A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Summary. Teaching preclinical medical students about doctor-patient communication gives them an opportunity to develop their interviewing skills prior to their having to elicit lists of symptoms in their clinical years. General practitioners should be among the more efficient interviewers in clinical medicine and therefore able to make important contributions to the teaching of interviewing skills. This paper describes the aims, objectives and methods of the preclinical communications skills course at St George's Hospital Medical School. The contribution of the Division of General Practice and Primary Care to the teaching of interviewing skills in the preclinical course has been evaluated using rapid group methods. Students were asked to identify examples of specific interviewing behaviours in videotaped general practice consultations, and to judge whether the behaviours were helpful or unhelpful in eliciting relevant information from the patient. Students who had been given experience in interviewing patients in small groups led by general practitioners identified significantly more helpful and unhelpful interviewing behaviours in the taped consultations than students who had not received the small-group teaching. Students rated the teaching as relevant and effective in terms of giving insights into the interviewing skills they needed to develop. Group methods of evaluation such as these might prove useful to other medical schools with class sizes of 150 students or more.     

Teaching skills improvement programmes in US internal medicine residencies†

Summary. The prevalence and nature of resident teaching skills improvement programmes (TSIP) are unknown. Although residents perceive themselves as important teachers of students, there is little information on how programme directors (PDs) view residents as teachers. A comprehensive questionnaire was sent to all 428 US internal medicine PDs in December 1990, of which 60% (n= 259 ) responded. Of the 259 responding programmes, only 20% (n= 51 ) had TSIPs. Characteristics of TSIPs were not uniform. Mean instructional time was 9 hours (range, 1–24 hours). The teacher most frequently utilized to develop and facilitate the TSIP was the PD. PDs from residencies with a TSIP indicated more strongly than PDs without a TSIP that residents contributed to students' learning. Fifty-one per cent of TSIPs required residents to attend. Evaluation/feedback as a teaching method was the most common topic covered in TSIPs. Long-term assessment of teaching skills after programme participation was done in 15% of TSIPs. Although PDs value the resident's role as teacher, current TSIPs in internal medicine residencies are few in number and lack standardization. PDs' attitudes probably influence whether residents are taught teaching skills and whether teaching skills are evaluated. Further investigation of appropiate curriculum for TSIPs and assessment of long-term effectiveness of TSIPs are needed.     

Multiple choice question tests in physiology: a preliminary attempt to apply the minimum pass level§

Summary. At the mid-term test in Part I Physiology at the University of Zagreb the students (n= 280) were graded by our standard pass level (SPL) arbitrarily set at 54% correct answers (SPL = 0.54). The test consisted of 50 items of the one best answer type. Items were selected from the pool by one examiner to conform, by his judgement, to the predetermined SPL. Post hoc the minimum pass level (MPL) was assessed independently by eight examiners and an MPL value of 0.60 for the whole test was obtained. The original Nedelsky scale was used in assessment of MPL but for statistical analysis the data was expressed as log(1/MPL) to linearize the scale of measurements and to reduce the variances. The data showed a large difference between examiners in their assessment of MPL. Nevertheless, the average log(1/MPL) value of individual items showed a significant negative linear relationship with the item difficulty indices as calculated from student's answers, indicating that despite the large heterogenity in assessment the average item log(1/MPL) may be acceptable as a reasonable prediction of item difficulty. Finally, ‘subtests’ were formed from the whole test by grouping items according to their log(1/MPL) value. The passing rate at these subtests was found to be identical despite the fact that they considerably differed in their MPL values. Therefore, the MPL value seems to be useful in setting objective standards for the decision of pass or fail, even when the MPL was assessed in a very heterogenous way.     

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.     

Teaching clinical methods to medical students

Summary. This paper demonstrates that it is feasible to teach clinical methods in general practice and describes the organization of an appropriate attachment. Willing practitioners, properly briefed, are competent to undertake clinical methods teaching and the attachment provides satisfaction to both students and teachers. It is possible to provide in primary care the elements which seem to be the key to this outcome — protected time, teaching in very small groups, direct observation and concentration on systematic examination rather than on particular physical signs. There is a strong case for the promoting of clinical methods teaching by general practitioners.     

An evaluation of early patient contact for medical students

Summary. The introduction of early patient contact for first-year medical students in the form of talking with a patient at an out-patient clinic was evaluated. The aim of the session was to give students an insight into the patient's view of the illness and treatment, and the effect of the condition on his or her lifestyle. Students found the visit useful and enjoyable. Students were asked to complete an evaluation questionnaire after the visit. Students said that they had learned a variety of things from the visit. These included: how it felt to be a patient (27%); the need to communicate clearly (23%); about doctor-patient interaction (23%); and the effect of illness on the patient (16%). Students also said that they would like to remember things from the visit to put into practice later on, particularly concerning the area of communication. The visit appeared to be a successful integration of preclinical and clinical disciplines.     

