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.     

Assessment of Students'' experiences in technical procedures in a medical clerkship

This study was designed to provide some insight into the manner and degree of students' acquisition of practical skills. One hundred and fifty-two of a total of 166 students in a medical clerkship during the first clinical year answered a questionnaire. The questionnaire contained fifty-eight different laboratory tests and technical procedures. The study revealed deficiencies in the teaching programme. On the average the students had been exposed to 19.4 procedures during their 13-week clerkship. We found no differences according to sex or age. Fourteen skills were considered mandatory. The mean result was 62% for these procedures. Urine analysis and participating in evening rounds gained best scores, while test for blood in faeces and discussing insulin dosage had the lowest scores, 14% and 10% respectively. In order to increase the amount of exposure to practical skills, some improvements in the teaching programme are suggested.     

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.     

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.     

Teaching interviewing skills to paediatric junior clerks using simulated mothers

In this article a training programme is described for improving interviewing skills of students in the fifth year (junior clerkship) of the medical curriculum. Two interviews with a 'simulated mother' form the core of the programme. The interviews are immediately followed by a feedback session in which the simulated mother discusses the strong and the weak points of the interview. In the feedback she makes use of a checklist with relevant points concerning the content and the process of the interview. Where required the comments are substantiated with fragments of the videotaped interview. In a 2-hour theoretical session, students are told how to prepare themselves for the interview. The learning effects of the training programme using simulated mothers were evaluated in order to determine: (1) the subsequent improvement in interviewing skills; and (2) the effect of the feedback session. It was found that students' interviewing skills improved significantly on the content and the process aspects after one or two interviews. In addition the feedback sessions proved very helpful, although no significant differences were revealed, when comparing the mean group scores for students who had had feedback sessions with the scores for those who had not. The results also revealed that two interviews were insufficient and that the training should include at least three interviews. This was borne out by the large number of students who asked for more interviews with simulated mothers. In the training programme the simulated mothers perform two functions: (1) playing the role of the mother of a sick child; and (2) giving feedback to students regarding their interviewing skills.(ABSTRACT TRUNCATED AT 250 WORDS)     

Teaching medical students about neurosis

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.     

The effect of clerkship site on medical student examination grades

Fairness and equity in grading medical students is a subject of continuing interest and concern. It appeared that the students on one clerkship site, the emergency room, were scoring less well on the written final examination than those on the other clerkship sites. Correlating the scores confirmed this impression. A simple intervention was made, and follow-up examination of the scores revealed that it was effective; in fact, the students on the emergency clerkship are now scoring higher than those on the other sites.     

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 tutor programme in obstetrics and gynaecology

A Tutor Programme was created in a third-year clerkship in obstetrics and gynaecology to remedy a student complaint of insufficient contact with teaching staff. Data obtained through the use of observational methodologies were integrated with data from questionnaires and student/teacher interviews to assess programme content, its contribution to student education, and the characteristics of student-teacher interactions. Teachers and students both expressed satisfaction at this opportunity to 'get to know each other'. A unique contribution of the programme was the discussion of a set of topics categorized as 'Medicine as a Career and Lifestyle', e.g. how to make career decisions, residency selection, etc.). These topics were not addressed elsewhere in the curriculum yet were of great importance to the students. The value of observational methods in comprehensive programme evaluation was reaffirmed.     

Changes in students' perceptions of clinical teaching as a result of general-practice clerkships

This study investigated whether a 3-week clerkship for third-year medical students in general-practice doctors' offices changed the students' perceptions of clinical teaching. The Preceptor Evaluation Questionnaire was administered to 138 junior medical students before and after their clerkships. The result of the study indicated that the clerkship had a positive effect on the students' perceptions. This finding was not related to their experiences in other clerkships nor to the grades they received for the clerkship.
The results indicate that the teaching relationship established between student and family doctor significantly affects students' perceptions of aspects of effective clinical teaching.     

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.     

Development of self-assessment skills in medical students

The purpose of this study was to examine the ability of third-year medical students to evaluate accurately their own level of knowledge and performance of skills associated with anaesthesia. A total of 130 students participated in the project by completing a self-assessment form which was later matched with the corresponding instructors' evaluation. Analysis of the data identified only 4.6% of the students' self-assessments to be in general agreement with those evaluations prepared by their instructors. When the data was divided according to the placement of the anaesthesia clerkship within the third-year curriculum no significant trends of any type were shown. Students did not improve in the course of the year in their ability to evaluate themselves accurately according to the objectives established by their clinical instructors. The nature of the evaluations prepared by the clinical instructors remained fairly constant, indicating that their objectives and criteria for acceptable performance remained unchanged throughout the year.     

Teaching clinical skills to pre-clinical medical students: integration with basic science learning

Clinical skills are usually learned by pre-clinical students in a manner divorced from their basic science foundations. The value of previously learned basic sciences thus fails to be re-enforced. A clinical skills course was developed for an experimental curriculum of medical students in their first year. It was organized and taught by a team of basic and clinical scientists and emphasized the basic pathophysiological principles underlying clinical skills. Sessions were supported by related basic science audiovisual resources and a series of clinical problems with questions obliging the student to reason through basic-science mechanisms. Over the span of the course, Students' interest shifted dramatically from a focus on proficiency in motor skills to an understanding of basic pathophysiological mechanisms underlying observed phenomena. Compared to conventional curriculum students, those in the experimental curriculum failed to show a diminution in perceived value of basic sciences in their future career and, on cumulative, cognitive examinations, scored equally in basic science, but significantly higher in clinical science subjects. A clinical skills course integrating both teachers and concepts from basic, as well as clinical sciences can improve student attitudes toward the basic sciences.     

