A human sexuality course for Oxford University medical students

A human sexuality course for clinical students in Oxford was held based on the format of similar courses held in the U.S.A. with one-and-a-half days of films and lectures followed by discussion in small groups. The course was largely successful and evaluation of attitudes and knowledge revealed that significant preliminary changes resulted. Students who failed to complete the course had more inhibited attitudes towards sexuality and less sexual information compared with those who attended the whole course. Advice is given to those intending to hold such a course elsewhere, including how more inhibited students, who probably are most in need of such teaching, might be encouraged to participate.     

Practical work in a behavioural sciences course

This paper describes a recent change in the practical component of the Behavioural Sciences course at Dundee Medical School. Results obtained from an evaluation of the change appear to show that students' learning was enhanced by the new form of practical work.     

The application of educational objectives within a classical institutional framework

The aim of this study was to evaluate a learning system based on educational objectives as applied at departmental level in an institution structurally and functionally preset to conventional methods. The subject of Clinical Therapeutics was divided into 453 specific objectives. Classes A and B (457 and 345 students respectively) were divided into twelve and thirteen groups respectively. The groups which studied the objectives took an anonymous examination using multiple choice questionnaires before and at the end of the course. Class C (155 students, nine groups) was taught conventionally by teachers in the ward and by lectures.
In the final examination each student was examined on eight of the objectives, in one topic and (only classes A and B) on a patient. A final score was obtained from the previous scores. In class C four examiners scored the same response to the same question independently. An analysis of the results showed that the examination based on educational objectives improved the agreement and eliminated the leniency differences among various examiners. However, the postcourse examination showed an unsatisfactory degree of progress in the group performances. The final examination bore no relationship to the postcourse performance of the groups, the only determinant of the final result being the precourse performance of the groups, i.e. the general standard of the class.
The inadequacy of the system is attributed to more general causes than those operating at departmental level and to difficulties in adaptation to a new system by both the students and the teaching staff.     

Attitude change in a human sexuality course that de-emphasizes small group activities

The attitudes of second-year medical students were measured to determine if positive attitude changes could be obtained in a human sexuality course that de-emphasized small group activities. Students were given a semantic differential instrument and were asked to rate four concepts related to human sexuality: (a) my sexuality, (b) masturbation, (c) homosexuality, and (d) my role in understanding sexual problems.
Significant changes in student attitudes were reported at the 0.05 level for the concept, my sexuality; at the 0.01 level for the concept, my role in understanding sexual problems; and at the 0.001 level for the concepts, homosexuality and masturbation. Females had more positive attitudes ( P 0.001), pre and post, towards homosexuality than did males. No significant differences were found between married and single students.     

When students learn numbers: evaluation of a course in clinical decision-making

This paper describes the evaluation of an innovative course in clinical decision-making (CDM). A traditional course in neurology taught concurrently to the same group of students by the same teacher was used for comparison. The aim of the course was to introduce students to the basic concepts of CDM as an aid to rational decision-making. The end-point of the evaluation was their perception of the immediate clinical relevance of CDM. It was postulated that by seeing this relevance they would be more likely to change their decision-making behaviour than by simply learning factual content or principles. The evaluation used an ongoing formative approach, including ethnographic analysis, questionnaires, small group discussion and supportive feedback for the teacher. The ongoing evaluation of the course resulted in revisions with increasing relevance within the students' level of experience, changes in sequence of presentations and encouragement of active student participation. A pre-test showed that students had difficulty in the correct assessment of the validity of data and in the correct revision of opinion. Results of the evaluation indicated that the CDM course did not achieve its objective of making students aware of the immediate clinical relevance of CDM. Possible reasons for this include the lack of reinforcement from clinicians suitable for modelling and the context specific nature of the learning of thinking processes. For a CDM course to be successful, it may need to be taught within the context of specific clinical topics. It is suggested that the evaluation approach used here is a cost-effective method when considering innovations in the curriculum and useful for generating further questions for study.     

