Smoking behaviour and attitudes among Australian medical students

Teaching about tobacco and related diseases is essential in the undergraduate medical course in order for students to gain knowledge about smoking and how to intervene with patients who smoke. The objective of the study was to assess students'smoking-related behaviour, knowledge and attitudes towards tobacco, and perceptions of their future role as doctors. Data were collected from two consecutive years of year 1 and year 5 medical students at the University of New South Wales, Sydney. A total of 594 (79%) of students across the 2 years completed the survey: 90% of year 1 students, and 69% of year 5 students. The daily smoking rate among the total medical students was 2.9%: 11.8% in year 1 (2.3% daily, 9.5% occasional) and 13.7% in year 5 (3.3% daily, 10.4% occasional). There were significantly more male than female smokers in year 5 (P < 0.05). The overall smoking rates for males in years 1 and 5 were 12.4% and 19.3%, and the smoking rates for females were 11.2% and 8%. Knowledge about the causal role of tobacco in the development of specific diseases improved significantly from year 1 to year 5 (P < 0.001). Nevertheless, in year 5 there remained a lack of knowledge about the relationship of smoking and some diseases. Fifty-seven per cent of students thought that their current knowledge was sufficient to counsel smokers, with year 5 students (89%) being far more positive than year 1 students (34%) (P < 0.001). Teaching medical students about smoking-related diseases and a patient-centred smoking cessation intervention results in an increase in knowledge, as well as positive perceptions about their future role in intervening with smokers.     

Introducing medical students to medical informatics

Summary. Medical informatics ( MI ) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill ( NCU ). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.     

A comparison of performance by medical and midwifery students in multiprofessional teaching

AIM: At Dundee University, midwifery and medical students are taught obstetrics together in a 2-week intensive course. We set out to test the hypothesis that staff time and effort could be saved by using shared resources in teaching a multidisciplinary group of students to an acceptable level. METHOD: In order to measure the knowledge gain by two different groups of students, we tested the students before and after a timetabled computer-assisted learning (CAL) session focusing on how to interpret a cardiotocograph (CTG). Also, half of each student group was given extra CTG teaching before the CAL session. RESULTS: The medical students (n=38) increased their median score from 9 to 17 after the CAL (P<0.001) but the midwifery students (n=13) only increased their median score from 12 to 14 after the CAL (n.s.). However, when given a tutorial and CAL, the post-test scores for both medical and midwifery students were similar and significantly higher than pre-test scores (median score increase from 8.5 to 18 for medical students, P<0.001, n=34, and from 9 to 16 for midwifery students, P<0.01 n=11). There was no significant knowledge gain by the medical students who undertook the additional tutorial. CONCLUSION: We conclude that shared resources could be used by medical and midwifery students to reach equivalent levels of skill in CTG interpretation. However, in order to achieve equivalence, staff time and effort was wasted as medical students were given unnecessary tuition.     

Audit in general practice: educating medical students

This paper describes the third stage in the evolution of methods of teaching on audit in general practice at the Department of General Practice, University of Glasgow. The authors asked the final year students to develop, carry out and submit a written report on an audit project devised by themselves, after briefing and with continued support. Every student asked was successful in producing a report and the standard was generally very high, although only two students completed the audit cycle in the 4 week period. More than half the students (51.7%) found the project valuable or very valuable. As many as 90.6% understood audit better or much better after doing the project and 83.4% thought that the project should continue to be part of the GP attachment. Seventy-eight per cent of the GP tutors thought that teaching audit to undergraduates in general practice was valuable or very valuable, 64.4% reported that the audit had been of benefit to their practice, and 89.9% thought that audit should continue to be part of the GP attachment. This method of teaching students about audit was the most successful of three methods tried. It has produced benefits both for students and for the general practices to which they were attached, ultimately producing benefits for patients.     

Contraception: a new practical learning package

BACKGROUND: A new self-directed learning package was developed to assist medical students learn the counselling and practical skills to enable them to communicate with men and women about contraception and related matters. OBJECTIVES: This paper describes the package and the way it was facilitated, the students' ratings of the package and their feedback about the session on the first time it was presented at four teaching hospitals. RESULTS: The students rated the contraception package as average. The reasons given were: no introduction to the contraception session, lack of a trained person to conduct and facilitate the contraception learning session, poor organization at one of the hospitals and too little emphasis on self-assessment. The assumption that the students had a basic hormonal knowledge prior to the contraception sessions was incorrect. DISCUSSION: The results suggest the contraception learning package needs a person with contraceptive knowledge, patient-doctor skills and experience with self-directed learning to be present throughout the 3-hour session and for tools to be available that emphasize self-assessment during the session. OUTCOME: The modifications to be made to the learning package include pairing male and female students, a reduction in duration of the learning stations, an additional learning station relating to hormonal contraception, and inclusion of pregnancy and ovulation testing. These modifications were suggested by the participating students.     

