Sociology in the British medical curriculum: a survey

A survey conducted among convenors of sociology courses in British medical schools showed a wide variation in course length, with two medical schools having no course, and two schools providing over 60 hours per year. A mean length of 32 hours was found, but there was considerable variation by region. London schools had a mean of 38.5 hours, compared with 40.5 hours in Scotland, and 22.3 hours in English provincial and Welsh schools. The latter group demonstrated a strong correlation between length of time the course had existed and the hours of tuition provided (r = 0.74, P = 0.007). No correlation was found at a significant level for London or Scottish courses. It is concluded that the London University edict making sociology compulsory in the medical curriculum has ensured a reasonable level of provision. Outside London, no such pressure has been available, and sociology has been squeezed as more subjects vie for curriculum time. Attitudes of non-sociology staff are reviewed and found to be predominantly negative. The recent report of the General Medical Council is noted, and it is suggested that the need for such a lobbyist outside London is necessary to ensure sociology attains a more secure and substantial place in the medical curriculum.     

The theory of planned behaviour in medical education: a model for integrating professionalism training

Context  Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum.
Objectives  This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students' implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed.
Discussion  We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.     

Undergraduate teaching of orthopaedic surgery

Orthopaedics is an important component of clinical practice and education in this subject is important. In order to discover how best to teach it a questionnaire was presented to undergraduates at Bristol University at the conclusion of their course. From their replies a course length of 6 weeks with maximum clinical contact, small groups and minimum numbers of lectures is recommended. Orthopaedic courses nationally have also been analysed and found to rely overmuch upon lectures, to have student groups which are too large and to combine orthopaedics with other courses too frequently. It is concluded that undergraduate and postgraduate medical training should be integrated and that 1 clinical year should contain courses which would be optional.     

Preparing doctors for tomorrow: information management as a theme in undergraduate medical education

The evolving nature of medical knowledge and technology requires that the practitioners of tomorrow be able to develop practice management and computer skills in order to enhance quality patient care, ongoing education, and research. The paper describes how the discipline of medical informatics can be integrated into an undergraduate medical curriculum, not as a course or series of courses but as a repeated theme throughout the 3-year system-based curriculum. Recommendations specific to integrating medical informatics into an undergraduate curriculum are outlined with respect to: (1) content; (2) content organization; (3) management; and (4) evaluation. Six areas of information and computer management applications are discussed. These are computer-assisted learning, retrieving and organizing information from computerised databases, the application of medical informatics tools to the critical appraisal of literature and associated statistical software packages, hospital- and office-based information systems, and electronic communications. Medical education has a history of resistance to change. Reference to guidelines and experiences of others who have negotiated information management and medical informatics changes into medical school environments can therefore be helpful. It is in this context that this paper is presented.     

Family attachments and medical sociology: a valuable partnership for student learning

This paper reports association within a curriculum of a theoretical programme in medical sociology for undergraduate medical students with a practical family attachment. These two components constitute the 'sociology' element of a course in behavioural science, and have equal weight for assessment purposes. Recognition of, on one hand, the mutuality of the two elements, and on the other, their similar but distinct theoretical underpinnings, suggests that such an association has the benefit of retaining the individual contributions of each component to student learning, while enabling theoretical and practical components to inform each other. Both are administered from the Department of General Practice of the University of Sheffield, UK. The consequences of such an educational provision are discussed.     

Information Management and Technology (IM&T): training provision in postgraduate medical education

Information Management and Technology (IM&T) is assuming a greater role within the modern NHS and there is an increasing need for members of the medical, and other health care, professions to receive appropriate training and education in these areas. Over half the Postgraduate Deans, Regional Advisers in General Practice and the Medical Royal Colleges have made a conscious decision to supply training in IM&T-related areas. These courses are open to a wide range of health care professionals. However, the number of reported places is not adequate for the large number of people who require the training. Less than half the organizations employed staff with a remit to provide training but over half provided courses in collaboration with educational establishments. As the medical undergraduate curriculum changes and incorporates training in computer skills, the links between the postgraduate institutions and medical schools must be fostered and developed. This will lead to increasing opportunities for health professionals both in the range of subjects and the number of places available.     

