The development and evaluation of a method of teaching liaison psychiatry to medical students

A method is described of teaching medical students aspects of psychiatry related to their work with physically ill patients. The teaching requires few resources and focuses on a limited number of educational objectives centred on the acquisition of knowledge of psychiatry relevant to medical practice. The course comprised eight weekly one-hour seminars held during the first clinical year attachment to medical firms, prior to the students' psychiatry attachments. Clinically based, traditional 'bedside' teaching was used, involving patients known to the students. In a preliminary analysis of the effects of the teaching, students who had participated in the seminars scored significantly better on a test of liaison psychiatry knowledge than a matched group who had not experienced the course.     

Influence of open- and closed-book tests on medical students' learning approaches

Context Two learning approaches are consistently distinguished in the literature: deep and surface learning. The deep learning approach is considered preferable. Open‐book tests are expected to stimulate deep learning and to offer a possible way of handling the substantial growth in medical knowledge. In this study we test the hypothesis that open‐book tests stimulate deep learning more than closed‐book tests. Methods Medical students in Years 2 (n = 423) and 3 (n = 306) participated in this study. They evaluated their preparation for open‐ and closed‐book tests using the test for Deep Information Processing (DIP). This questionnaire consists of 24 items divided into three subscales: Critical Reading; Broaden One's Context, and Structuring. A paired t‐test was used to analyse the data. Results Both cohorts scored significantly higher when preparing for closed‐book tests for the overall DIP score and on the Broaden One’s Context and Structuring scales. Year 3 students also scored significantly higher on the Critical Reading scale when preparing for closed‐book tests. Gender differences were found: women used deeper learning approaches than men. Conclusions Our hypothesis was not supported. In fact, the opposite was found: closed‐book tests stimulated a deep learning approach more than open‐book tests. Three possible explanations are: deep learning is particularly necessary for remembering and recalling knowledge; students feel more confident when preparing for closed‐book tests, and students are more motivated to study for closed‐book tests. The debate on the concept of deep learning in higher education should probably be renewed.     

Growth of analytical thinking skills over time as measured with the MATCH test

Context Ber’s Comprehensive Integrative Puzzle aims to assess analytical clinical thinking in medical students. We developed a paediatric version, the MATCH test, in which we added two irrelevant options to each question in order to reduce guessing behaviour. We tested its construct validity and studied the development of integrative skills over time. Methods We administered a test (MATCH 1) to subjects from two universities, both with a 6‐year medical training course. Subjects included 30 students from university 1 who had completed a paediatric clerkship in Year 4, 23 students from university 2 who had completed a paediatric clerkship in Year 5, 13 students from both universities who had completed an advanced paediatric clerkship in Year 6, 28 paediatric residents and 17 paediatricians. We repeated this procedure using a second test with different domains in a new, comparable group of subjects (MATCH 2). Results Mean MATCH 1 scores for the respective groups were: Year 4 students: 61.2% (standard deviation [SD] 1.3); Year 5 students: 71.3% (SD 1.6); Year 6 students: 76.2% (SD 1.5); paediatric residents: 88.5% (SD 0.7), and paediatricians: 92.2% (SD 1.1) (one‐way anova F = 104.00, P < 0.0001). Students of both universities had comparable scores. MATCH 1 and 2 scores were comparable. Cronbach’s α‐values in MATCH 1 and 2 were 0.92 and 0.91, respectively, for all subjects, and 0.82 and 0.87, respectively, for all students. Conclusions Analytical clinical thinking develops over time, independently of the factual content of the course. This implies that shortened medical training programmes could produce less skilled graduates.     

Clinical epidemiology: an experiment in student-directed learning in Western Australia

This paper describes an experiment at the University of Western Australia (UWA) medical curriculum, in which the focus of the 1 week of face-to-face teaching in public health in the 3-year clinical rotation was changed from important health problems affecting whole communities to one emphasizing the use of epidemiological principles to enhance doctors' decision-making. The students are now left to choose the clinical subject matter, and instead of being presented with predetermined readings selected by the teaching staff, the students have assumed responsibility for discovering the latest relevant information on the topics they choose and of presenting this to the class. The teacher now spends much less time in front of the class, providing only mini-tutorials each day on presenting to small groups, and on the skills required to understand the published literature on the aspects of the diagnosis, investigation, management and prognosis of individual patients.
The topics chosen by students for exploration differ little, either in terms of the nature of the health problems concerned or the epidemiological principles at issue, from those covered previously when the programme was set entirely by the staff. However, attendance at the course has improved sharply, the short time between mini-tutorials and application of the material they cover has increased the perceived relevance of the teaching, and feedback collected systematically from successive classes of students has been very positive. Any anxiety on the part of the staff at relinquishing control of the curriculum has proved unfounded while the new programme has much to recommend it as a model of self-directed learning.     

