The development and evaluation of a method of teaching liaison psychiatry to medical students

A method is described of teaching medical students aspects of psychiatry related to their work with physically ill patients. The teaching requires few resources and focuses on a limited number of educational objectives centred on the acquisition of knowledge of psychiatry relevant to medical practice. The course comprised eight weekly one-hour seminars held during the first clinical year attachment to medical firms, prior to the students' psychiatry attachments. Clinically based, traditional 'bedside' teaching was used, involving patients known to the students. In a preliminary analysis of the effects of the teaching, students who had participated in the seminars scored significantly better on a test of liaison psychiatry knowledge than a matched group who had not experienced the course.     

The relative role of 'A' level chemistry, physics and biology in the medical course

The performance of 209 students in the 2nd MBBS, first clinical year and final MBBS examinations has been compared retrospectively with their grades in chemistry, physics and biology at 'A' level. The mean grade has also been determined for students from different social classes and secondary education.
Significant differences in marks for biology were found between successful and not so successful students, especially in the pre-clinical part of the course. Significant differences in marks and significant correlations were also found for physics but not to any great extent for chemistry. The relative role of these three basic sciences in the medical course is discussed. The suggestion is made that there is a need for a re-appraisal of the privileged position of chemistry as an unquestioned science requirement for entry to medical school.     

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.     

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.     

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.     

The impact of curricular change on medical students' knowledge of anatomy

BACKGROUND: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. AIM: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. SETTING: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK. METHODS: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. RESULTS: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. CONCLUSION: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.     

Learning human anatomy: by dissection or from prosections?

Two matched groups of first-year preclinical medical students studied the gross anatomy of the lower limb by different methods. One group dissected in the traditional manner (as in the existing curriculum) while the other worked according to an experimental programme which excluded dissection by students. Preparatory study guides were supplied to the experimental group and each of their practical classes on soft tissues began with a priming session at which the structures to be encountered were introduced. The instructor then demonstrated these structures to the group on a prosected wet specimen and bones. Thereafter, the students were allowed to handle and discuss the specimens without staff supervision. At the end of the programme, both groups submitted to a 300-item two-choice paper and a practical test. A debriefing questionnaire was also completed by the experimental group. In both tests, the experimental group performed better than the traditional group and the difference was statistically significant (P less than 0.05) in the theory paper. Further, the experimental programme was completed in about 74% of the time taken by the traditional programme. All the participants commented positively on the experimental programme and expressed the opinion that it had helped them understand the lower limb better than dissection had done for the upper limb. These results suggest that working from prosections is a very effective way of learning human gross anatomy. Such a programme is worthy of consideration by departments having to contend with unfavourable student:cadaver ratios and curtailed teaching time.     

A comparison of the performance on three multiple choice question papers in obstetrics and gynaecology over a period of three years administered at five London medical schools

Four, and later five, of the medical schools in the University of London collaborated in administering one multiple choice question (MCQ) paper in Obstetrics and Gynaecology to their students at the end of the Obstetrics and Gynaecology courses. The paper was amended twice after intervals of approximately 12 months. The results showed differences in performance between the five schools on questions and alternatives within questions, which were common to all editions of the paper (the ‘short’ paper). These differences were also shown in the first two editions of the full paper (the ‘long’ paper), but were not apparent in the third. There was a significant improvement in performance from the first to the second paper edition of the long by approximately 11%, but this was reversed from the second to the third edition, where there was a significant decrease in performance by approximately 4%. We cannot here exclude the possibility that this decrease in the third edition has resulted from sample bias. The rank order of the schools may result from differences in methods of teaching. It seems that such relative performance between London medical schools is contributed to by the differences in course length and by the occurrence of a mid-course test. It appears also that student performance in any of the schools has not been uniform over the period of the study, there being a peak during the period when the second edition of the paper was used. Variations in student selection occurring between schools may effect some of these differences. There was also a marked difference in students' performance between Obstetrics and Gynaecology. The short papers appeared easier than the full papers. Whilst this may be due to the greater clarity of phrasing for the questions of the short paper, we also believe the subject matter of the short paper may be more relevant. A distinct effect could also be shown, over the period, due to improvements in the wording of the questions. It is possible that students perform better at Obstetrics than at Gynaecology.     