The teaching of behavioural sciences

Summary. Medical science over the last few decades has undergone vast changes. Technologically it has advanced at a rapid pace. There has been a realization as well that the behaviour of individuals and communities also influences the occurrence of disease. Medical schools around the globe have realized the need for incorporating behavioural sciences as an integral part of the basic sciences taught to medical students.
This paper presents the experience of Christian Medical College, Veilore in teaching behavioural sciences. Students are taught sociology, psychology and medical anthropology through a community-based, problem-oriented teaching programme. The students have first-hand experience of living in a community and learn by observation and interaction. Pre- and post-assessment has shown a significant improvement of their knowledge and attitude. Feedback from students also indicates that they find this programme relevant and interesting.     

Lessons learned from complementary and integrative medicine curriculum change in a medical school

OBJECTIVES: This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum. METHODS: A qualitative approach was selected as a first step in evaluating the phenomenological experience of introducing the CAM Educational Project in 2000-05. In 2005, semi-structured interviews were conducted with faculty staff and graduating students who had participated in all 4 years of the CAM Project. Qualitative content was analysed focusing on linguistic data and contextual meaning. RESULTS: The overall response to the integration of CAM curricular elements into the medical school curriculum was positive among all faculty and graduating medical students. Participant experiences were often dependent on the perceived rigour of alternative approaches to a presenting patient problem, along with the importance attributed to openness to patient perspectives as part of evidence-based practices. There was an appreciation of the importance of developing increased awareness and utilisation of CAM in medical practice, as well as a recognition of resistance by some medical school faculty to CAM approaches. CONCLUSIONS: This evaluation of a specific CAM educational project suggests potentially transferable findings to other medical schools. Integrating CAM into the medical school curriculum requires a dedicated team if it is to result in a significant change. This change requires that CAM practices are visible to both students and faculty, that there is a co-operative climate, accessible resources, and institutional support, and that CAM content is embedded into the existing curriculum. All these factors combined can lead to sustainable integration of CAM content issues into the medical school curriculum.     

Professionalism and the basic sciences: an untapped resource

CONTEXT: Medical, technological and societal developments influence doctors' professional responsibilities and present challenges to educating medical students about professionalism. Medical education about professionalism generally focuses on behaviours and competencies which are taught primarily by clinicians in clinical courses and settings. DISCUSSION: Many professional competencies in medicine parallel those in science. We consider here whether medical professionalism can also be taught through the basic science courses which often initiate medical education, and which are typically taught by scientists. CONCLUSIONS: Like doctors, basic science faculty staff can teach professional competencies to medical students. Science faculty are well situated to teach professional competencies and should do so. They can model how to pursue evidence and manage conflicting information. They can also provide explicit messages to students about professional competencies and their value, and create learning objectives that reinforce those messages.     

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.     

Effective teaching of communication skills for medical practice: selecting an appropriate clinical context

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical practice, they must be taught within an appropriate clinical context. The present paper describes and provides rationale for seven criteria by which to select clinical issues which are appropriate foci for communication skills courses. The criteria are : (1) the issue must be one which is encountered frequently in clinical practice; (2) the issue must be associated with a high burden of illness; (3) there must be evidence that practitioners need to improve skills for dealing with the issue; (4) there must be an intervention, of which communication skills are an integral component, that is demonstrably effective for dealing with the clinical issue; (5) the intervention must represent a cost-effective means of dealing with the issue; (6) the intervention must be acceptable to doctors and be able to be incorporated into routine medical practice; (7) the intervention must be acceptable to patients. Examples of clinical issues which fit these criteria are given in the paper and include smoking, hazardous alcohol consumption, non-adherence to treatment instructions, overdue cervical screening, inappropriate diet, recovery from medical interventions, and breaking bad news to patients.     

What is the educational impact of standards‐based assessment in a medical degree?

CONTEXT: Many medical courses use standards-based assessment, usually reported by a restricted range of categories, but there is little evidence of its educational impact. This study aimed to evaluate the impact on medical student learning of changing to standards-based assessments reported by distinction, pass or fail. METHODS: We carried out a prospectively planned before-and-after study within an undergraduate medical course using a questionnaire to compare motivation and approaches to the study, and a diary to compare the number of hours spent studying. RESULTS: Questionnaire response rates were 607/752 (81%) before the change and 651/780 (83%) afterwards. Daily diary response rates were 1074/1478 (73%) before, and 1304/1844 (71%) after the change. Deep motive declined with class year during norm-referenced assessments but not with standards-based assessment (r = - 0.11 versus 0.01; P < 0.02). Deep strategy increased significantly under standards-based assessments in students in Years 2 and 3 (mean difference 0.64 [0.08-1.2]; P < 0.05) and Year 6 (mean difference 2.0 [0.03-3.9]; P < 0.05). Competitiveness scores declined as students progressed through the course in both cohorts. Students identified themselves as feeling more like a doctor after the change to standards-based assessments. Time spent studying was largely unchanged but the proportions of wanted discretionary study increased from 64% to 71% for students in Years 2 and 3, and from 65% to 70% for students in Years 4 and 5. CONCLUSIONS: The changes were associated with beneficial effects on deep motive, deep strategy, professional identify and intrinsically motivated study. There were no changes in competitiveness and minimal changes in amount of time spent studying.     