Introducing resident doctors to complexity in ambulatory medicine

Objectives Medical education instructional methods typically imply one ‘best’ management approach. Our objectives were to develop and evaluate an intervention to enhance residents’ appreciation for the diversity of acceptable approaches when managing complex patients. Methods A total of 124 internal medicine residents enrolled in a randomised, crossover trial. Residents completed four web‐based modules in ambulatory medicine during continuity clinic. For each module we developed three ‘complex cases’. Cases were intended to be complex (numerous variables, including psychosocial and economic barriers) and to suggest multiple acceptable management strategies. Several experienced faculty members described how they would manage each case. Residents reviewed each case, answered the same questions, and compared their responses with expert responses. Participants were randomly assigned to complete two modules with, and two modules without complex cases. Results A total of 76 residents completed 279 complex cases. Residents agreed that complex cases enhanced their appreciation for the diversity of ‘correct’ options (mean ± standard error of the mean 4.6 ± 0.2 [1 = strongly disagree, 6 = strongly agree]; P < 0.001). Mean preference score was neutral (3.4 ± 0.2 [1 = strongly favour no cases, 6 = strongly favour cases]; P = 0.72). Knowledge post‐test scores were similar between modules with (76.0 ± 0.9) and without (77.8 ± 0.9) complex cases (95% confidence interval for difference ? 4.0 to 0.3; P = 0.09). Resident comments suggested that lack of time and cognitive overload impeded learning. Conclusions Residents felt complex cases made a valuable contribution to their learning, although preference was neutral and knowledge scores were not affected. Methods to facilitate trainee comfort in managing medically complex patients should be further explored.     

Profile of the medical student and his outlook on medical education—the Basrah experience

The aim of the study was to obtain the students' views on the current system of medical education with focus on training and evaluation in the College of Medicine, University of Basrah, Iraq. The data were gathered by circulation of a questionnaire to students belonging to all the classes (1 to 6 years). An attempt was made to look for trends in student responses and attitudes over the years. National service, i.e., joining the national health care system, appears to be the dominant motive among the first-and second-year students in choosing the profession. Though the practice of general clinical disciplines at the basic doctor's level are pieferred, general practice per se does not seem to be popular. An apparent dislike for certain curricular subjects was observed which was more evident among students who had to pass an examination in that subject during the particular year. Lectures and dictation of notes are rated low. A good majority of students consider their active participation in the learning–teaching process as something highly useful. Though examinations are not generally liked, the students showed their preference for periodical tests as compared to a single annual examination. Students generally do not prefer assessment based on problem solving exercises. Little use is made of the library and there is hardly any student–teacher contact outside the classroom. The study has brought out the need for greater emphasis on self-directed learning. The relevance of the students' views in educational planning are highlighted in the discussion.     

What is feedback in clinical education?

OBJECTIVE: Feedback is important in clinical education. However, the medical education literature provides no consensual definition of feedback. The aim of this study is to propose a consensual, research-based, operational definition of feedback in clinical education. An operational definition is needed for educational practice and teacher training, and for research into the effectiveness of different types of feedback. METHODS: A literature search about definitions of feedback was performed in general sources, meta-analyses and literature reviews in the social sciences and other fields. Feedback definitions given from 1995 to 2006 in the medical education literature are also reviewed. RESULTS: Three underlying concepts were found, defining feedback as 'information'; as 'reaction', including information, and as a 'cycle', including both information and reaction. In most medical education and social science literature, feedback is usually conceptualised as information only. Comparison of feedback definitions in medical education reveals at least 9 different features. The following operational definition is proposed. Feedback is: 'Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance.' CONCLUSIONS: Different conceptual representations and the use of different key features might be a cause for inconsistent definitions of feedback. The characteristics, strengths and weaknesses of this research-based operational definition are discussed.     

