Basic sciences in problem-based learning and conventional curricula: students' attitudes

The purpose of this study was to compare the attitudes toward basic sciences of students in a preclinical problem-based curriculum and a conventional lecture-based curriculum at the end of their second year of medical school. The results showed that the PBL class had more positive attitudes toward basic sciences than students in the conventional class. These results may reflect a learning environment where students meet many scientist role models as teachers and where basic science is learnt in the context of clinical problems.     

Personal journal writing in a communication skills course for first-year medical students

Summary. Student journals are used at all levels of education to facilitate academic and personal learning. This paper describes the experience of journal writing from both a student and teacher perspective, in a communication skills course for first-year medical students at Queen's University, Kingston, Ontario, Canada. As one of the requirements of the course, students described their individual reactions to each weekly session in a journal. Teachers responded to each journal entry. Guidelines for journal usage in this course are described. The content of the journals includes topic-related information, comments concerning the student's individual experience of the course, and personal thoughts related to life experiences and becoming a doctor. A summary of evaluations of journal writing by teachers and students is presented. We have observed that journal writing facilitates a personal and reflective perspective to the first-year medical curriculum for both students and teachers. Journal writing appears to initiate and encourage self-awareness by providing a safe place for students to describe their experiences and relationships and to question their own values and beliefs. In the journal, through a mutual sharing of thoughts and feelings, barriers between students and teachers are diminished, leading to enhanced rapport and communication.     

Interviewing skills: self-evaluation by medical students

In an independent learning project, 52 third-year medical students carried out a structured self-assessment of two videotaped psycho-social interviews they had conducted with volunteer clients 1 year earlier, as part of a previous course. The interviews had been conducted in small tutorials with feedback from their clients, fellow students and tutors, facilitated by videotape playback. During the sequence of 16 tutorials each student had carried out an early and a late interview and had observed and participated in the discussion of the interviews of 14 peers. Students were asked to tally the frequencies of various interview behaviours, to evaluate the quality of their behaviours, and to establish priorities for future learning. The videotapes were also reliably rated by an independent observer. Students' overall self-assessments correlated 0.46 with those of the independent observer. This correlation was higher than is typically reported in studies of the validity of self-assessment. In absolute terms, the students' mean rating of interviewing performance was 3.2 (adequate plus) which was significantly lower than the observer's mean of 3.6 (adequate to good). Results are discussed in terms of Gordon's (1992) two recommendations for improving the validity of self-assessments and two further suggestions, for paired comparisons and low-threat learning environments, are added.     

The new Dundee medical curriculum: a whole that is greater than the sum of the parts

The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.     

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.     

Evaluation of an instruction programme on diabetes diet by means of a teaching machine

In 119 patients with diabetes, student nurses, social workers, dietitians and medical students a pretest was carried out with multiple-choice questions on the subject of diabetes diet. The group was then exposed to programmed diet instruction with a teaching machine. There was a significant learning effect as measured by the score differences with identical and analogue post-tests. Programmed self-teaching with feed back by multiple-choice questions seems to be an efficient method of instruction of basic facts of nutrition for diabetics thus enabling the physician to spend more time on the patient's personal problems.     

Language as a barrier to the acquisition of anatomical knowledge

The language of instruction for medical students at the University of Hong Kong is English, which is their second language. This presents a potential barrier to their academic learning. We have studied the extent of this problem by looking at the amount of terminology students have to assimilate during their anatomy course and the way in which the terminology is structured and explained (this provides, more generally, an indication of the factual loading to which medical students are exposed). We have also investigated the effect of the quality of students' language skills on their examination results in anatomy class tests and MBBS exams. It was found that students' entrance levels in English correlated well with their final examination results and that the quality and quantity of their English also correlated highly with scores in class tests. On this basis, we conclude that language is one of the most important barriers to students' academic success in the department and that current teaching materials may not be appropriate.     

Introduction of recording booklets in general practice teaching.

A system of recording booklets had been introduced for fifth-year students during their course of teaching in general practice. The booklets guide the student in his study of the development, presentation and future prognosis of patients with chronic and complicated disease in the community. The students abilities and the teaching were assessed using case histories in a system of computer assisted learning.     

Teaching and assessing clinical skills: a competency-based programme in China

The objective of this study was to develop a compentency-based clinical skills teaching and assessment programme in China utilizing modern teaching techniques. Medical teachers from three schools agreed on items for inclusion in the complete physical examination of an asymptomatic adult, an outline for an adult and paediatric history, and important interviewing skills. Lesson plans, performance checklists, and written and videotape training materials were developed. Standardized patients were trained at one school to assist with the teaching at that school and with the assessment at all three schools. A national, a provincial, and a local medical school in China were used. Before beginning the new curriculum for students in their first year of clinical training, baseline data were collected on skills of students at various levels of training in the previous curriculum at all three schools. Although in the previous curriculum there was some improvement in clinical skills among advanced compared to more junior students, performance was lower than expected by staff. One year after implementation of the new curriculum, students were evaluated. These students significantly outperformed their counterparts as well as the more senior level students tested the previous year. This project has established a competency-based teaching and assessment programme in China that allows for rapid improvement in the clinical skills of students. Within a short time, a sophisticated group of medical educators has been formed, who now function as consultants to other educators in their own country. Many aspects of this programme are being adapted throughout China and are applicable to medical schools throughout the world.     

