audit. Unsurprisingly, 39% found the data collection boring or very boring; however, 60% found the feedback session very interesting or interesting. Both the data collection and the feedback were considered relevant by the majority of students (57% and 70% respectively). Students' self-reported knowledge also dramatically increased (P < 0.0001 ).     

Training clinical teachers in psychiatry to teach interviewing skills to medical students

To study the feasibility of training all clinical teachers in psychiatry to teach interviewing skills to medical students, 24 (unselected clinicians were assigned to one of four different training methods. They received either experiential or didactic instruction, and their initial teaching sessions were either supervised or unsupervised. A total of 287 medical students subsequently received feedback training from these teachers. While all students showed significant increases in skill after training, those taught by experientially trained teachers showed the greatest gains. Neither supervision nor the teachers' own interviewing skills exerted significant effects on students' performance. It is concluded that with only brief training unselected clinicians can become effective teachers of essential interviewing skills. Feedback training in such skills can, therefore, be incorporated into existing curricula without major disruption of other requirements.     

Variation by medical school in career choices of UK graduates of 1999 and 2000

OBJECTIVE: To report on how newly qualified doctors' specialty choices, and factors that influenced them, varied by medical school. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who graduated in the UK in 1999 and 2000. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 year after graduating, and factors influencing their choices. RESULTS: There were some significant differences between medical schools in the career choices made by their graduates. For example, the percentage of respondents who expressed the choice of general practice was significantly low among graduates of Oxford and Cambridge and high among graduates of Birmingham and Leicester. There was also significant variation between medical schools in choices for hospital medical and surgical specialties. There were significant differences, too, between medical schools in the extent to which career choices had been strongly influenced by graduates' inclinations before starting medical school and by their experience of their chosen specialty, particular teachers and departments at medical school. As well as the differences, however, there were also many similarities between the schools in graduates' career choices. DISCUSSION: Medical schools currently provide students with a broad training suited to any subsequent choice of specialty. We suggest that the similarities between schools in the career choices made by graduates are generally more striking than the differences. We raise the question of whether there should be any specialisation by individual schools to train students for careers in particular branches of medical practice.     

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.     

Career preferences of the 1984 medical graduates of Sri Lanka

A total of 196 graduates from the four medical schools in Sri Lanka responded to a postal questionnaire on their career preferences and factors influencing the choice of specialty. Medicine (38%), surgery (21%), paediatrics (15%) and obstetrics (12%) were the most popular choices. 'Service' specialties such as anaesthesia (1.5%), pathology (1.5%) and radiology (1%) were strikingly less attractive. Community medicine (2%) and general practice (2%) were similarly unattractive; medical administration (0.5%) was the least popular choice. In the choice of a career, opportunity for direct contact with patients (59%) was the most important determinant when compared to financial reward (12%), social prestige (10%) and fixed hours of work (12%). Research prospects (6%) and teaching opportunity (5%) were relatively unimportant considerations. The graduates preferred employment in the state health service (65%) to teaching in the clinical departments of medical schools (26%) and full-time private practice (7%). Pre- and paraclinical departments of medical schools attracted only 2% of the graduates. A total of 80% of the graduates wished to practise in the capital city or a major provincial city, while 10% chose to seek employment overseas. These results will be useful in planning undergraduate and postgraduate education, and in designing policies to attract manpower to the scarcity and high priority disciplines, so that the imbalances encountered would be minimal in the future.     

Answering multiple-choice questions in high-stakes medical examinations

OBJECTIVES: To examine whether changing initial answers during a multiple-choice question (MCQ) test in medicine brings about better overall test results, as has been shown in other academic fields. METHODS: A total of 36 answer books from the German Second National Medical Board Examination, with 580 MCQs (where 1 answer out of 5 must be selected), were used for analysis. RESULTS: We confirmed that high-stakes MCQ test scores in medicine did indeed improve when students changed their answers once. Further changes of answers did not improve the scores. CONCLUSIONS: In written, high-stakes medical examinations, we recommend that students be encouraged, after further reflection, to change their answers in MCQ tests for questions for which they had previously had doubts about the answers.     

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.     

A survey of medical undergraduate community-based teaching: taking undergraduate teaching into the community

Summary: Summary. This article summarizes the findings of a survey investigating the extent to which medical schools in the United Kingdom have developed community-based undergraduate teaching: the types of courses being run and their content; whether they are being evaluated; and how the students are assessed. Courses have been categorized under four main headings: (1) based in general practice, for teaching about general practice as a clinical specialty or using practice patients for teaching general medicine and basic clinical skills; (2) community-oriented, led by GP or community tutors; (3) specialist teaching led by hospital consultants; and (4) agency-based teaching. Twenty-eight schools responded to a written request for information and details of 83 courses were received.     

The approaches to learning of students in a traditional and in an innovative problem-based medical school

The way in which students approach their learning is dependent on a variety of factors including the characteristics of the departments and teaching to which they are exposed. These factors appear to influence whether the students adopt a surface, deep or strategic approach. In order to explore further the relationship between educational context and approach to learning, a comparison was made between students attending a traditional medical school and those attending a problem-based medical school. The results showed marked differences, with the problem-based school being higher on deep approach and lower on surface approach than the traditional school. This study provides one of the first pieces of evidence of a difference between students in the two types of medical school which can be directly attributed to the educational environment. Students in the problem-based school appear to have an approach to learning which more closely approximates the aims of most medical schools. The results provide support for the philosophies and strategies of the problem-based schools.     

Teaching bioethics to medical students: the Newcastle experience

Summary. Over the past two decades in the USA, bioethics has become an accepted component of medical education, whereas in Australia, 10 years or even less would encompass the history of most existing programmes. Given the legendary conservatism of medical schools in Australia and the intractability of the medical curriculum, this is still a remarkable achievement. But does the teaching of bioethics change the thinking and/or decision-making behaviour of medical students or practitioners exposed to such courses? Those involved know only too well how difficult such courses are to design and evaluate since the connection between ethics education and practice is not known and may never be demonstrated to the satisfaction of critics. Critics not only seek answers to the questions of whether the teaching of bioethics makes a difference, which is a fair question, but they also seek answers to the question of whether bioethics should be taught in medical schools. Can bioethics be taught? Whose bioethics is being taught? What does the trained bio-ethicist contribute? Some of these questions arise from misunderstanding and some reflect the still too dominant view in medical schools which divides disciplines into those which provide ‘practical skills’, and those which contribute only theoretical and therefore peripheral knowledge. The authors will address these questions in the light of their experience at Newcastle, Australia, where the Faculty of Medicine has been teaching bioethics for over a decade.