Test-enhanced learning in medical education

CONTEXT: In education, tests are primarily used for assessment, thus permitting teachers to assess the efficacy of their curriculum and to assign grades. However, research in cognitive psychology has shown that tests can also directly affect learning by promoting better retention of information, a phenomenon known as the testing effect. COGNITIVE PSYCHOLOGY RESEARCH: Cognitive psychology laboratory studies show that repeated testing of information produces superior retention relative to repeated study, especially when testing is spaced out over time. Tests that require effortful retrieval of information, such as short-answer tests, promote better retention than tests that require recognition, such as multiple-choice tests. The mnemonic benefits of testing are further enhanced by feedback, which helps students to correct errors and confirm correct answers. APPLICATION TO MEDICAL EDUCATION: Medical educational research has focused extensively on assessment issues. Such assessment research permits the conclusion that clinical expertise is founded on a broad fund of knowledge and effective memory networks that allow easy access to that knowledge. Test-enhanced learning can potentially strengthen clinical knowledge that will lead to improved expertise. CONCLUSIONS: Tests should be given often and spaced out in time to promote better retention of information. Questions that require effortful recall produce the greatest gains in memory. Feedback is crucial to learning from tests. Test-enhanced learning may be an effective tool for medical educators to use in promoting retention of clinical knowledge.     

Thinking the post-colonial in medical education

Context  Western medicine and medical techniques are being exported to all corners of the world at an increasing rate. In a parallel wave of globalisation, Western medical education is also making inroads into medical schools, hospitals and clinics across the world. Despite this rapidly expanding field of activity, there is no body of literature discussing the relationship between post-colonial theory and medical education.
Discussion  Although the potential benefits of international partnerships and collaborations in education are incontrovertible, many medical educators are sometimes too unreflecting about what they are doing when they advocate the export of Western curricula, educational approaches and teaching technologies. The Western medical curriculum is steeped in a particular set of cultural attitudes that are rarely questioned. We argue that, from a critical theoretical perspective, the unconsidered enterprise of globalising the medical curriculum risks coming to represent a 'new wave' of imperialism. Using examples from Japan, India and Southeast Asia, we show how medical schools in non-Western countries struggle with the ingrained cultural assumptions of some curricular innovations such as the objective structured clinical examination, problem-based learning and the teaching of clinical skills.
Conclusions  We need to develop greater understanding of the relationship between post-colonial studies and medical education if we are to prevent a new wave of imperialism through the unreflecting dissemination of conceptual frameworks and practices which assume that 'metropolitan West is best'.     

Medical students' attitude towards psychiatry: a ten-year comparison†

Medical students' interest in and attitudes toward psychiatry, both as a field of education and as a medical specialty, have been explored by a number of investigators. The present study compares two series of investigations completed at the McGill University teaching hospitals over a ten year span and involving third year medical students in 1968–69 (n=59) and in 1978–79 (n=168). The findings of these two studies are evaluated in two parts: (1) comparison of attitudes toward psychiatry before and after clinical training in 1978–79. (2) comparison of the results obtained in 1969 with those in 1979. The results of the comparison showed that students currently put more emphasis on the clinical aspects of psychiatric training and less on the theoretical and research aspects of psychiatry. Thirty-two percent of students in 1979 found psychotherapy to be the most useful treatment modality as compared with only 10 percent in 1969. Findings reflecting the usefulness of organic therapies in psychiatry remained fairly consistent, but behaviour therapy was found to be less useful by students in 1979 than in 1969. In the 1969 survey, 2 per cent of the third year students indicated an interest in psychiatry as a future career as compared with 3.3 per cent in 1979. The implications of these findings are discussed in relation to the psychiatric training programmes in medical schools.     