Medical statistics: content and objectives of a core course for medical students

Summary. British medical school teachers of medical statistics aspire to teach statistical concepts without requiring medical students to undertake every statistical technique in the book. In the typical course of 20–30 hours, about 50 topics are taught, usually requiring the student to perform a technique. In a survey of current practice in 20 courses it is shown that a core syllabus of 36 topics, including 14 techniques to be performed, is feasible for almost all existing courses. Clear student learning objectives now need to be agreed to encapsulate this syllabus.     

Subjective and behavioural evaluation of the teaching of patient interview skills

Summary. One aim of the course in general practice and public health medicine during the final year at the University of Sheffield is to help students to develop further their interpersonal communication skills with particular reference to their skills in interviewing patients. During the course students meet twice in small groups with a tutor in order to review audiotape recordings of interviews with patients seen during their general practice attachments. The main activity during these tutorials is group discussion of the interviewer's behavioural options at significant points during the interview. Students also listen individually with a tutor to an interview that they have recorded, discuss this interview and assess it against a set of explicit criteria as part of their summative course assessment. In response to an anonymous end-of-course questionnaire, 85% of students felt that their interview skills had been improved by the teaching and 68% that listening to their own recordings had been the most helpful aspect. During interviews with simulated patients recorded at the end of the course, students asked more open questions, fewer questions referring to physical symptoms, more questions referring to feelings, beliefs or behaviour and fewer questions of a check-list type than during interviews recorded at the start. A number of students also requested examples of specific events during the end-of-course interviews although none had done so at the beginning of the course. All of these changes were statistically significant and were in directions that were consistent with the teaching in the small-group tutorials.     

An early ‘clinical trial’ as a teaching exercise: the Book of Daniel 1.1–15 (1.1–20)

Summary. This article discusses a very early clinical trial from the Old Testament. One of Daniel's and his companions' tribulations in Babylonia is explicated within the framework of the modern clinical trial. Even if many, or maybe even most, guidelines for good clinical trial practice are violated (it can even be argued that this is not really a clinical trial), a discussion of this biblico-historical episode in, for example, a problem-based course in (clinical) epidemiology or a course in the critical appraisal of the literature, can be a useful (and possibly entertaining) exercise.     

A case-based anatomy course

Summary. A course is described in which the students give consideration to clinical cases as they review their current knowledge, and follow a set protocol which guided them in preparing their learning. The students are required to examine a case history, put down as key words either their first answer or the knowledge they consider they would need to answer specific questions. They then select stations at which additional information, wet specimens, models and radiological images assist them in upgrading their knowledge. They complete the exercise by writing a final answer to the questions on the case. The tutor is able through examination of the key words to determine the knowledge of the students as they enter, and confirm appropriate learning by inspection of the final answer. The students are able to identify their own deficiencies, develop strategies for thinking and learning, resulting in the acquisition of expertise in problem solving, and extend their communication skills by working with colleagues. While the course was designed for second-year anatomy teaching it could be applied to other disciplines.     

A skills programme for preclinical medical students

An education programme in which preclinical medical students are introduced to common procedural skills is described. This programme is presented by a multidisciplinary health care team using short lectures, demonstrations, mannequin practice, and, in selected instances, practice on class-mate volunteers. The programme was evaluated by the students immediately following the presentation and for one class during their clinical activities one year later. The students' support for this programme was generally enthusiastic and remained undiminished upon reflection 12 months later.     

Medical training and English language proficiency

Summary. Concern is often expressed about the English language proficiency (ELP) of students engaged in professional training. This report assesses the ELP of the 1990 and 1991 intakes into medicine at the University of Sydney. A quick screening test and individual in-depth tests were used in a two-stage design. Admission to the course is highly competitive and most students are selected from the top 0.75% of Higher School Certificate results but 15% and 19% of the year cohorts were found to be below average in ELP. English proficiency was found to be consistently correlated with first- and second-year university results. Initiatives taken to support students with language disadvantages and to ensure that graduates will be able to communicate effectively with patients are outlined.     

Simple surgical audit: an aid to undergraduate curriculum development

Summary. This study investigates the usefulness of a simple surgical audit in designing the undergraduate surgical curriculum in the newly established medical school of the United Arab Emirates. The audit system was designed for use by people previously unaccustomed to this activity. The pattern of disease is found to be biased towards a young male expatriate population. It has been possible to predict the likelihood of a particular disease being available for teaching purposes and has drawn attention to the relative absence of some conditions which are commonly found elsewhere. Allowances need to be made for this and teaching strategies other than those which require direct patient contact should be considered. This method of curriculum design may find use in other places where health care patterns are changing.     

