Measuring the attitudes of dental students towards social accountability following dental education – Qualitative findings

Background: The term social accountability has gained increased interest in medical education, but is relatively unexplored in dentistry.

Aims: The aim of this study is to explore dental students’ attitudes towards social accountability.

Methods: A qualitative study utilizing focus groups with University of Otago final year (5th year) Bachelor of Dental Surgery (BDS) students was carried out. A questionnaire designed to measure medical students’ attitudes towards social responsibility was used as a guide. Following data collection, framework analysis was used to analyze each of the three focus groups, and repeating themes were noted.

Results: Analysis of the focus groups discovered recurring themes, such that participants believed that dentists should be accountable to society in a professional context and that they are responsible for patients who present at their clinic but that there is no professional obligation to help reduce oral health inequalities by working with populations facing inequalities. There was strong agreement that there needs to be change to the dental health care system from a structural and political level to address oral health inequalities, rather than individual dentists assuming greater responsibility.

Conclusion: Our findings show that dental education may not be accountable to society in the sense that it is not producing graduates who believe that they have an obligation to address the priority oral health concerns of society.     

Legal risks and responsibilities of physicians in the AIDS epidemic

Existing law in the United States applicable to physicians' obligations to treat AIDS and HIV-infected patients is summarized and ways are identified to strengthen current law so that these obligations are more sharply defined. Courts have affirmed an obligation to treat both in limited emergency situations and within the consensual physician patient relationship. Also, physicians may assume contractual obligations to entire groups of patients under employment contracts with hospitals and prepaid health plans and by agreements for Medicare and Medicaid reimbursement. Annas describes antidiscimination statutes as limited in scope and suggests ways to strengthen them. He maintains that physicians have special legal obligations because society has granted them special privileges, and he supports delineation and enforcement of ethical obligations by organized medicine, state licensing boards, hospitals, and medical schools.     

The culture of criticism and argument in health education

A programme to introduce skills in critical analytical reading and writing in postgraduate tertiary students in Public Health Management is described. The students had considerable professional experience, but their previous academic learning did not require a critical-analytical approach. The ability to review and analyse past theory and practice and to critically analyse and evaluate public health programmes is an essential element of the skills required by graduates. The paper describes and discusses the teaching and learning strategies used in critical analysis sessions. The personal and systemic barriers to achieving substantial change in cultures of learning are reviewed. As a limited response to a perceived problem, significant changes in the ability of students to critically analyse published material and write appropriate essays were achieved. The value of critical analysis in public health is described and the implication for medical education at all levels is considered.     

Twelve tips to avoid ethical pitfalls when recruiting students as subjects in medical education research

Medical education research has unique characteristics that raise their own set of ethical issues, which differ significantly from those commonly found in clinical research. In contexts where researchers have a dual role as teachers, free consent to participate in research may be undermined and students’ data must be kept confidential from faculty who play any role in their academic or professional path. Faculty members who recruit students as research subjects within their institution for education research should pay particular attention to ensure students’ consent to participate is indeed free and continuous and that their privacy is adequately protected. A good understanding of ethical standards and of the appropriate strategies to fulfill them is essential to conduct ethical medical education research and to ensure ethics approval is obtained. These twelve tips draw from the Declaration of Helsinki, from the ICMJE recommendations and from the example of their application to medical education research in a Canadian and North American context. They aim to act as a reminder and as a guide to address the main ethical issues which should be given proper consideration when designing a study involving students as subjects for medical education research.     

The assessment and treatment of the acutely ill patient--the role of the patient simulator as a teaching tool in the undergraduate programme

The assessment and treatment of the acutely ill patient is an essential part of the role of the pre-registration house officer, and research has demonstrated that management of such patients in the ward setting is often sub-optimal. However, this is an area which is difficult to teach at an undergraduate level, particularly without exposing patients to unnecessary risk. A patient simulator such as the SimMan could allow these issues to be addressed in a safe, reproducible and controlled environment. A protocol for the assessment and treatment of the acutely ill patient was designed. This was then implemented using a series of three teaching sessions during which small groups of final year medical students took part in simulated clinical scenarios on the SimMan mannequin. A questionnaire was administered to participating students before and after teaching to assess their perceived confidence and competence in a number of areas deemed important for newly qualified house officers. Data from 23 students were obtained and demonstrated a significant improvement in students' perceived levels of confidence and competence following training on the simulator. Feedback from students was extremely positive with all students reporting that sessions were a valuable addition to the final year programme. The SimMan allows students to gain knowledge and skills in a vital area of clinical practice which hitherto had been poorly covered within the curriculum. The sessions will be incorporated into the teaching programme for all future final-year students.     