医学生医院感染知识需求调查

目的了解某肿瘤医院多重耐药菌（MDRO）的分布情况,为医院感染防控提供依据。方法回顾性分析贵州省肿瘤医院2011-2013年临床送检标本中分离的MDRO监测资料。结果2011-2013年共检出1 165株MDRO,产超广谱β 内酰胺酶（ESBLs）大肠埃希菌检出最多（626株,占53.73%）,其次为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）（209株,占17.94%）;各年检出MDRO数量呈递增趋势。MDRO标本来源以痰/咽拭子（346株,占29.70%）、分泌物（322株,27.64%）及尿（227株,19.48%）为主;检出科室主要为重症监护病房（ICU）（210株,占18.03%）,其次为泌尿外科（173株,占14.85%）。结论该肿瘤医院患者分离的MDRO主要来源于呼吸道、伤口分泌物及泌尿系统,应加强对高危科室及易感人群的监控,制定有针对性预防控制措施,遏制MDRO的感染和传播。     

Audit encourages an evidence-based approach to medical practice

OBJECTIVES: This study was designed in order to identify any changes taking place in students' ability to incorporate research evidence into clinical practice after the introduction of an evidence-based medicine session into their audit teaching. DESIGN: We chose to look at the references cited in students' audit projects as a way of making a retrospective assessment of their ability to use evidence. Each of a sample of 221 projects was analysed for the number and accuracy of references, the phase of the audit cycle in which the references were cited, the topic chosen and the use of computers. A smaller sample were assessed for quality. SETTING: The Department of General Practice at Glasgow University. SUBJECTS: Final-year medical students. RESULTS: We found that there was an increase in quality and quantity of citation of references by the students over a 3-year period which corresponded with changes in teaching methods. CONCLUSIONS: It is possible that this increase in the quantity and quality of reference citation by final-year students was in response to a change in the content of teaching sessions, but there may be other reasons for this. The experience of researching and carrying out the projects has given students first-hand experience of the techniques of evidence-based medicine. Requiring students to state their information sources and include a copy of the abstracts from cited papers would assist further studies of this kind.     

Attitudes of Medical Students Towards Psychiatry

Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on “Attitudes Towards Psychiatry” (ATP-30). Results: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. Conclusion: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.     

Humanizing medicine: a special study module

As medical schools begin to implement their new curricula under the guidance of Tomorrow's Doctors, the authors wish to raise some discussion on the form and content of the special study module (SSM) component. In order to do this they put forward in this paper proposals for an SSM in Medicine and Literature. This course has been designed jointly and will be run concurrently in three Scottish medical schools: Glasgow, Aberdeen and Dundee. Arguments for the course's acceptability to faculties of medicine and to students are discussed and its inclusion in the curriculum in terms of its educational impact, skills training, effect on personal development and broadening of the student's perspective are justified. The course structure, content and assessment procedures are described and a reading list proposed. The General Medical Council points out that SSMs should be seen as opportunities for innovation and this course demands a different educational approach from the standard objectives-led approach of most medical education. A process-led model is more appropriate as it stresses the way that students develop while taking the course rather than the end point reached at its finish.     

Portfolios as a learning tool in obstetrics and gynaecology undergraduate training

CONTEXT: We developed a structured portfolio for medical students to use during their obstetrics and gynaecology undergraduate training. The main objective was to support the learning process of the students. We also wanted feedback information to enhance teaching. METHODS: The study population consisted of 91 medical students who completed the portfolio during their training course. The portfolio consisted of a 28-page A5-size booklet. The students entered all the clinical procedures they had performed and all the deliveries they had attended. After each group session, they answered questions about what they had learned and evaluated the performance of the teacher. They also indicated their general evaluation of the course and the portfolio itself. The teachers listed the 13 most important skills to be learned during the course. The students were asked to evaluate their own development on a scale of 0-5 before and after the course. A content analysis was performed on all the texts the students produced, and all quantitative variables were coded. RESULTS: The amount of text written in the portfolio correlated (P < 0.001, F-value 4.2) with success in the final exam. In addition to acting as a logbook, use of the portfolio enhanced the learning process during the course. Students' attitudes towards the portfolio were mainly positive. Students appreciated the departmental interest in their learning process. CONCLUSION: Portfolios support the personal and professional development of medical students. A portfolio clarifies the learning goals and helps students to monitor how these goals are achieved. A portfolio encourages constant self-reflection.     