Teaching disability and rehabilitation to medical students

Summary. A survey of UK medical schools was undertaken to determine the teaching that was being offered on disability and rehabilitation. In general, teaching on this topic appeared fragmented and inadequate but a number of interesting innovations were identified. These included: a drama workshop run by a group whose members mainly have learning disabilities at St George's Medical School, student-directed learning at the University of Dundee and structured teaching programmes at the Universities of Leeds and Edinburgh. The General Medical Council Education Committee's 1991 discussion document on the undergraduate curriculum specifically mentions disability as an important topic. A number of schools mentioned that they were in the process of revising their curriculum as a consequence. Recommendations arising from the findings of the survey include integration of disability and rehabilitation into clinical teaching, focus of teaching on those types of disability which are common in the community, greater emphasis on functional assessment in teaching the physical examination, and the wider use of standard assessment instruments, for example for activities of daily living, cognitive impairment and locomotor disability. There is a need for improved communication between medical schools to facilitate the spread of educational activities on this topic.     

The modified essay question: effect of author location on student performance

The Department of Family Medicine at Jefferson Medical College, Philadelphia has utilized the modified essay question (MEQ) as an evaluative instrument in its required third-year clerkship since 1976. Previous analysis had indicated that students who participated in their clerkship at the university family practice centre (FPC) consistently performed at a higher level on their MEQ examinations than students who participated in clerkship activities at affiliated FPCs. In order to test the hypothesis that university-taught students had higher final examination scores because university teachers developed and graded the examinations, MEQs were developed by affiliate teachers and used for one half of five final examinations during the 1982-83 academic year. Students at the university-trained site continued to perform better than affiliated-trained students, even on MEQs developed by their own teachers. These results, as well as the significant administrative time involved in the project, have caused the Department of Family Medicine to revert to its previous policy of university teachers being responsible for the final examination.     

The teaching of interviewing skills: comparison of experienced and novice trainers

During a clerkship in psychiatry thirty-six medical students were randomly allocated to one of three teachers who differed widely in their experience of teaching essential interviewing skills. Each teacher taught two groups of six medical students using videotape feedback and discussion of practice interviews. Independent raters who were blind to the teachers to whom the students had been assigned rated pre and post-training interviews. All three teachers proved effective in teaching interviewing skills and it is concluded that most teachers could probably be taught to carry out this training.     

Does clinical clerkship alter students' attitudes to a career choice of psychiatry?

A 50-item questionnaire, designed to link attitudes to psychiatry directly with how these might influence a career choice of psychiatry, was administered to medical students before and after their clinical clerkship in psychiatry. Many of these changed in a positive direction, e.g. 'job satisfaction', 'life-style', 'training available' and 'multidisciplinary approach'. The influence of important people in their lives was predominantly negative; this may emphasize the impact of psychiatric 'role models'. Male and female students differed in how they changed. Males appeared influenced by external factors, e.g. 'work hours' and 'career structure', and females by internal ones, e.g. 'interest in knowing more about self'. Females were also more likely to wish for a career in psychiatry. Psychiatry was ranked higher in career choice at the end of the clerkship.     

Residents' training goals in respiratory knowledge and skills: perspective of three parties

Medical residents, full-time respiratory teaching staff, and community-based doctors rated the importance of fifty-five respiratory training goals involving knowledge and skills necessary for the future practices of all medical residents. Residents also rated their perceived preparedness in these training areas. Intra-and inter-group analyses indicated that residents agreed more often, and consistently assigned more importance (94% of goals) to the training goals than did the teachers and doctors. Although the residents considered themselves prepared for 69% of the training goals, they also had moderate intra-group disagreement. These results may reflect variable training experiences and/or institutional practices, but areas of less than adequate preparation were identified and can be corrected. The other two groups were in general agreement except regarding some clinical skills. This study offers possible explanations for the group responses and indicates the potential benefit for groups to discuss, identify, and survey training goals.     

The clinical learning environments in medicine, paediatrics and surgery clerkships

Using questionnaires, the students of the 1981 graduating class from McGill's Faculty of Medicine were investigated for their perceptions of the nature of the clinical instruction and of the roles of the consultant, resident and intern staffs during clerkships in medicine, paediatrics and surgery. Personal student diaries were used to assess time spent on various clinical activities. The results indicated that students perceived learning to be different in the three disciplines, with the acquisition of clinical skills (technical and problem-solving skills) greater in medicine and surgery than in paediatrics, and the acquisition of interpersonal skills and factual knowledge greater in paediatrics than in medicine and surgery. Students perceived themselves as passive observers in surgery and formed personal relationships more easily with staff in medicine and paediatrics than in surgery. In contrast, students perceived more emphasis on team effort in surgery. Time spent on activities related to direct patient encounter was greatest in medicine. The findings suggest that the learning environments in clinical disciplines are not homogeneous and this has implications for curricular planning and clinical teaching.     

Teaching skills in communication to medical students— a critical review of the methodology

Over the past decade, there has been a substantial increase in papers concerned with training medical students in communication skills. In this paper, we consider what constitutes an adequate methodology for such research and whether recent papers meet this standard.