The effect of a checklist on medical students' exposures to practical skills

The effect is evaluated of a checklist exploring acquisition of practical skills by medical students during the first clinical course in internal medicine. A group of forty-five students using the checklist was compared with two reference groups doing their clerkship before and after the study group. The amount of exposure to practical procedures increased by about 30%. At the same time exposure to some simpler procedures was reduced, while there was an increase in exposures to more complicated procedures. The conclusion is that a checklist has potential value for increasing exposure to practical procedures, if given with advice about the procedures to be preferred and by demand for mastery of particular skills.     

Health promotion in the medical curriculum

It has been argued that health promotion should be included in the medical curriculum, if medical education is to match the needs and health goals of communities. In spite of the medical profession's awareness of the importance of health promotion, few universities in the UK have introduced a substantive course on the subject. This paper describes the teaching of health promotion in Nottingham Medical School. It identifies the aims and objectives of the course which are amongst others to develop an understanding of: the factors which influence the perception and experience of health and illness; the concepts of health promotion and health education; the scientific basis of health promotion; the relative effectiveness of approaches used; the measurement of health status and health behaviour; and health policy and planning. An innovative element of the teaching involves a community project which gives students experience of health promotion in practice. Evaluation of the impact of the course suggests that students perceive it to be interesting, stimulating and enjoyable, whilst examination and continuous assessment indicate that it has also influenced students' knowledge and understanding of the subject.     

Can first-year medical students contribute to better care for patients with a chronic disease?

First-year medical students at the University of Western Australia are attached to a patient with a chronic illness in order to begin to understand the world of the chronically ill and their families. The patients are recruited by general practitioner preceptors who have been reticent in accepting first-year students because of their perceived immaturity and lack of medical knowledge. Not only have the preceptors' reservations proven groundless, but the teaching exercise has produced an unintended and positive side in that 35% of students discovered new information which was judged by the patients' general practitioners to be of significant help in the total management of patients' illness. Since these were only first-year medical students, the effect should be much greater with more mature students. Doctors often have incomplete records and act on incomplete information. Medical students are a means of correcting some of these deficits. In return they develop better psychosocial and communication skills and achieve considerable personal development by demonstrating to patients, their preceptors and themselves that they can be useful in contributing to more effective patient care.     

Community-based learning in obstetrics for undergraduate medical students

Summary: Medical students on their obstetrics and gynaecology attachment were randomly assigned to attend hospital ( n = 24) or general practice ( n = 18) obstetric clinics once weekly for 4 weeks. The students completed self-assessment questionnaires at the beginning and end of the attachment. There was a significant improvement in the level of knowledge and skills required for antenatal care, care in labour and postnatal care by the end of the attachment, with no difference between hospital or general practice groups. There was a significant increase in the level of interest in the future practice of obstetrics only in the general practice group. However, this difference could be explained by the greater number of students in the general practice group who were by chance in the 'no or don't know' category at the start of their attachment. We conclude that general practice based clinical teaching of obstetrics can be a suitable alternative to hospital-based clinical teaching for undergraduate medical students.     

Objective measure of incidental learning in oncology

The learning experience of 150 third-year medical students in the specific area of paediatric oncology during a 6-week required paediatric clerkship, was assessed.
The clerkship, during which emphasis is placed on patient contact, was based at each of two institutions (A and B). Institution A, with a large relevant patient population and more teaching staff in the field of paediatric oncology, relies primarily on incidental learning relative to this area during the clerkship. Institution B, with smaller related patient groups and teaching staff, employs didactic instruction in this field. Results of pre- and post-testing at both institutions revealed comparable and significant gain in information relative to paediatric oncology in both student groups. Pre-test scores did not increase during the course of the school year, suggesting that the influence of specific prior clerkships was negligible. Differences in the amount learned between individual student rotational groups were less marked in institution A, where opportunities to contact patients and teaching staff concerned with this specific area, was more consistent.     