Clinical teachers' tacit knowledge of basic pedagogic principles

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.     

Clinical placements for medical students: factors affecting patients' involvement in medical education

Many medical students now have contact with patients from the very beginning of their course and the increasing numbers of medical students means that more and more patients will be exposed to students during their medical treatment. This paper presents the attitudes of 281 patients towards medical students encountered in a primary or secondary care setting. Particular attention is paid to consent, types of procedures undertaken and the title given to the medical student. The study showed that the likelihood of patients agreeing to be involved in medical education depended on the patient, the student and the procedure being undertaken. Recommendations have been made to the university on the basis of the results with the aim of maximizing patient involvement and satisfaction in order to further medical student education.     

Caring for the chronically ill: a clinic for final-year medical students

In 2000 the Diabetes Centre and the Medical Oncology Department of St Vincent's Hospital, Sydney established a joint clinic for the teaching of final-year medical students. The clinic was established amid concerns that hospitals are increasingly focused on acute care and have few resources available for teaching about chronic conditions. The clinic aimed to improve both patient care and learning opportunities by engaging students in useful activities with chronically ill patients. The students met with their patients regularly to monitor progress, adjust medication (under supervision) and arrange support services. The students and staff from both units met once a week in a coordination meeting where cases were reviewed and learning issues discussed. Students had informal interactions with medical and allied health staff at other times. Overall the clinic provided a rich learning environment for students with a focus on the development of the integrated skills required in the care of chronically ill people, rather than on the specific medical disciplines involved.     

Patient rights and medical education: clinical principles

The rights of patients may be considered within three broad categories: (i) health as a fundamental human right, (ii) equitable healthcare provision by governments and institutions, and (iii) professional relationships with individual health practitioners. Doctors should be well prepared in medical schools to understand and uphold patient rights. A simplified framework for learning and for teaching medical students about patient rights is proposed with the acronym DROIT--dignity, respect, obligation, information and trust.     

Entrustable professional activities (EPAs) for teachers in medical education: Has the time come?

On a daily basis, patients put their trust in the healthcare system for safe and high-quality healthcare. However, what evidence do we have as an educational community that our supervising faculty members are competent to fulfill this responsibility? Few, if any, requirements exist for faculty members to have continuous professional development in the field of medical education. Many faculty “love to teach”, however, this love of teaching does not make them competent to teach or assess the competence of trainees whom they supervise. Faculty members who have a significant role as a teacher in the clinical setting should be assessed with regards to their baseline competence in applicable teaching EPAs. When competence is reached, an entrustment decision can be made. Once proficient or expert, a statement of awarded responsibility (STAR) may be granted. The time has come to reach beyond the “standards” of the old adage “see one, do one, teach one” in medical education. In this personal view, the authors outline an argument for and list the potential benefits for teachers, learners, and patients when we assess clinical teachers using EPAs within a competency-based medical education framework.     

A comparison of real patients,simulated patients and videotaped interview in teaching medical students about alcohol misuse

Doctors perform poorly in identifying and in treating patients with alcohol misuse problems and this has been linked to inadequate undergraduate education. We compared three methods of teaching among Aberdeen medical students. In groups of eight or nine students, teaching was conducted with a simulated patient, with real patients or with a videotaped interview. The teachers were five consultant psychiatrists. At the end of each teaching session, students completed a measure of knowledge (multiple-choice questions), two measures of attitudes towards alcohol misusers and a questionnaire tailored to assessment of the teaching session. From the class of 176 students, 156 (89%) participated in the study. Two-way analyses of variance identified a significant difference between teaching methods; students rated the simulated patient sessions as more helpful in acquiring interview skills (F = 11.71, df 2, p < 0.001). We have since expanded our use of simulated patients in the undergraduate teaching programme.     

Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment

It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.     

