Assessment of undergraduate general practice teaching

Final-year medical students at the University of Bristol were asked to outline a plan of management for an elderly female patient who presented with several problems. These problems were presented in the form of a 'patient management questionnaire'. This questionnaire was completed before and again after a 9-week course that included a 3-week attachment to two general practitioners. The patterns of answers were compared to look for modifications in the plan of management that could be attributed to the teaching. The results indicate a broader plan of management after the course with more students considering the physical, social and family needs of the patient, rather than the clinical problems alone. Nevertheless, further experience of this method of assessment is needed before the technique can be considered a useful tool in the evaluation of general practice teaching.     

The assessment of cognitive abilities in clinical medicine

A study to test the hypotheses that discrete cognitive abilities necessary to clinical practice can be identified and their achievement reliably assessed by methods applicable to a large number of students is described.
Eight supposedly discrete cognitive abilities related to clinical consultation were defined and the performance of medical students in them tested by short-answer question papers. In addition, knowledge of specific definitions and of therapeutics was examined.
The study, conducted over one academic year, involved 222 medical students—102 in the penultimate, and 120 in the final year of their undergraduate course.
Marking strictly to a previously agreed schedule was undertaken independently by three examiners; and students' performance in relation to each ability (and area of knowledge) determined.
The findings showed intra- and inter-marker reliability to be highly satisfactory; and student performance in any one ability to be independent of that in any other. This suggests that the cognitive abilities chosen are indeed discrete.
The importance of cognitive abilities is discussed in relation to education and training in clinical medicine.     

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.     

Integrated medical student teaching. A combined course in community medicine, general practice, geriatrie medicine and mental health

In order to provide 'horizontal' integration of related clinical subjects, a combined teaching course in community medicine, general practice, geriatric medicine and mental health has been devised. The course lasts 12 weeks and is divided between joint teaching of topics of common interest and clinical clerkships in individual disciplines. A joint assessment takes place at the end of the course. The course was popular with students who all felt that it covered topics not encountered in other parts of the medical curriculum. A course of this type leads to a better integration of clinical subjects and avoids repetition or omission of topics which are not clearly the responsibility of any individual department.     

Some problems in teaching clinical decision-making

Evaluation of a number of courses in clinical decision-making (CDM) indicates that there are well-defined problems in teaching this subject. This paper describes some of the difficulties and proposes appropriate remedies. Problems in teaching undergraduates are different from those in the postgraduate years. Three areas where the principles of CDM are particularly useful to undergraduates relate to the structuring of clinical problems, clarifying the place of value judgements and developing new concepts regarding test ordering, particularly the importance of false positive rates and the overwhelming power of prior probabilities. In postgraduate teaching the most important areas relate to the origin of probability and of utility estimates. The complexity of decision analysis also needs critical comment. Two remedies are suggested which will help course developers when faced with these problems. Firstly, the early introduction of concepts regarding sensitivity analysis, making it clear that with the aid of CDM we are able to deal with a wide range of probability estimates, precision rarely being required in clinical medicine. Secondly, the availability of educational support systems will help expert clinicians teach CDM concepts within their own field.     

Theoretical versus practical orientations in pre-clinical biochemistry teaching

A pre-clinical lecture on the relevance of biochemical theory to clinical practice may adopt either a theoretical or a practical orientation. These two approaches were compared in an experiment involving seventy-one second-year medical students. Theory-orientated teaching was superior for promoting recall, while neither method showed overall superiority for promoting application. These results suggest hypotheses for future research.     

Medical student assessment of videotape for teaching in diagnostic radiology

A series of six videotape recordings, prepared jointly by the Department of Radiodiagnosis and the Television Service, University of Leeds, described some aspects of the radiology of the chest, using only radiographs. A small group of final year medical students viewed these videotapes over the space of a few days. Their scores for factual questions immediately afterwards were compared with their attitudes to the learning experience, expressed anonymously without knowledge of these scores. Students who scored the highest marks were most consistently critical of the videotapes; those with lower marks tended to record favourable attitudes when they performed best and unfavourable attitudes at other times. Scales set up by the students themselves to evaluate the experience produced a wide range of detailed and constructive suggestions. In general, students commented very favourably on the capacity of videotape to present fine radiographic details and we conclude that it is an appropriate medium for this purpose.     

Undergraduate teaching of orthopaedic surgery

Orthopaedics is an important component of clinical practice and education in this subject is important. In order to discover how best to teach it a questionnaire was presented to undergraduates at Bristol University at the conclusion of their course. From their replies a course length of 6 weeks with maximum clinical contact, small groups and minimum numbers of lectures is recommended. Orthopaedic courses nationally have also been analysed and found to rely overmuch upon lectures, to have student groups which are too large and to combine orthopaedics with other courses too frequently. It is concluded that undergraduate and postgraduate medical training should be integrated and that 1 clinical year should contain courses which would be optional.     

A modified essay question evaluation of pre-clinical teaching of communication skills

This paper describes the use of a modified essay question to investigate the nature of certain cognitive changes associated with some quite specific preclinical teaching. Although the teaching was aimed at developing communication skills, it appeared to draw attention to some broader aspects of health and the role of the general practitioner. The MEQ indicated that a number of important changes appeared to be associated with the teaching experience.     

Review of undergraduate small group teaching with television in general practice

To help new part-time lecturers to develop skill in undergraduate small group teaching, videorecorded seminars conducted by each lecturer were reviewed at a series of staff meetings using analyses produced by experienced full-time staff. One year later a second series of comparable seminars was recorded and, using a simple method of communication analysis, the lecturers were found to be less opinionated and more non-directive towards students.     

Undergraduate teaching of genetics

The results of a survey of general practitioner opinion on the need for medical genetics in the undergraduate medical curriculum are presented. There was unanimous agreement that the subject should be taught and it is concluded that this should occur in both the clinical and pre-clinical years.     

