Students' written reports as an essential part of a casebased learning programme in anatomy

Summary. This paper reports on second-year medical students' views and performance on the written reports for the cases that were studied in a case-based learning programme in anatomy at the University of Otago in 1988. The mean marks for the reports for the three main categories of student entry are presented. Differential performance on the written reports relative to the case-based component of the examination held at the end of the year has been determined for each student in the class and ranked in order. The proportions of students falling in the top and bottom quartiles for the class are given. The data taken together indicate that with an intensive programme of case-based learning in 1988, optimal performance in the written reports was reached at an early stage by the graduates whereas the two undergraduate categories improved their performance towards the end of the programme.     

Undergraduate education in rural primary health care: evaluation of a first-year field attachment programme

In an effort to evaluate the first part of the rural field attachment programme at the University of Zimbabwe Medical School, a self-assessment questionnaire was administered to the first-year students. Assessment criteria were derived from the stated aims of the school's new undergraduate medical curriculum. The results indicate that students view the programme as relevant and of value of their training as future doctors, even though they were dissatisfied with aspects of the programme. There was some evidence that more emphasis should be placed on the limitations on what doctors can do to solve the health problems of rural Zimbabweans. Contrary to previous opinions of some individuals, students whose homes are in rural areas benefited from the programme and found it of value. Better orientation and selection of supervisors would benefit the programme. Recommendations for field attachment programmes are made based on the findings.     

The contribution of general practice to medical education: expectations and fulfilment

The aim of this study was to discover what students expected to learn during their fourth-year general practice attachment, to compare this with their GP tutors' expectations and to determine the extent to which the students' expectations were fulfilled. Questionnaires were used to gather this information; students completed them on the first and last days of the 4-week attachment and tutors shortly after the attachment. Students and their tutors had the highest expectations of the course in helping to raise awareness of the psychological and social aspects of ill health and develop clinical decision-making and management skills. At the end of the course students thought that they had gained most in these areas. Both students and tutors had lower expectations of the course helping to develop physical examination and practical skills and to improve knowledge in certain clinical areas. These were also rated lowest in terms of fulfillment. This study was carried out at a time when it is being suggested that more undergraduate teaching should take place in general practice and that this could include the teaching of practical skills and clinical subjects traditionally associated with hospital-based teaching. The results suggest that the expectations of students and GP tutors would need to be modified, as well as extra resources provided, if there is to be a shift in teaching towards the community.     

Residents' perceptions of their teachers: facilitative behaviour and the learning value of rotations

Summary. Despite changes in modern medicine the role of the clinical teacher remains central to medical residents' education and rotations continue to be their dominant educational context. Residents have strong positive feelings for clinical teachers who are perceived as interested in teaching and for those rotations that provide a balance of educational opportunities and patient care responsibilities. Research in residency education has focused on teacher behaviours used to teach medical residents clinical information or patient care skills but has neglected teacher behaviours used to facilitate effective learning relationships with residents. To explore the impact of clinical teachers' use of facilitative behaviours on residents' educational experience, we use concepts stemming from the psychologist Carl Rogers' work previously shown to be associated with positive learning outcomes — empathy, unconditional positive regard, and congruence. These constructs are measured by the use of the four scales of the Barrett-Lennard Relationship Inventory (BLRI) — level of regard, unconditionality of regard, congruence and empathy. Our study measures the correlation between residents' perceptions of clinical teachers' use of facilitative behaviours and residents' evaluation of the learning value of rotations. Thirty-three residents completed the BLRI on a different clinical teacher for each of six monthly rotations. A total of 158 surveys were returned. There were strong positive correlations between three of the BLRI variables and residents' perception of the learning value of rotations. Potential uses of these findings are discussed.     

An unwelcome visitor? The opinions of mothers involved in a community-based undergraduate teaching project

Summary. This paper describes the family case study, a community-based project for Cardiff medical students involving them in self-directed learning. A comparison is made (using self-administered questionnaires) between the opinions of mothers and students who participated in the 1990/91 project. The results indicate that mothers recruited to the study tended to come from the middle classes and be in stable relationships. The vast majority found participation in the study to be an enjoyable experience. This contrasts sharply with the opinions of students who often expressed concerns about imposing on their families. The study demonstrated that most students were able to pace their self-directed learning by visiting their families on a regular basis. The majority obtained ‘hands-on’ experience of the baby's development and, according to the mothers, improved in competence as a result. The high maternal response rate and the quality of the answers have prompted the authors to consider whether mothers could be more involved in teaching and assessment of medical students in the future.     