Congruence between student and instructor perceptions of clinical teaching in paediatrics

The purpose of this study was to examine the similarities and differences in what students and instructors perceive to be the importance, and instructor use of, representative effective clinical teaching skills noted in the literature. Teaching staff members (n = 74) and students (n = 96) in three successive quarters in a required clerkship in paediatrics completed parallel forms of a clinical teaching survey. Providing feedback and positive reinforcement, showing personal interest in students, communicating knowledge and learning objectives effectively, motivating students, exhibiting knowledge of current practice and physical diagnosis, and spending time reviewing histories and demonstrating and supervising physical examinations were all thought to be important by both students and teaching staff members. Both students and instructors, however, perceived history/physical examination skills to be somewhat less important than the other clinical teaching skills, although instructors believed this skill to be significantly more important than did students. In general there was a great deal of consistency and reliability among student and instructor perceptions of the importance of these representative effective clinical teaching skills. In contrast, teaching staff members consistently believed they used each skill significantly more than students judged they did. Not surprisingly, the more important that teaching staff members believed each skill to be, the more they reported using that skill in their own teaching. These findings suggest that it is important for clinical instructors to be vigilant in assessing the effectiveness of their teaching methods.     

Peer assessment feedback marking in a large medical anatomy class

Peer assessment is a valuable tool for developing student skills whereby they gain insight into evaluating their own level of understanding within a subject. It encourages student participation in the processes of learning and assessment, but is not widely utilized. This paper reports on the issues raised by this method of assessment when used to mark clinical case studies in a large anatomy class of first year medical students.     

Cultural diversity in Australian medical education

The present study sought to explore the relevance of cultural dimensions and cultural diversity among overseas and local medical students. The main comparison among the fourth year medical students studied was between Asian origin and Anglophone background students. The measures used included cultural variation, reasons for studying medicine, learning approaches and strategies, patient interaction confidence, and medical practices anxieties. Results indicated cultural differences between the two groups, and relationships between cultural variables and, in particular, reasons for studying medicine, learning approaches and strategies, and patient interaction confidence. Results were interpreted according to Hofstede's(1980, 1986) theory of cultural dimensions as they may apply in the educational setting.     

The social contract challenge in medical education

Medical education has been criticized for loss of touch with the health needs of society. A social contract implies that medical schools, their students and teaching staff have certain rights and privileges in return for serving society. Commitment to this important reciprocal relationship makes it necessary to ensure that medical students gain understanding of the basic health needs of the communities they will serve. Health, Illness and the Community (HIC) is a mandatory course in the first and second years of the curriculum at the University of Toronto. Its goal is to provide students with community learning experiences by involving over 300 community agencies as learning sites. The course takes place one half-day per week throughout first and second year. All 177 students initially work with patients in their homes and in public health units and related agencies. Students are then assigned to agencies using health determinants and health promotion strategies. In the second year, each student selects an agency in the community, and carries out for the entire year a major project focused on the interaction of a health problem with a social issue. This educational initiative has been received well by community agencies and patients. Teaching staff have been enthusiastic and students have performed very well. A major obstacle has been the negative attitudes of some students to community-based learning, but these appear to be improving with time. Involving multiple agencies as learning sites is a feasible method for enabling students to learn about community health needs.     

Attitudes towards transferable skills in medical undergraduates

CONTEXT: Changes to the style of medical teaching will place a greater responsibility on individual medical students to manage their own learning, highlighting the need for students to develop good so-called 'transferable' skills at an early stage in their undergraduate career. OBJECTIVES: To assess the attitudes of first year undergraduates towards transferable skills, and investigate the gender difference in these attitudes. To assess the contribution of their first year course to skills development. SUBJECTS: First year students, enrolled on a traditional-style course. METHOD: A questionnaire asking the students to consider: (a) the importance of named transferable skills for medicine; (b) their own ability in these areas; and (c) the influence of their first year course. RESULTS: All students, irrespective of gender, regarded transferable skills as very important to medicine, rating organizational skills and self-learning skills as most important. Overall, students have a high level of confidence in their own skills. Male students rated their overall level of skills more highly than women. In particular they rated their information handling, managing self-learning and technical skills more highly. Students feel that their first year course has enhanced their skills in most areas. CONCLUSIONS: Our results suggest that students will feel equipped to succeed in a learning system which places the onus on them to take responsibility for their own learning. They clearly believe that they have the necessary skills for independent learning. The study highlights the need to enhance students' self-evaluation skills.     