Undergraduate teaching of the behavioural sciences at a new medical school in Ghana

A programme of teaching in the behavioural sciences at a new medical school in Ghana is described. Students are introduced to problems in their first year and these are used as a means of working in small groups, for self-directed learning and the collection of data. The course continues for 5 years and leads on to a residential posting at a psychiatric hospital, and embodies a close association between 'clinical' medicine and psychological medicine. The programme has only been running for 2 years and so an adequate objective evaluation cannot yet be made, but judged subjectively it is enjoyed by students.     

Relevant behavioural and social science for medical undergraduates: a comparison of specialist and non-specialist educators

AIM: To compare what medical educators who are specialists in the behavioural and social sciences and their non-specialist counterparts consider to be core concepts that medical graduates should understand. BACKGROUND: Previously perceived as 'nice to know' rather than 'need to know', the General Medical Council (GMC) now places behavioural and social sciences on the same need-to-know basis as clinical and basic sciences. Attempts have been made to identify what components of these topics medical students need to know; however, it remains unknown if decisions over programme content differ depending on whether or not educationalists have specialist knowledge of the behavioural and social sciences. METHODS: In a survey of medical educationalists within all UK medical schools, respondents were asked to indicate from a comprehensive list of psychological, sociological and anthropological concepts what they considered a minimally competent graduate should understand. Comparisons were made between the concepts identified by specialist behavioural and social science (BSS) educators and those without such training. RESULTS: Despite different disciplinary backgrounds, non-specialist educators largely concurred with BSS specialist educators in the concepts they considered tomorrow's doctors should know about. However, among BSS specialists there remained disagreement on what BSS content was relevant for graduates. Differences reflect specialist knowledge and recognition of the role of theoretical underpinning of BSS and reveal gaps in non-specialists knowledge. CONCLUSIONS: Educationalists with formal training in the full range of behavioural and social sciences should be involved in the development of BSS curriculum content at both national and school levels.     

Elective modules in the behavioural sciences

An elective modules programme in the behavioural sciences was designed for the undergraduate medical curriculum at The Ohio State University College of Medicine. The programme provides a mechanism by which a broad range of behavioural science content can be introduced into the curriculum without increased allocation of teaching staff or budget. Student preference data indicate some clear differences with the more popular modules being those which focus on skills or behaviours that students perceive to be useful in the immediate practice of medicine. The elective aspect of the programme was part of its initial appeal, both to students and teaching staff. Two years of course evaluation data from the students indicate that most individual modules and the programmes as a total have been successful in achieving their intentions. The programme has now been included as a permanent component of the curricula.     

Primary knowledge, medical education and consultant expertise

We have studied the knowledge of students and clinicians that they actually used to follow up four problems in general medicine. Some unexpected similarities and differences in their readily accessible or primary knowledge were found in groups from first-year clinical medical students to consultants. There is no linear increase in the quantity of primary knowledge with experience, but qualitative changes are very much more important. At all levels individuals show a remarkable dissimilarity in the knowledge they use to solve clinical problems, so that the bulk of personal knowledge used is individual. Comparatively rarely do people use the same knowledge to solve any one clinical problem. However, there is evidence of a general tendency towards increasing uniformity in knowledge as a result of the medical school years. After houseman level, individuality increases again. These changes result in consultants achieving an identical profile to first-year clinical medical students in terms of the extent to which their primary knowledge bases are held individually or in common. These findings suggest that consultant expertise is actually based on individual experience rather than a common core of knowledge. The influence of medical school in providing such a common knowledge base is (1) limited and (2) reversed by clinical practice. The results suggest the necessity for increased vocational and practice-oriented components in medical education, particularly in postgraduate education.     