Medical education in action: community-based experience and service in Nigeria

Problem-based, student-centred learning at the Faculty of Health Sciences, Unilorin, Nigeria were incorporated in the overall objectives of producing students with a sense of service and a strong inclination toward broad community care and preventive medicine. The educational programme reflecting this concept was called COBES (community-based experience and service). Twice a year groups of between seven and fourteen students, each accompanied by two to three staff members, settled in a village or other community for 1 month. According to the Faculty's objectives, each group assessed the size of its community (population, areal map) at first. Malnutrition and infectious diseases were selected as the two health problems which were to be studied in depth during the first two COBES placements. Data were collected and analysed by the students from which deductions were made, and at the end of the placement a written report was required by the Faculty. Three learning situations and the experience gained from them by one group of students are reported:

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Medical students' perceptions of their learning about the doctor-patient relationship: a qualitative study

Objective To describe and discuss Year 5 medical students' perceptions of their own learning about the doctor?patient relationship. Methods We carried out a qualitative study of semi‐structured interviews with 16 Year 5 medical students using 3‐way analysis at the School of Medicine, Federal University of São Paulo, São Paulo, Brazil. Results For experiences at the pre‐clinical stage, the subcategories were: positive aspects of the medical psychology course; great distance between theory and reality, and strong desire for clinical practice. For experiences at the clinical stage, the subcategories were: demand for opportunities to discuss the doctor?patient relationship; teachers as either role models or anti‐models; clinical situations favourable for developing empathic relationships, and clinical situations unfavourable for developing empathic relationships. For views about future experiences, the subcategories were: apprehension about ethical behaviour; anxiety about handling patients' psychosocial characteristics, and fear of professional ethics cases or legal action. Discussion To compensate for the lack of practical activities during the pre‐clinical stage, students search for extracurricular activities that often overload them. Because teachers function as professional role models, their attitudes towards patients have great importance. Students fear not being able to maintain their empathic capacity in the future because of work‐related issues. Knowledge of the psychological aspects of the doctor?patient relationship helps students to comprehend their experiences. Gradual contact between student and medical practice from the beginning of the course is advised. It should be followed by interdisciplinary discussions that deal with the technical aspects of cases and the doctor?patient relationship.     

Emotional Intelligence and Personality Traits as Predictors of Occupational Therapy students' Practice Education Performance: A Cross‐Sectional Study

This study investigated whether occupational therapy students' emotional intelligence and personality traits are predictive of specific aspects of their fieldwork performance. A total of 114 second and third year undergraduate occupational therapy students (86.6% response rate) completed the Genos Emotional Intelligence Inventory (Genos EI) and the Ten‐Item Personality Inventory (TIPI). Fieldwork performance scores were obtained from the Student Practice Evaluation Form Revised (SPEF‐R). Linear regressions were completed with the SPEF‐R domains being the dependent variables and the Genos EI and TIPI factors being the independent variables. Regression analysis results revealed that the Genos EI subscales of Emotional Management of Others (EMO), Emotional Awareness of Others (EAO), Emotional Expression (EEX) and Emotional Reasoning (ERE) were significant predictors of various domains of students' fieldwork performance. EAO and ERE were significant predictors of students' Communication Skills accounting for 4.6% of its variance. EMO, EAO, EEX and ERE were significant predictors of students' Documentation Skills explaining 6.8% of its variance. EMO was a significant predictor of students' Professional Behaviour accounting for 3.2% of its variance. No TIPI factors were found to be significant predictors of the SPEF‐R domains. Occupational therapy students' emotional intelligence was a significant predictor of components of their fieldwork performance while students' personality traits were not. The convenience sampling approach used, small sample size recruited and potential issue of social desirability of the self‐reported Genos EI and TIPI data are acknowledged as study limitations. It is recommended that other studies be completed to investigate if any other relevant constructs or factors are predictive of occupational therapy students' fieldwork performance. Copyright © 2016 John Wiley & Sons, Ltd.     

Conditions for successful reflective use of portfolios in undergraduate medical education

Aim Portfolios are often used as an instrument with which to stimulate students to reflect on their experiences. Research has shown that working with portfolios does not automatically stimulate reflection. In this study we addressed the question: What are the conditions for successful reflective use of portfolios in undergraduate medical education? Methodology/research design We designed a portfolio that was aimed at stimulating reflection in early undergraduate medical education, using experiences described in the medical education literature and elsewhere. Conditions for reflective portfolio use were identified through interviews with 13 teachers (mentors), who were experienced in mentoring students in the process of developing their portfolios. The interviews were analysed according to the principles of grounded theory. Results The conditions for successful reflective use of portfolios that emerged from the interviews fell into 4 categories: coaching; portfolio structure and guidelines; relevant experiences and materials, and summative assessment. According to the mentors, working with a portfolio designed to meet these conditions will stimulate students' reflective abilities. Conclusion This study shows that portfolios are a potentially valuable method of assessing and developing students' reflective skills in undergraduate medical training, provided certain conditions for effective portfolios are recognised and met. Portfolios have a strong potential for enhancing learning and assessment but they are very vulnerable and may easily lead to disappointment. Before implementing portfolios in education, one should first consider whether the necessary conditions can be fulfilled, including an appropriate portfolio structure, an appropriate assessment procedure, the provision of enough new experiences and materials, and sufficient teacher capacity for adequate coaching and assessment.     