Towards a rational approach to student evaluation by examinations

The major functions of examinations are noted and a scheme of multiple choice testing is outlined which distinguishes between the certification function and the grading function of examinations. This scheme has been in operation since January 1976 in the Department of Anatomy, University of Cape Town, and preliminary results are presented which show: (i) greatly enhanced reliability (ii) unimpaired validity when the multiple choice procedures described were used.     

Development and exploratory trials of a cognitive preference inventory for medical students

A medical cognitive preference inventory was developed and tested with two samples, one in Israel and the other in the United States. Acceptable levels of internal consistency of the whole test and of its three subtests were demonstrated. Direct and indirect evidence for the validity of the test was provided. The potential uses of the test for student selection and evaluation as well as for programme evaluation were discussed. Two forms, E and F, each consisting of eighteen items, are recommended for use with medical students. A combination of these two forms is designed as form G. Administration of one form to half of a sample and the other form to the other half, followed by pooling the individual scores, thereby obtaining results comparable to those of form G, is recommended when time to administer the inventory is limited.     

Interns'' evaluation of their preparation for general practice: a comparison between the University of Tromsø and the University of Bergen

A total of 168 interns who have graduated from the Medical Schools of Bergen and Tromsø were asked about various aspects of the medical curriculum. In Bergen the curriculum has a traditional structure with a pre-clinical and a clinical part, but in Tromsø the pre-clinical and clinical subjects are integrated. In addition, the students in Tromsø spend long periods in municipal hospitals and in the primary health care service. We were interested in how the interns from the two universities evaluated their respective curricula and how prepared they felt for their current work. There was a response rate of 86% to the questionnaire. The results showed that the interns from Tromsø are more satisfied with their education and feel more confident in their practical skills than the interns from Bergen. They are also more motivated for future work in general practice. In our opinion the main reason for these results is the difference in curricula in the two medical schools. Other possible reasons are also discussed.     

The St Andrews MD (1935–1972)

The St Andrews MD, 1935–1972, has been investigated. The number of awards has declined and the proportion of doctors proceeding to MD has also declined. The average time between the award of the MB ChB degree and the MD degree was 11 years. About one third of the awards were at the Honours or Commendation grade. Only two doctors gained Honours in both the MB ChB and the MD. A smaller proportion of women gained an MD degree, but of those that did a similar proportion received Honours or Commendation as in the male group. Laboratory-based studies are more likely to attract the higher grades of award compared with clinically based studies.
Subsequent achievement areas show almost half the graduates to be in clinical or laboratory hospital work, 15% in administrative posts, 27% in academic posts but only 5% in general practice. Even less are in industry or the services.     

Teaching sociology to medical students

A recent change in many medical curricula has been the introduction of courses in the behavioural sciences. These courses, while introduced with the intention of emphasizing interpersonal and behavioural skills, have not been shown to lead to any of the changes towards which they are directed. Rather, there is evidence that students find these courses 'waffly' and boring. If the sociology component of these courses is to lead to change, then there is the need for a continuing process of evaluation and modification. In this paper we report upon one medical sociology course, its evaluation, subsequent modification and re-evaluation. Our evidence would suggest that sociology courses can lead to changed attitudes and values, but that such changes are contingent upon the overt application of relevant sociological concepts to the health care field.     

Patients'' reactions to a two-way mirror in general practice

From a survey of 200 patients in two general practices it would appear that the patients' reaction to the use of a two-way mirror is on the whole not unfavourable. The results suggest, however, that in the very personal setting expected of general practice people suffering from psychiatric problems (especially depression) should be given every opportunity to decline consultation in front of the mirror and if any patient becomes upset, then the mirror should be 'turned off' immediately. Internal examinations should not take place when the mirror is in use.     