The medical school as a social organization

The paper reviews sociological research on the medical school as a social organization from the 1950s to the present. Despite significant differences between societies in the organization of medical education, such research has been largely confined to the USA. Some reasons for this are suggested. Ways in which the climate and organization of medical schools--at least in Great Britain--have changed in the recent past are described as well as reasons for such changes. It is argued that more research into these processes and into the organizational obstacles to change, including cross-national studies, are needed.     

Challenges of educating for medical professionalism: who should step up to the line?

Context  The teaching of professionalism has recently become an important issue in medical education. Medical professionalism remains controversial, but several recently published institutional documents on professionalism seem to express an implicit, yet broad consensus on three points: that professionalism mainly consists of adherence to a specific set of professional attributes constitutive of medical role morality and readily identifiable as virtues of medical professionalism (VMP); that medical education needs to focus on the endowment of these attributes, and that medical ethicists should play a central role in assuming this educational responsibility.
Methods  This paper examines the assumption that the task of supporting the development of the VMP should primarily fall to medical ethicists. Considerations in favour of this position are weighted against a set of countervailing considerations. The latter include the charge that the VMP are too vague as educational guidelines, that they may not be teachable, and that the responsibility for their development must be shared across the medical faculty.
Conclusions  Medical ethics educators are right to embrace the professionalism agenda on four conditions: that the limitations of addressing the formation of professional attributes in university-based teaching are recognised; that there is clinical as well as university-based evaluation of professional attributes; that the development of the VMP as a process of professional socialisation is seen as an interdisciplinary educational project, and that the examination and explanation of the cognitive grounds of the VMP are the focus of medical educators' activities.     

A systematic review of medical skills laboratory training: where to from here?

OBJECTIVES: The aim of this review was to evaluate the effectiveness of medical skills laboratories or simulators. In particular, it aimed to determine if performance in medical skills laboratories is transferable to actual clinical performance and maintained over time. METHODS: A range of databases was utilised to search for relevant papers published from 1998 to June 2006. Articles were included in the review if they met a number of criteria that included the evaluation of a skills laboratory or simulator for the purpose of procedural skills training, that participants were either undergraduate medical students or postgraduate medical trainees, and that the study used a randomised, controlled trial (RCT) research design in evaluation. RESULTS: A total of 44 RCTs were identified for inclusion in the review. Overall, 32 (70%) studies reported that simulator training significantly improved procedural skills performance in comparison with standard or no training. Twenty (45%) RCTs assessed the transfer of simulator performance to clinical skills performance; however, 8 of these used animal models, not real patients. Only 2 studies assessed the maintenance of skills post-intervention, both at 4-month follow-up periods. CONCLUSIONS: Medical skills laboratories do lead to improvement in procedural skills compared with standard or no training at all when assessed by simulator performance and immediately post-training. However, there is a lack of well designed trials addressing the crucial issues of transferability to clinical practice and retention of skills over time. Further research must be carried out to address these matters if medical skills laboratories are to remain an integral component of medical education.     

MOR: a simulation-based assessment centre for evaluating the personal and interpersonal qualities of medical school candidates

Context Medical school admissions traditionally rely heavily on cognitive variables, with non‐cognitive measures assessed through interviews only. In recognition of the unsatisfactory reliability and validity of traditional interviews, medical schools are increasingly exploring alternative approaches that can provide improved measures of candidates’ personal and interpersonal qualities. Methods An innovative assessment centre (MOR [Hebrew acronym for ‘selection for medicine’]) was designed to measure candidates’ personal and interpersonal attributes. Three assessment tools were developed: behavioural stations, including encounters with simulated patients and group tasks; an autobiographical questionnaire, and a judgement and decision‐making questionnaire. Candidates were evaluated by trained raters on four qualities: interpersonal communication; ability to handle stress; initiative and responsibility, and self‐awareness. Results In the years 2004–05, the 588 medical school candidates with the highest cognitive scores were tested; this resulted in a change of approximately 20% in the cohort of accepted students compared with previous admission criteria. Internal consistency ranged from 0.80 to 0.88; inter‐rater reliability ranged from 0.62 to 0.77 for the behavioural stations and from 0.72 to 0.95 for the questionnaires; test–retest score correlation was 0.7. The correlation between candidates’ MOR scores and cognitive scores approached zero, reflecting the value of MOR in the screening process. Feedback from participants indicated that MOR was perceived as fair and appropriate for medical school screening. Discussion MOR is a reliable tool for measuring non‐cognitive attributes in medical school candidates. It has high content and face validity. Furthermore, its implementation conveys the importance of maintaining humanist characteristics in the medical profession to students and faculty staff.