Can revisiting pre-clinical coursework at the end of medical school enhance learning for near-peer teachers?

Many medical schools have integrated early clinical skills courses to ease the “pre-clinical” to “clinical” transition for medical students. However, it may also be beneficial for medical students to revisit the pre-clinical basic sciences after their core clerkship rotations to foster a deeper understanding of causal pathways of disease that often take a backseat to clinical management principles during the clerkship experience. To this point, the author reflects on the learning benefits she experienced at the end of medical school when she served as a near-peer teacher in an integrated, organ-based physiology and pathophysiology course for first-year medical students. “Teaching to learn” as a senior medical student may be a way to consolidate and foster deeper understanding of medical knowledge in the post-clerkship period of medical school.     

Can a dedicated teaching and learning environment in ambulatory care improve the acquisition of learning outcomes?

Current trends in undergraduate medical education are moving away from traditional ward based learning to ambulatory care teaching. We wanted to know whether students gain more learning outcomes from a dedicated ambulatory teaching environment than a conventional outpatient clinic. A comparative evaluation study using a semi-structured student questionnaire and a structured patient questionnaire was performed. Results indicated the learning environment and organization of the teaching in the Ambulatory Care Teaching Centre (ACTC) rated higher. Surprisingly, however, more learning outcomes were achieved in the conventional outpatient clinic setting, but each venue demonstrated particular strengths with regard to individual outcomes. The level of patient satisfaction in the ACTC was high implying patient care was not adversely affected utilizing this setting. This information will inform practice for the content of future teaching sessions in the outpatient setting.     

Can you keep a secret? Pretences of confidentiality in HIV/AIDS counseling and treatment in Eastern Indonesia

A critical feature of contemporary interventions of HIV is the provision of voluntary counseling and testing. Protecting the confidentiality of the client is a lynchpin of successful counseling. This article explores the teaching and implementation of the concept of confidentiality in highlands Papua, Eastern Indonesia. Results of participant observation and in-depth interviews with clinic staff in 2009 and 2010 show that confidentiality is an ideal poorly taught and systematically violated in practice. Identifying, labeling, and regulating HIV-positive persons appears more important than enacting the humanitarian and moral imperative of protecting client rights. Confidentiality becomes the means to enact dividing practices and to create categories of persons-those who choose to adhere to therapies and those who do not. The implications of this pattern are discussed with reference to wider humanitarian initiatives.     

Can a ward simulation exercise achieve the realism that reflects the complexity of everyday practice junior doctors encounter?

Recent changes in medical education have resulted in an increased focus on patient safety. It is vital that new doctors can recognize and manage acutely-ill patients, as well as work safely and effectively as a member of a multi-professional team. A ward simulation exercise has been developed to provide a safe, but authentic setting to support junior doctors with further practice and feedback. In developing such an exercise realism is important in recreating the complex climate in which the junior doctor has to function as part of the healthcare team in the hospital ward. This paper shares the design methodology of a ward simulation exercise and the views on its authenticity from both the junior doctors and the observers.     

Can students' reasons for choosing set answers to ethical vignettes be reliably rated? Development and testing of a method

Although ethics is an important part of modern curricula, measures of students' ethical disposition have not been easy to develop. A potential method is to assess students' written justifications for selecting one option from a preset range of answers to vignettes and compare these justifications with predetermined 'expert' consensus. We describe the development of and reliability estimation for such a method -- the Ethics in Health Care Instrument (EHCI). Seven raters classified the responses of ten subjects to nine vignettes, on two occasions. The first stage of analysis involved raters' judging how consistent with consensus were subjects' justifications using generalizability theory, and then rating consensus responses on the action justification and values recognition hierarchies. The inter-rater reliability was 0.39 for the initial rating. Differential performance on questions was identified as the largest source of variance. Hence reliability was investigated also for students' total scores over the nine consensus vignettes. Rater effects were the largest source of variance identified. Examination of rater performance showed lack of rater consistency. D-studies were performed which showed acceptable reliability could nevertheless be obtained using four raters per EHCI. This study suggests that the EHCI has potential as an assessment instrument although further testing is required of all components of the methodology.