Student-directed problem-based learning in general practice and public health medicine

The development and implementation are described of a new 6-week course in general practice and public health medicine for final-year medical students. This course is based on the principles of student-directed problem-based learning in small groups and makes substantial use of student attachments to local general practices which act as learning resources. Student assessment is by profiles. Course evaluation is by qualitative feedback, and the results of this are presented. The course offers a flexible learning environment in which the aims of its designers and the goals of their students can be achieved.     

A programme for treating chemically dependent medical students

Summary. The first American programme for chemically dependent medical students at the University of Tennessee, Memphis is described. The goals of the Aid for the Impaired Medical Student (AIMS) Program are to provide confidential treatment for chemically dependent medical students, to assure that recovering students are able to resume their education, and to protect patients and others from the harm that may be caused by impaired students. The Program is administered by the AIMS Council, consisting of medical professionals and elected student representatives. The Council oversees the management of cases, including investigation of students who may be impaired, intervention when chemical dependency is suspected, diagnostic evaluation, treatment and aftercare, and post-recovery advocacy for students. The Program's experience includes 18 cases of suspected chemical dependency, with four self-referrals and 14 students referred by third parties. Eleven students have been diagnosed as chemically dependent and have completed treatment programmes. Nine have maintained recovery and eight have graduated. One student subsequently relapsed and committed suicide. Obstacles in programme implementation have involved absence of perceived need, the view that chemically dependent students should be dismissed from school, and reluctance of students to report classmates. Resources have included highly respected student representatives, a supportive administration, assistance of the impaired physicians programme, and medical insurance and professional courtesy to defray costs. Although the number treated has been modest, the AIMS Program is an important vehicle for training students regarding chemical dependency and their professional obligations toward impaired colleagues.     

Ownership of direct ophthalmoscopes by medical students

In September 1986 the Department of Education and Science withdrew the equipment grant for clinical medical students. This coincided with a reduction of 50% in the level of ownership of direct ophthalmoscopes amongst a group of 51 medical students who commenced their medical studies after September 1986 (no longer eligible for the equipment grant), when compared with a group of 63 students (in the same clinical year) who started the medical course before 1 September 1986 and who were hence still able to claim the equipment grant. The majority of non-owners gave lack of finance as the reason for non-ownership. Owners of ophthalmoscopes performed ophthalmoscopy more frequently than non-owners, but the difference did not reach statistical significance.     

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.     

The assessment of cognitive abilities in clinical medicine

A study to test the hypotheses that discrete cognitive abilities necessary to clinical practice can be identified and their achievement reliably assessed by methods applicable to a large number of students is described.
Eight supposedly discrete cognitive abilities related to clinical consultation were defined and the performance of medical students in them tested by short-answer question papers. In addition, knowledge of specific definitions and of therapeutics was examined.
The study, conducted over one academic year, involved 222 medical students—102 in the penultimate, and 120 in the final year of their undergraduate course.
Marking strictly to a previously agreed schedule was undertaken independently by three examiners; and students' performance in relation to each ability (and area of knowledge) determined.
The findings showed intra- and inter-marker reliability to be highly satisfactory; and student performance in any one ability to be independent of that in any other. This suggests that the cognitive abilities chosen are indeed discrete.
The importance of cognitive abilities is discussed in relation to education and training in clinical medicine.     

Teaching medical students about neurosis

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.     

Microfiches as an aid to teaching histology

A set of six colour microfiches and an atlas of black-and-white prints of the photomicrographs used in the microfiches have been prepared by the author and have been used for teaching an Histology course to medical students for 4 years. Student reaction to them and their use has been gauged by voluntary questionnaires. Of students who responded, 78% found the microfiches made the course easier for them; 76% like the microfiches because they can use them for home study; 77% find them useful for class discussion; 62% like them because of their colour reproduction. A small group of fifteen students, who failed the Histology course the year prior to the introduction of microfiches and subsequently repeated the course, felt they could revise better with the help of the microfiches. Also they felt the course was clearer. Comparison of the examination results of the students for the 4 years preceding the introduction of microfiches with those of the 4 years since, shows an improvement in mean percentage achieved together with a decrease in the standard deviation (s.d.).