Communication skills teaching, learning and assessment

This paper outlines an introductory course in teaching communication skills to medical students in a preclinical context. The aims of the course, its content and teaching methods are described. Novel features include the active participation of selected patients in teaching and assessment, and the use of a form of role-play named 'listening triads'. The main focus of the paper is assessment, and results are recorded, relating to a class of 114 second-year students during the academic session 1983-84. Assessment of the students' learning was measured by Modified Essay Question (MEQ); students' problems face-to-face with patients were identified by patients, students, and by staff members observing interactions. Problems of fitting these educational assessments into a traditional academic 'certifying' type of assessment remain unresolved at present. This course was found to be acceptable by the preclinical students, and their lack of clinical knowledge did not appear to interfere with their learning. They were enthusiastic about the supervised contact with patients, which appeared to contribute significantly to the way the course was received.     

A model case-study for teaching the principles of emergency medical referrals in a rural African setting

A model case-study for imparting knowledge of the principles of emergency medical referrals to medical students is described. The case-study, which is undertaken by small syndicate groups of students, effectively combines the advantages of group interraction with those inherent in a problem-solving approach. It has helped not only to stimulate student interest in a subject which many have found rather boring and theoretical, as with most other subjects related to organization of health services, but is also a pointer to the effectiveness of case methods as teaching tools.     

Simulation-based medical education is no better than problem-based discussions and induces misjudgment in self-assessment

Simulation-based teaching (SBT) is increasingly used in medical education. As an alternative to other teaching methods there is a lack of evidence concerning its efficacy. The aim of this study was to evaluate the potency of SBT in anesthesia in comparison to problem-based discussion (PBD) with students in a randomized controlled setting. Thirty-three fourth-year medical students attending a curricular anesthesiology course were randomly allocated to either a session of SBT or a session of PBD on an emergency induction method. Ten days later all students underwent examination in a simulator. The performance of each student was evaluated by weighted tasks, established according to a modified Delphi process. Confidence and a multiple-choice questionnaire were additionally performed pre- and post-intervention. A total of 32 students completed the study. Participants in the SBT group presented with significantly higher self-assessment scores after the intervention than students in the PBD group. However, students in the SBT group achieved only slightly and statistically insignificantly higher scores in the theoretical and simulator examination (p > 0.05) with only a moderate effect size of d = 0.52. The current study demonstrates that both PBD and SBT lead to comparable short-term outcomes in theoretical knowledge and clinical skills. However, undesirably, SBT students overrated their anticipated clinical abilities and knowledge improvement.     

Computer awareness among medical students: a survey

The objective of the study was to assess the attitude of Edinburgh University medical students towards computers and to evaluate the effects of changes in the curriculum and intercalated BSc towards computer knowledge. During March to November 1995 a questionnaire was distributed in lectures, seminars and tutorials to all Edinburgh University medical students. Overall, 65% of students returned the questionnaire, divided equally between both genders. Only 2% of students had not used a computer in the previous year. The most frequent application used was E-mail and the most frequent site, the Greenfield suite micro lab, within the medical school. The average score for self-perceived computer knowledge on a scale of 0–10 was 4.19. This score was significantly higher for the students who own a computer and who have an intercalated BSc honours degree as well as the pre-clinical students compared to the clinical students. There is also a strong correlation between computer use and doing a second year special option module. With regards to attitude towards computers, 86% of students agreed that computer skills will be beneficial to them in their future career and 62% of all students wanted a structured course in computer use as part of the MB ChB course. There has been a general increase in computer literacy amongst the medical students in Edinburgh. This is specially so for the pre-clinical students who have had the brunt of the changes in the curriculum. The tendency for both the lower knowledge and use by the clinical students can, in part, be due to the accessibility of computers to these students.     