The students' view of an innovative undergraduate medical course: the first year at the University of Newcastle,N.S.W.†

An innovative medical course commenced in 1978 in a new medical school at the University of Newcastle. An evaluation of the student response to the first year of this course was carried out. This evaluation aimed to assess how far the students had progressed towards the attainment of the long-term Faculty objectives on which the Newcastle curriculum is based. Students' perceptions of educational innovations were obtained and compared with the Faculty's stated aims. Students felt that they could approach a problem scientifically, in a manner consistent with the Faculty's specified methods. In the area of team work, students had accepted the need for training in team skills as preparation for work after graduation. Students have adapted to the use of objectives, to assessment for competence, and to the marking of one another's papers. These methods had been introduced to facilitate the development of skills necessary for independent and continuing self-education. Patient contact was designated as the greatest strength of the first year. Students expressed concern for patient well-being and the influence of student activities on patients. This indicated that students had progressed some way towards the attainment of the Faculty objective that they should develop an humanitarian approach to patients.     

Subjective and objective outcomes of communication skills training in first year

An 8-hour training programme in basic communication skills was carried out for an entire behavioural science class. Students participated in small-group practical workshops which focused on attending and primary accurate empathy ( Egan, 1975 ). The latter was assessed objectively by written responses to short trigger statements, and in matched pre- and post-training measures showed a significant overall increase in empathetic responding. Student evaluations of the project were positive and allowed suggestions for increasing the impact of similar training efforts in the future.     

Medical interviewing: initial student problems

Although every lecturer in a department of medical education would endorse the importance of sound medical interviewing the position of courses on this subject is generally unstressed. In the past few years a course has been developed in the Department of Internal Medicine at the University hospital of Utrecht in which special attention is paid to the sort of problems students experience in the initial phase of medical interviewing. Use is made of simulated patients. At the same time attention is given to both the medical and communicative aspects. This approach is specially appreciated by the students. Self assessment shows that they report a considerably enhanced proficiency. Observations and questionnaires show that the students have problems mostly on the emotional level, both in coping with their own emotions and in discussing personal and emotional topics with a patient.     

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.     

Population Studies: an integrated course in epidemiology and sociology for medical students

At the Royal Free Hospital School of Medicine, London, an integrated course in epidemiology and sociology for preclinical students was introduced in 1979. The course--Population Studies--is taken by the 100 second-year medical students in the summer term before they enter their clinical years. It occupies one full day and one half day each week for 8 weeks--approximately 80 hours of tuition. Population Studies is unusual in two respects. Firstly, it introduces a substantial amount of epidemiology into the preclinical curriculum. And, secondly, this is the only London medical school to integrate the teaching of sociology and epidemiology into the one course.     

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.     

The assessment and manipulation of personal diet: an undergraduate practical in human nutrition

The Department of Paediatrics at King Saud University, Riyadh, Saudi Arabia offers to medical undergraduates an optional course in nutrition and growth. This paper describes the practical experiences offered in dietary assessment and manipulation which was one component of the course, together with an assessment of its value by the students and the authors. Generally, it seemed that the component had been successful but three changes might be considered: although hand analysis of crude dietary data to determine nutrient intakes is a useful exercise, computer analysis should also be included; the principles of dietary manipulation (in effect, the principles of therapeutic dietetics) will require more emphasis; the students should make a detailed analysis of a patient's diet as well as their own. Regarding the nutrition and growth course as a whole: assessment of clinical skills would probably benefit from the same structured approach as used in the dietetic assessment; a preliminary assessment of the students' nutritional knowledge at the start of the course should be incorporated.     

Project work in the medical curriculum

This paper outlines one component, the project, which in 4 years became an integral part of the Human Ecology course at the Department of Community Medicine at the University of Glasgow. Although it is to be retained in some form, it would seem that the full potential of the device for medical undergraduates has not been realized; instead of retaining it in a token or contracted form, it could have served as the basis for cementing the learning and experience gained in the two halves of the division between the pre-clinical and the clinical years.