Comparison between medical students' experience,confidence and competence

OBJECTIVES: This study was undertaken to determine whether or not breadth of clinical experience and student levels of confidence were indicators of competency on standardized simulator performance-based assessments. METHODS: All students (n=144) attending an educational session were asked to complete a 25-point questionnaire regarding specific clinical experiences and levels of confidence in their ability to manage patient problems. For enumeration of clinical experiences, students were asked to estimate the number of times a situation had been encountered or a skill had been performed. For level of confidence, each response was based on a 5-point Likert scale where 1=novice and 5=expert. Students then participated in a standardized simulated performance test. Median and range were calculated and data analysed using Spearman rank correlations. A P-value <0.05 was considered significant. Level of confidence data were compared to performance during clinical rotation and to marks in the anaesthesia final examination. RESULTS: A total of 144 students attended the session, completed the questionnaire and participated in the standardized test. There were wide ranges of experience and confidence in the 25 listed items. Analysis of data showed good correlation between clinical experience and level of confidence. There was no correlation between clinical experience, level of confidence and performance in a standardized simulation test. Neither was there any correlation between level of confidence and clinical grades or written examination marks. CONCLUSIONS: Clinical experience and level of confidence have no predictive value in performance assessments when using standardized anaesthesia simulation scenarios.     

Special study modules: an opportunity not to be missed

The General Medical Council's (GMC's) Tomorrow's Doctors has proposed a radical rethink of undergraduate medical education. The two main planks of the proposals are the core curriculum and special study modules (SSMs) or options. Medical schools around the country have been much exercised in creating their core curricula but there has been less time given to a consideration of the SSMs. This paper looks at the GMC's proposals for SSMs and emphasizes their importance in introducing innovation and originality. Three different categories of SSM are described and a justification made for including each in the curriculum. The focus is on what non-medical subjects might contribute to medical education.     

Item response theory: applications of modern test theory in medical education

CONTEXT: Item response theory (IRT) measurement models are discussed in the context of their potential usefulness in various medical education settings such as assessment of achievement and evaluation of clinical performance. PURPOSE: The purpose of this article is to compare and contrast IRT measurement with the more familiar classical measurement theory (CMT) and to explore the benefits of IRT applications in typical medical education settings. SUMMARY: CMT, the more common measurement model used in medical education, is straightforward and intuitive. Its limitation is that it is sample-dependent, in that all statistics are confounded with the particular sample of examinees who completed the assessment. Examinee scores from IRT are independent of the particular sample of test questions or assessment stimuli. Also, item characteristics, such as item difficulty, are independent of the particular sample of examinees. The IRT characteristic of invariance permits easy equating of examination scores, which places scores on a constant measurement scale and permits the legitimate comparison of student ability change over time. Three common IRT models and their statistical assumptions are discussed. IRT applications in computer-adaptive testing and as a method useful for adjusting rater error in clinical performance assessments are overviewed. CONCLUSIONS: IRT measurement is a powerful tool used to solve a major problem of CMT, that is, the confounding of examinee ability with item characteristics. IRT measurement addresses important issues in medical education, such as eliminating rater error from performance assessments.     

Effect of variations in sequencing of clinical tutorials

The sequence in which different specialties are presented to medical students may influence their impact. However, the subject has been rarely examined. In the present study a variety of educational outcomes were evaluated for a second-year medical school class. They followed a series of eight clinical tutorials but did so in four different sequences. The outcomes assessed were: (1) student achievement during their tutorial year and in several major clinical courses taken in the third medical school year; (2) student perceptions of the tutorial experiences and the impact of the tutorials on subsequent clinical training; and (3) student choices of clinical courses and programmes in their third and fourth years.
The results indicated that the sequence of the eight tutorials had no adverse effect upon the educational outcomes examined.