An introductory educational session improves medical student knowledge and comfort levels in caring for patients with physical disabilities

BackgroundDespite a growing number of people living with disabilities (PWD), many experience health disparities related to access to high quality medical care. Lack of knowledge and low comfort level of medical providers in caring for PWD is a significant barrier and can lead to poor health outcomes. Education of future physicians is an important factor in addressing these health disparities.Objective/HypothesisThe objective of this study is to assess the knowledge and comfort level of first-year medical students towards PWD before and after a mandatory educational session focused on the health disparities and appropriate care of PWD. We hypothesized that this introductory session would lead to a greater awareness and improved comfort level around caring for PWD.MethodsFor the two academic years 2016–2018, we created a mandatory educational session for first-year students consisting of a 30-min lecture followed by discussion of video vignettes and a PWD patient panel. Students completed pre- and post-session surveys that evaluated changes in knowledge and comfort levels around working with PWD, and elicited their feedback.Results355 students participated in the educational session and among 278 matched pre- and post-survey responses, we found a significant improvement in knowledge and comfort levels towards encountering PWD. Student feedback was overwhelmingly positive with the PWD panel receiving the highest effectiveness rating.ConclusionA mandatory educational session for medical students including didactics, videos, and testimonials on caring for PWD improved students’ knowledge and comfort levels. Additional research on the long-term effects of early training is needed.     

Influences on medical students' decisions to study at a rural clinical school

Objective: To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Design: Third‐year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year‐long placement at a RCS. Results: Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. Conclusion: The most important positive influence on Monash third‐year medical students' decision to study at an RCS is the perception of high‐quality clinical experiences and education. This perception arises from rural exposure during pre‐clinical years.     

某医学院学生HIV/AIDS知识·态度·行为

目的了解医学生对艾滋病知识的掌握情况以及相关行为和态度，为今后开展健康教育提供依据：方法自行设计艾滋病知识、态度、行为调查问卷，采用匿名方式对某医学院一～四年级468名在校学生进行调查。结果97．6％的学生知道艾滋病是一种传染病；85．2％的学生认为目前艾滋病不能治愈；68.8％的学生毕业后不愿意到收治艾滋病病人的科室工作；23．1％的学生认为自己处于感染艾滋病的危险之中；有6．6％的学生承认有过性行为：不同年级学生所掌握的艾滋病知识差异有显著性。结论在医学生中开展预防艾滋病健康教育是必要的，应将预防艾滋病健康教育作为医学生必修课程。     

Brief problem-solving questions in medical school examinations: is it necessary for students to explain their answers?

OBJECTIVE: To compare outcomes when answers to objective type problem-solving questions are marked with and without consideration of students' explanations of their answers. DESIGN: Students answered six multiple-part problem-solving questions on the final examination for a course in clinical biochemistry. Each part required a choice from a list, a number or a few words, plus an explanation or justification. Scores were determined independently for the answers alone and for the answers plus explanations. The outcomes of the two marking methods were compared. SETTING: Department of Pathology, University of Otago Medical School, Dunedin, New Zealand. SUBJECTS: Final year preclinical medical students. RESULTS: Marks were slightly higher for answers alone than for answers plus explanations (overall mean, 82.1%; standard deviation, 9.8% vs. 77.1%; 9.3%; P < 0.001 by paired t-test). There was a very high correlation between scores derived from the two methods (r=0. 87). Consideration of the answers alone (without explanations) was about as good as answers plus explanations in identifying students who performed at different levels overall on the examination and in identifying the weakest students. CONCLUSIONS: The data suggest that when students arrived at the correct answers, their information and reasons were usually correct and that answers alone discriminate adequately among students with different levels of knowledge and ability. By dispensing with the requirement for explanations, we would be able to ask more questions and mark objectively, so competent students should not be disadvantaged by the lack of opportunity to explain their reasoning.     

Computer education: attitudes and opinions of first-year medical students

Summary: students' attitudes towards medical informatics were evaluated with self-administered questionnaires, answered by 140 (77%) first-year medical and dental students. Fourteen per cent classified their computer literacy as negligible and 49% as deficient. Ninety-six per cent had used a computer before and 59% used one regularly. Nineteen per cent had computer education in secondary school and a further 16% attended courses given by a computer company. Only 16% read regularly about informatics. These results are similar to those observed in more industrialized countries, except that high-school education is more deficient. To 93% of these students, computer literacy is important for doctors, and to 85% computers may be very useful in many areas of health care. In the opinion of 66% of students, the computer-based patient record will be available within the next 3 to 10 years. Women showed lesser computer literacy (77% computer illiteracy to 39% in men), but there were no relevant differences in attitudes, behaviour and beliefs towards medical informatics between gender, for the same level of computer literacy. Computer education in the undergraduate curriculum was demanded by 92%, and 75% of these preferred an elective course. Weekly hours suggested for lectures should be 1 (54%) or 2 (42%), and for hands-on practice 2 (54%) or 4 (31%) hours. The curriculum should include medical applications (83% of students), information science theory and technology (44%), micro-informatics (44%), bibliographic database search (27%), programming languages (23%) and statistical packages (23%). Gender, computer literacy or course did not correlate significantly with students' opinions about the contents of undergraduate education.     

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.