Medical education and the maintenance of incompetence

We think of medical education as a process that moves novices from a state of incompetence to one of competence. This paper explores the idea that education may, at times, actually lead to incompetence as a result of over-emphasizing particular discourses that construct what competence is. This paper explores four discourses each with its own terminology and core conceptualizations of competence; each of which creates different roles for students and teachers. No one discourse is ideal and all drive teaching and assessment in particular ways. Sometimes these forms of teaching or assessment may inadvertently foster incompetence. In this paper I argue that, as with medical treatments, medical educators must pay more attention to the side-effects of the discourses that shape medical education.     

Nursing faculty teaching basic skills to medical students

Medical education often uses a 'see one, do one, teach one' approach to teaching basic skills, whereas nursing education uses a more intense, competency based approach. Many nursing faculty become experts in teaching skills; however, there is little literature evaluating medical student skills training led by nursing faculty. The purpose of this paper is to describe and report initial evaluation data on an innovative teaching strategy using nursing faculty to teach specific skills to medical students. Nursing faculty designed a hands-on four hour clinical skills training laboratory for medical students. All (176) medical students completed and evaluated this skills laboratory and their own preparation for these skills. Medical students felt the laboratory was outstanding or good (94%), the content was at an appropriate level (94%) and the relevance was high or medium (96%). Medical students felt more prepared to perform the skills after completing the skills laboratory than before, and when compared to previous medical students without the skills laboratory. Many medical students commented positively about the nursing faculty. Nursing faculty teaching specific skills to medical students is acceptable and effective and provides medical students with positive exposure to nurses as experts.     

What role do medical students have in shaping the future of the National Health Service?

A newly qualified doctor’s personal view, exploring how a struggling health service and changing medical education may impact the future role of the medical student. Medical curriculums and the health service might benefit from medical students taking an expanded role in error prevention, public health promotion and clinical responsibilities.     

Introducing undergraduate medical teaching into general practice: an action research study

Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.     

Feedback of audit results can improve clinical teaching (but may also impair it)

The objective of this study was to determine whether formal, written feedback to teachers would improve the quality of teaching. Twenty-seven units that were teaching clinical skills in teaching hospitals (TH), district general hospitals (DGH) and GP surgeries were used as the setting. One hundred and eighty-eight students in Audit Phase 1 (1997) and 175 students in Audit Phase 2 (1998) completed a questionnaire regarding time utilization during teaching sessions, tutor characteristics and course attributes. Feedback of results from the Audit Phase 1 questionnaire to each individual unit was combined with anonymized results of the other units. TH units (which had scored poorly in the first questionnaire) significantly improved the quality of their teaching. This was seen in increases in (1) the degree of prior preparation, (2) the number of sessions that adhered to the guidelines provided in the study guide, (3) time spent with patients and (4) the interest shown in the students. By contrast, the DGH units and GP units (which had scored well in the first questionnaire), scored poorly in the second questionnaire for prior preparation (GP units) and educational value (DGH units). It is concluded that feedback can improve the quality of student teaching. However, when presented as a contrast with other poorly performing units, feedback may induce complacency.     

Student access and use of IT during general practice attachments

As universities change the delivery of their medical undergraduate courses, many have started to develop the community as a learning resource. In Manchester, part of the rationale behind problem-based learning is that students become familiar with the tools for finding information. Within the medical school and its main teaching hospitals, students have access to varied information resources using IT. These are often less available from off-campus sites and particularly within general practice. Even where available, students may not use them. Initial evaluation suggests that IT facilities are particularly useful for students who have longer placements. However, students prioritize their use of time in the community and furnishing general practices with a computer and other IT equipment does not, in itself, promote use by the students unless there is a perceived need. Training and support within the practice needs to be undertaken to enhance the learning environment for the undergraduates.     

Twelve tips on setting up and running a peer-led medical education society

Peer-led teaching is an established paradigm with benefits for student teachers, learners and the wider medical community. Students are increasingly taking ownership of such teaching, which has fuelled the creation of new peer-led medical education societies at universities around the UK. Students wishing to undertake such an endeavor must contend with concerns over the quality of peer-led teaching, logistical challenges, lack of senior support and difficulties accessing relevant resources to design and appraise their initiatives. Peer-led medical education societies represent a relatively novel concept, and students may struggle to find practical information on how to approach these challenges. We propose that these obstacles can be overcome by thorough event planning, understanding the role and features of high quality peer-led education in supplementing medical school curricula, maintaining a strong working relationship with local medical faculty, and learning from the wider medical education community.