Is new always better? A comparison of an established teaching method with a new teaching method in a surgical course

A comparison has been made between the effective- ness of a problem-solving exercise and a formal lecture on medical Students' learning during their surgical attachment. The format of a clinical trial has been adapted. No difference has been shown in the knowledge conveyed by the two methods, although the students preferred the problem-solving exercise. No assessment has been made in this study of differences in the students ability to solve problems after exposure to different methods of teaching.     

An experimental assessment carried out in an undergraduate general practice teaching course (OSCE examination)

Professional examinations should be fair, comprehensive, objective, and appropriate to the discipline above all. If at the same time they can be made administratively easier, interesting and in themselves a teaching/learning experience, so much the better. General Practice is a difficult subject to examine in the traditional subjective manner, yet unless students and their courses are assessed then the subject loses credibility and respect in the frenetic run-up to Finals. The Objective Structured Clinical Examination seemed a more appropriate examination than any tried so far and an experiment was mounted to instruct the Liverpool University Medical School Department of General Practice Tutors in the technique and to test several station 'formats'. At this first attempt many snags were found, but some interesting lines of enquiry and further study were opened up. No attempt was made to produce an accurate mark for individual students in this test, although all were given an insight into strong and weak areas. The experiment demonstrated that an OSCE in Primary Care or General Practice is possible and can be organized. The examiners can be taught the technique reasonably quickly and need have no previous experience of formal examinations. A working Health Centre can be used.     

A factor analytic study of teaching in off-campus general practice clerkships

The Preceptor-evaluation questionnaire (PEQ) was developed at the University of Mississippi Medical Center to evaluate the clinical teaching behaviour of general practice doctors in private practice who have one or more third-year medical students per year in their offices for a required general practice clerkship. The PEQ was designed to provide feedback to these doctors and the sponsoring department in an effort to improve teaching in this setting. Developed from the input of family practice doctors who have supervised students in their offices and from a review of related literature, the instrument was given to students to determine the level of importance they attributed to each teaching characteristic. A principle components factor analysis and subsequent varimax rotation produced six significant teaching factors in this setting. These six factors were:

• 1 demonstrates a humanistic orientation toward patients and staff;
• 2 demonstrates a humanistic orientation toward student;
• 3 provides opportunity for practice;
• 4 motivates and stimulates student's thinking;
• 5 communicates effectively with student; and
• 6 demonstrates comfort and confidence in the roles of doctor and teacher.

The factor relating to the humanistic orientation toward student has not appeared as a separate factor in other studies of clinical teaching. This may be due to the unique aspects of the relationship between student and doctor in this setting which may not occur in other settings. The PEQ and similar reliable and valid instruments can provide valuable information for the doctors in these off-campus teaching situations as well as provide useful programme planning information for the sponsoring academic departments. This information may also be valuable for off-campus residency training.     

An appraisal of methods of evaluating training in psychiatry

A survey of American chief residents ^¶ in psychiatric training centres was carried out to assess how these training programmes gathered feedback on teacher effectiveness and programme content. The chief resident in each programme was asked to report how his or her department elicited information from their residents about course and teacher quality. Responses from 184 training centres in the United States were obtained and accounted for 75% of the existing centres. Fifty questionnaires were returned with the survey results and were analysed. The seven factors of clinical teacher effectiveness previously described in the literature were used to evaluate these questionnaires. The majority lacked consistent coverage of the teaching factors with the percentages of questionnaires covering a specific behaviour as follows: teacher organization, 58%; instructor knowledge, 42%; group interactional skills, 42%; instructor enthusiasm, 30%; clinical supervision skills, 25%; display of professional characteristics, 19%; and clinical competence, 17%.     

A new integrated course in preventive and community medicine

An integrated course in Preventive and Community Medicine was introduced at the Christchurch Clinical School, New Zealand in 1974. Details of the fourth and fifth clinical years as well as the elective studies in the trainee intern (sixth) year are presented. The implications of the topic studies, rotating attachments, preventive medical examinations, preventive medical ward rounds, problem-orientated record studies, simulated disabilities and Clinico-Pathological Conferences are discussed. Some preliminary conclusions are drawn from the evaluation of this course.     

Directing medical student clinical case presentations

This paper reports results from an ethnographic study examining different instructional approaches among clinical instructors in a department of internal medicine. The focus of the paper is on different questioning styles adopted by the instructors during student case presentations and the impact of these questioning styles on medical students. A means of classifying questions is presented and suggestions for further research are offered.     

Pre-registration posts in general practice

Though the UK Medical Act of 1978 made the creation of pre-registration house officer posts in general practice in the UK a serious proposition there have been few attempts to explore the possibility. The absence of agreed educational objectives for the year makes it impossible to conduct the properly evaluated experiments that might assuage existing doubts about the appropriateness of introducing general practice as a setting in an objective way. Experience so far shows that carefully designed schemes are both feasible and worthwhile in the opinion of those involved. The implications for general practice are explored, the need for new educational thinking is discussed and suggestions about criteria for the approval of practices are put forward.     

Evaluation of teaching on interpersonal interactions

In 1978, the second-year pre-clinical Behavioural Sciences course at Monash University Medical School was restructured to improve monitoring of, and feedback on, the development of interpersonal relationships between individual students and individual old age pensioners they were studying. Results indicate that integration of lecture, discussion, and practical experience with a carefully defined, multistage project appears to help students in learning about interpersonal relationships, and helps staff to evaluate both student performance and teaching.     

An evaluation of a course for undergraduate teaching of general practice

This paper presents an evaluation of the undergraduate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaluation justifies the time spent on clarifying the undergraduate educational objectives.