The impact of student-generated learning issues on individual study time and academic achievement

OBJECTIVES: The aim of this study was twofold. The first question concerns the way students make use of the learning issues they generate (as strict guidelines or as global guidelines) and whether this changes across years of training. The second question concerned the relationship between the way students make use of learning issues and the time spent on individual study and achievement on two tests of knowledge. DESIGN: A questionnaire was developed, containing seven items that measured to what extent students study strictly according to the student-generated learning issues and six items that measured to what extent students study beyond the student-generated learning issues. The questionnaire also contained one question in which students had to estimate the mean time spent on individual study. Achievement was measured by two forms of tests of knowledge, a block test assessing course content and a progress test assessing long-term functional knowledge. SETTING: Medical School of Maastricht University, the Netherlands. SUBJECTS: Medical students (response=69%) from the problem-based curriculum at the Maastricht University. RESULTS: During their first year students study strictly according to the content of the learning issues, whereas in later years students studied more according to their own learning needs and interests. In addition, students who tended to study beyond the generated learning issues spent more time on individual study and achieved better on both tests. CONCLUSIONS: Students in a problem-based curriculum seem to become better self-directed learners during the years of training.     

Effectiveness of problems used in problem-based learning

Where problem-based learning (PBL) is the main method used in medical curricula, the literature suggests that it is crucial that the problems used are effective in facilitating students to identify relevant learning issues. These learning issues guide the students' studying. The present investigation explores the extent to which students identify relevant issues following exposure to prepared paper problems. In the preparatory year, in an Introduction to Medicine module, four groups of students were exposed to six themes (Health Care System, Environment and Health, Alternative and Islamic Medicine, Chronic Illness, Infectious Diseases, and Prevention and Health Promotion). Each group had two facilitators per theme. Having discussed the prepared problems, the students identified learning issues which were collected for the purpose of the study. Two content experts, using a Likert scale, analysed learning issues for their concordance to staff objectives per theme. Kappa coefficients were computed for the six PBL themes in order to assess inter-rater agreement. Learning issues identified as having no relationship to theme objectives were further analysed for their relevance to theme objectives. No objective was totally omitted by any student group. There was a 100% concordance of objectives to learning issues demonstrated over four themes. The relationship of learning issues to theme objectives ranged from 55–85% in the theme on health care system, and 73–94% in the theme on environment and health. Irrelevant learning issues were identified in the first two PBL themes addressed. Kappa coefficients over the six PBL themes varied from 0·49 to 0·82.     

Readiness for self‐directed change in professional behaviours: factorial validation of the Self‐reflection and Insight Scale

Context Self‐reflection, the practice of inspecting and evaluating one’s own thoughts, feelings and behaviour, and insight, the ability to understand one’s own thoughts, feelings and behaviour, are central to the self‐regulation of behaviours. The Self‐Reflection and Insight Scale (SRIS) measures three factors in the self‐regulation cycle: need for reflection; engagement in reflection, and insight. Methods We used structural equation modelling to undertake a confirmatory factor analysis of the SRIS. We re‐specified our model to analyse all of the data to explain relationships between the SRIS, medical student characteristics, and responses to issues of teaching and learning in professionalism. Results The factorial validity of a modified SRIS showed all items loading significantly on their expected factors, with a good fit to the data. Each subscale had good internal reliability (> 0.8). There was a strong relationship between the need for reflection and engagement in reflection (r = 0.77). Insight was related to need for reflection (0.22) and age (0.21), but not to the process of engaging in reflection (0.06). Conclusions Validation of the SRIS provides researchers with a new instrument with which to measure and investigate the processes of self‐reflection and insight in the context of students’ self‐regulation of their professionalism. Insight is related to the motive or need for reflection, but the process of reflection does not lead to insight. Attending to feelings is an important and integral aspect of self‐reflection and insight. Effective strategies are needed to develop students’ insight as they reflect on their professionalism.     

Non-verbal communication: evaluation of a computer-assisted learning package

Summary. A computer-assisted learning (CAL) package was developed on non-verbal communication. Its effectiveness was evaluated by comparing learning based on use of the package with that based on a didactic lecture covering the same topic. A class of 151 first-year medical students was divided into two groups, balanced for gender and home/overseas students. One group was asked to use the CAL package, the other group attended the lecture. Knowledge was assessed one week later by a written test, and reactions to using the CAL package were obtained via a questionnaire. Each group was then allowed and encouraged to use the other resource and then asked about their preferences for type of resource at the end of term. Mean score on the knowledge test was reliably better in the CAL group. In addition, scores increased as the time spent using the CAL package increased: this relationship was highly significant. Use of the CAL package varied from 15 to 120 minutes (median 45). Users reported that it was easy to operate, was an adequate or good resource for learning about the subject, and was a good or reasonable use of their time. After using both types of learning resource half the students judged the CAL package more useful for learning about the subject, and half preferred it to the lecture (the other half had the opposite judgement and preference). This study provides evidence that a CAL package can effectively substitute for traditional didactic teaching in a medical school. Good quality CAL, however, requires substantial resources and high calibre staff to develop and maintain it.     

Medical teaching—help or hindrance?

The paper describes an ongoing research study into the learning practices of medical students. Responses from structured interviews of forty-four (20%) first-year students at the University of New South Wales indicate that they work long hours, use few resources, consult little with teaching staff, co-operate a lot with each other and see themselves as responsible for their own learning. It is suggested that teacher training activities should take more notice of the actual learning practices of students if teachers and students are not to become confused and disillusioned.     

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.