The role of actors in teaching communication

This paper describes a series of communication workshops designed to improve the consultation skills of third-year clinical medical students during their period of attachment in general practice, and to enable them to understand the differences in perspective and attitude existing between doctor and patient and their effect on the process and outcome of the clinical interview. The workshops involve a group of professional actors as simulated patients. The advantages of this method are discussed in terms of increased lay participation in the teaching.     

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.     

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.     

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.     

Constructing a new course for undergraduate teaching of general practice

This paper outlines in Part I the method used to analyse and re-define a set of educational objectives on which a new course of teaching of general practice in the later clinical years is based. Part II describes the course, the learning methods, behavioural attainments and the techniques of evaluation to be implemented. A year was spent on the exercise by a group which comprised the professorial head, consultant senior lecturer and a senior registrar tutor from the Department of General Practice, Queen's University, Belfast, and a consultant educationalist, a senior lecturer, Department of Education, of the same University.     

Integrating general practice tutors into an undergraduate programme

Eighteen tutors appointed to the Department of General Practice at Dundee were visited. They provided information for a study to determine the degree of their involvement in the Department. A structured questionnaire standardized the interview and the results are described. The study showed a considerable level of success in integrating this group of practitioners into the teaching activities of the Department. Results also suggested that some educational objectives were not clearly defined, and surprisingly there appeared to be an underuse of this group of motivated teachers.     

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.     

Evaluation of a practical approach to teaching about communication with terminal cancer patients

Teaching about communication between doctors and terminal cancer patients is problematic. A practical model that requires individual student problem-solving and group discussion with minimal staff involvement has been described. An evaluation showed that this model was effective in exposing students to different points of view, could result in changes in behaviour and was found to be interesting by the majority of students.     

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.     

A teaching methods course in Manchester for general practitioner teachers

A teaching-methods course for general practitioner teachers is described. It lasts for 20 days, split into four 5-day residential sections held at intervals of 6 months. The sections are respectively entitled person-to-person teaching, small group teaching, teaching behaviour, and a micro-training laboratory. They recur in a cycle. The approach in each section is that of experimental learning--necessarily, since an aim of the course is to enable the members to apply the same approach in their own teaching. The methods of three of the sections are given in some detail. The person-to-person teaching section, concerned mainly with the learning of counselling skills, is dealt with fully by Long et al. (1976), and is here presented very briefly. The limited evaluation and assessment procedure, and their results, are offered together with certain general conclusions.     

Attitude changes in the vocational training of general practitioners

This investigation examined the extent to which attitudes of doctors who participated in a one-year training programme for general practice changed in intended directions by training. A large number of questionnaires, validated in earlier research, were administered to 84 trainee general practitioners (GPs) both at the start and at the end of the training year. There appeared to be a strong to very strong shift in the intended direction with regard to the demarcation of work between general practitioners and specialists, the feeling of competence at work, the fear of making mistakes, beliefs about taking risks when making medical decisions, confidence in specialist technical examinations and the way general practice work is experienced. By the end of the training students hardly differed from, or had even gone further in the intended direction than, experienced general practitioners.     

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.     

The workload of trainees in general practice

During their first training period in general practice the authors felt that they did not encounter the balanced workload which is the foundation for learning to be a GP. Previous studies confirmed the existence of differences in overall and specific workload between trainees and trainers. From their own experience and from the relevant literature they addressed several factors which might affect the workload of trainees. A study was undertaken to determine differences in workload between trainees and trainers, and to investigate whether certain characteristics of practice and of trainees affect the workload of trainees. Details of surgery consultations with 34 trainee-trainer partnerships were recorded in the north of the Netherlands over 2 weeks. Questionnaires were filled in by trainers, trainees and practice assistants from these 34 general practices. The total number of contacts recorded was 10,103. It was found that trainees see fewer elderly and female patients, less chronic and oncological conditions, but more minor illnesses. They see only 30% of patients with problem behaviour. Factors that influence the trainees' workload, as compared to their trainers' are: list size; selection in the allocation of patients; trainee's experience prior to starting the training stage, and the trainee's sex. Except for problem behaviour, trainees generally see a cross-section of their trainer's practice population. Selection would provide a more balanced workload for trainees.     

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.     

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.     

Educational assessment of general practice experience for psychiatric trainees

Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitations of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.     

Objectives and Students' learning in general practice

Student views of objectives and learning, during 4 weeks spent in general practice in the fifth year, are compared to those of the GPs to whom they were attached. Relationships between these views are discussed, together with their implications, for the wider contributions made by general practitioners to the undergraduate curriculum.