Teaching medicine with cases: student and teacher opinion

In a second-year family medicine course taught using simulated patients the students commented most favourably on the clinical relevance of the topics, the enthusiasm of teachers, and the opportunity to interview simulated patients with their fellow students, in contrast to their basic science courses, which did not give them patient contact. They felt most confident about skills acquired in relation to diseases with a limited number of key symptoms, signs and treatments (meningitis, otitis) and less confident about diseases with many symptoms and treatments (diabetes, trauma, arrhythmias). They made few comments about alternative cases which might have been selected. Their adverse comments were about the workload. During tutor meetings over 4 years, a key concern which emerged was to find cases with a level of complexity suitable to the students. The tutors emphasized these principles of case selection: the cases should be based on real life and include most of the signs and symptoms of the disease; contain one or at most two foci; have nodal decision-making points; emphasize clinical reasoning; reinforce prior knowledge; permit the transfer of knowledge to other cases; and permit the assessment of associated technical skills.     

Improving presentation skills of family medicine residents: a randomized controlled study

A randomized controlled time series design was used to evaluate the influence of an educational intervention designed to improve the presentation skills of family medicine residents. Each resident gave three presentations, with the educational intervention occurring between the first and second presentations in the experimental group, and between the second and third presentations in the control group. The presentations were evaluated using a standardized format. The experimental group, in contrast to the control group, showed significant improvement in scores for all major criteria after receiving the educational intervention between presentations 1 and 2. This improvement continued with repetition between presentations 2 and 3. After receiving the educational intervention between presentations 2 and 3, the control group also demonstrated significant improvement in several key areas. We conclude that an educational intervention can improve the presentation skills of family medicine residents. Education coupled with repeated opportunities for presentation will produce a greater improvement in resident performance than repeated presentations alone.     

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.     

Teaching of musculoskeletal medicine: a survey of general practitioners and deans

Summary. A survey was conducted of all general practitioners on the Family Health Service Authority List in Wiltshire and of the deans of all medical schools in the United Kingdom. The results are presented. The findings indicate that the teaching of musculoskeletal medicine is not adequate.     

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.     

Mental health in the community

Medical education needs to reflect the rapid development of community-based health care, particularly in the area of mental health. 'Mental health in the community' is a week-long collaborative course organized through the Department of General Practice at Liverpool University for first-year clinical medical students. It aims to introduce them to the range of mental health problems that exists in the community and the resources available to deal with them; to improve their counselling skills and to reduce their anxiety about mental health, both their own and other people's. The paper describes the wide variety of teaching methods and visits which are offered during the week. The course is evaluated using the method developed by Stake. Although there are some problems with student participation, 'Mental health in the community' has a significant positive overall effect on students' knowledge and anxiety levels with regard to mental health. It is making a contribution to the reorientation of medical education in Liverpool.     

Hopes and concerns of a first-year medical school class

Summary. To assess the hopes and concerns of first-year medical students, the 1991 Oregon Health Sciences University (OHSU) Medical School class was surveyed during orientation. Using qualitative research methods, student responses were grouped into general categories. The most common ‘hopes’ were to provide personal care and develop relationships with patients, to attain self-fulfilment, and to enjoy the personal challenge and variety of medicine. Common ‘concerns’ were family issues, outside intervention into medicine, and loss of self. The hopes and concerns of this class revolve primarily around personal issues, rather than issues relating to their local community or to society. This information may be useful in student counselling and curriculum development. Further research is necessary to evaluate changes in this class's attitudes over time. The methodology of this study may be useful in the evaluation of the attitudes of subsequent first-year medical school classes at OHSU, and at other institutions.     

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.     

Allocation of junior hospital doctors to pre-registration posts: does Britain need a national matching scheme?

The attitudes of British postgraduate deans and senior medical students to the introduction of a national pre-registration house officer allocation scheme were investigated by postal questionnaire. Several postgraduate deans expressed interest, but most were not in favour of the proposal. Students held similar views. The advantages and disadvantages of a national scheme are discussed.     