Teaching plastic surgery to medical students

A plastic surgery syllabus for third-year medical students is described. It is intended for a teaching programme in which plastic surgery is integrated into the surgical teaching on the same basis as the other surgical specialties. The syllabus was designed to concentrate on aspects of plastic surgery relevant to the needs of undergraduates. An audit of the teaching showed that the students were readily interested and considered the teaching to be relevant to their examinations and to their future as doctors. A survey of all plastic surgery centres in the British Isles showed that similar teaching was being undertaken in 11 centres out of 51.     

Experiences with a method for obtaining feedback on a medical curriculum undergoing change

Summary. Successful innovation and change in the way medical students are prepared are notoriously difficult. The relationship between the administrative structures of the medical school and its teaching hospitals, other responsibilities of its teachers and administrators, and the intricacies of the curriculum as a system of interrelated components, mean that any real change has wide repercussions. An opportunity for evaluation of a curriculum undergoing change was presented at the University of New South Wales, when the Faculty of Medicine introduced a new 6-year medical curriculum in 1988. The change was made to address a number of problems experienced with the old 5-year curriculum. The Course Evaluation Committee was in a unique position to conduct an ongoing evaluation of the new curriculum, year by year, as it was being introduced. A method for obtaining feedback from both staff and students on a medical curriculum undergoing change, is described. While some sample results are presented, the paper concentrates on the advantages and disadvantages of, and our experiences with, this method. Advantages include the specificity and timing of the information collected, and the high response rate. One disadvantage was the repeated use of the same cohort of students. Some staff still perceived the evaluation process as a threat, or were sceptical about the value and validity of student feedback. Whether staff acknowledged ownership of the new curriculum also affected the use of feedback.     

Education in family and community health: the challenge faced by a new medical school

This paper describes the efforts of the Department of Family and Community Health at Sultan Qaboos University in providing opportunities for the development of 'hands-on' problem-solving skills appropriate for Oman. The curriculum of the Department is discussed, highlighting the unusual emphasis of this discipline in both the preclinical and clinical curriculum of the College of Medicine. The importance of continuous assessment and supervision of students is discussed. Course-work in the preclinical curriculum of the Department is kept to a minimum. Field-work forms an important part of preclinical training, where application and problem-based learning are emphasized. During the clinical years the students are exposed to an integrated series of lectures and practicals covering core knowledge in clinical medicine. Practical clinical training, over a total period of 15 weeks, takes place at a variety of sites where common problems in primary health care in Oman are handled by students under supervision.     

Medical student abuse: perceptions and experience

Summary. A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first-and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.     

Medical students' attitudes to and knowledge of the aged

Summary. It is a fact that, with the increase in life expectancy, an increasing proportion of the population will consist of elderly people in future years, particularly those over 85 years of age ( Bromley 1988 ). The provision of care for the aged is an important aspect of undergraduate medical training ( Gale & Livesley 1975 ; Steele 1987 ). However, it is essential to realize that if medical practitioners do turn their attention more towards the elderly, their knowledge about the aged and their attitudes towards them are of vital importance. Moreover, studying medical students' attitudes and knowledge would be valuable for the training and education of future practitioners.     

Influence of context and preferred learning environments: approaches to studying physiology

Summary. One hundred and twenty-eight medical students who had experienced a traditional-style preclinical curriculum completed three self-report questionnaires. Using factor analysis of students' responses this study explores interactions between study orientation, preferences for different kinds of learning environment, and evaluations of the physiology course. Such interactions can provide insight into the reasons why students fail to adopt effective learning strategies. Although many students had the intention to understand, they did not adopt a deep approach. Achievement motivation was strong, test anxiety high, and the course was perceived to be competitive. The meaning orientation merged with the achieving orientation; students were thus performance rather than task oriented. These students perceived the course to have been challenging, as did students within the reproducing orientation and who had ‘surface’ preferences. Students within the non-academic orientation had difficulty coping with the course. The findings suggest that conventional teaching and assessment methods are preventing students from developing appropriate criteria and internal standards for evaluating performance. An illusion of comprehension may prevent students from seeing the need to adopt more effective learning strategies and cause ‘good’ students with the ability to adopt a deep approach to abort the pursuit of deep understanding. Students' preferences and evaluations of teaching and assessment indicate that students within the different learning orientations have different educational needs. The implications for instruction and evaluation are discussed.