Independent learning among general practice trainees: an initial survey

Self-directed learning is a natural way for adults to learn. Vocational training for general practice is a preparation for unsupervised clinical work that will be supported, in the main, by continuing medical education. This study uses the Self-Directed Learning Readiness Scale to investigate factors influencing readiness for such learning among a sample of general practice trainees. Three principal factors emerged from analysis: enjoyment and enthusiasm for learning; a positive self-concept as a learner and a factor suggesting the possibility of a 'reproducing' orientation to learning. These factors may reflect approaches to learning in general rather than these adopted for professional learning, but offer helpful pointers for the development of both vocational training and of continuing medical education.     

Gynaecological teaching associates in the 1990s

Chairmen of academic obstetrics and gynaecology departments in the USA and Canada were asked if they used gynaecological teaching associates (GTAs) and their opinions of their educational and cost effectiveness. Three-quarters of chairmen used GTAs and were satisfied with the educational aspects of GTA instruction. Departmental discretionary funds provided all or part of the GTA funding in 40% of departments and the medical school all or part of the GTA funding in 72%. As more monies came from departmental discretionary funds, chairmen were increasingly dissatisfied. Because the 1990s will be difficult financially, it was hypothesized that chairmen may eventually cancel GTA programmes as expendable 'luxuries'.     

Clinical tutor evaluation: a 5-year study by students on an in-patient service and residents in an ambulatory care clinic

Summary. Medical students on an in-patient service and residents working in an ambulatory care clinic have regularly evaluated their clinical tutors over the 5 years 1985-1989. Both groups of raters reliably and predictably evaluated their tutors and both emphasize between-tutor comparisons more than actual rating values for individual tutors. Tutors active in both contexts regularly receive higher ratings from the medical students than from the residents. Mid-course feedback to tutors in the medical course had no impact on end-of-course ratings. In neither context did tutor ratings improve from one evaluation to the next. Both groups reliably discriminate between the teaching skills and the personality traits of individual tutors.     

Career preference and choice of practice locations by Saudi medical students

Summary. The identification of career preference and intended practice location of medical students may provide a useful contribution to the projections and distribution of doctors across different specialties in the country. Information for this study was obtained from a survey of medical students in the final years at King Saud University College of Medicine in Saudi Arabia. This included demographic characteristics, career choice, training location, qualification in view and intended practice locations. The majority (61.2%) intended to specialize and subsequently practise in the major disciplines of medicine, surgery, paediatrics and obstetrics. Twenty-eight per cent were not sure of their future career choice. Only a few (3.5%) chose primary care and none chose pathology or anaesthesia. More men chose medicine, paediatrics and surgery, but more women chose obstetrics and primary care. The majority (81.2%) would like to have foreign certificates, but all the Saudis would subsequently practice in Saudi Arabia and mainly in large cities. The implications of this career pattern and practise locations are discussed with recommendations for health planners and medical schools.     

The development and evaluation of Basic Epidemiology: Student''s Text

This paper describes the development and evaluation of a World Health Organization book Basic Epidemiology: Student's Text. This book was a response to a need identified by members of the WHO Global Environmental Epidemiology network. A draft was commented on by members of the Network and then at an editorial meeting. Two thousand copies of a pre-publication version were prepared and this version was formally evaluated by 13 teachers of introductory courses of epidemiology and less formally by members of the Epidemiology Network. A high response was received to the evaluation questionnaires; 45% of the students rated the test overall as 'very useful' and another 54% as 'useful'; many useful comments were received and were incorporated into the final version which will be published by WHO in 1993.     

Medical graduates evaluate the effectiveness of their education

Summary. In response to the General Medical Council's 1991 Consultative Document proposing changes to medical curricula, the King's College School of Medicine and Dentistry, London, established a steering group to plan a new curriculum. As part of this process a postal survey was undertaken of five cohorts of King's graduates to ascertain how well the medical course they had undertaken had equipped them for practice. The questionnaire explored the level of factual content, the adequacy of their skills training, and the development of personal attributes during the course. A total of 371 graduates replied, a response rate of 78%. Over 70% indicated that their education had satisfactorily equipped them for their medical practice. Significant differences were found, however, between those now practising in primary care and those in hospital medicine regarding the importance attached to different subjects within the curriculum, and also with respect to the personal attributes the graduates felt they had acquired. Both groups identified deficiencies in virtually all aspects of their skills training: clinical, analytical, communication, management and technical.
This feedback from some of the 'consumers' of medical education is now being used to assist the planning of the new King's curriculum.