Interprofessional education in medical school

The opinions of entering medical students regarding interprofessional education (IPE), and their reasons, are described in this article. More female than male students favour IPE, 49 as compared to 25%. Students who endorse IPE give different reasons for their position than students who oppose it. The former group refer to increased communication and respect among health professionals, increased knowledge about mutual roles and function, greater equality among members of the health team and improved patient care. The opposing group fear that IPE would lower the quality of education by increasing class size and slow the pace of instruction to accommodate students with limited scientific backgrounds. Students also protest against having to study irrelevant subjects and acquire irrelevant skills. The opposing group is concerned primarily with IPE's effect on medical students; the group in favour is concerned more with the effect on patients and interprofessional relations. It seems that opinions about IPE are part of a basic attitudinal structure that medical students bring with them when they enter medical school. The implications for IPE in medical school are discussed.     

The introduction of problem-based learning projects into a clinical correlation course in the first year of the Edinburgh medical curriculum

Thirty hours were allotted to problem-based learning projects in the first year of a new medical curriculum in Edinburgh. Those projects have been very successful in encouraging student initiative and in satisfying the students'desire for contact with patients, relatives and medical staff early in the curriculum. The difficulties involved in this form of teaching and the shortcomings of the exercise are discussed.     

Comparison of didactic lecture, self-reading and self-instruction as learning methods in medical students of western India

A controlled study was conduced on a batch of fifty-four medical students in the paraclinical period of study, to compare the relative effectiveness of self-reading of books, didactic lecture and use of self-instruction kits as teaching-learning experiences. The assessment was done by an immediate and delayed objective type examination as well as questionnaire.
The results indicate self-reading to be relatively ineffective. Didactic lectures and use of self-instruction kits have a similar rating in objective assessment while, subjectively, the students expressed a marginal preference for self-instruction kits.
Comparison of the performance of the students grouped according to merit reveals that there is no significant difference between the three methods of learning in the lower group while the upper group did perceptibly better with self-instruction kits than with didactic lecture.     

The British contribution to sponsored postgraduate training for overseas doctors

More effective use could be made of the resources devoted to the sponsored postgraduate training of overseas doctors in Britain. There is need for careful selection and planning of training programmes. More attention should be given to providing skills in communication, management and education. Clinical training requires the better provision of posts carrying responsibility. Training of leaders in the basic medical sciences should be based to a greater extent on courses leading to M.Sc. and less upon pure research degrees (there is also a major need for a broadly based M.Sc. for non-medical science graduates who will teach the basic sciences). A major recommendation is that a central office should be established which would plan programmes for and supervise all sponsored trainees, under contract with the sponsoring body.     

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.     

The reform of medical education: a Canadian model †

The Flexner reforms of the early 20th century were successful in correcting a mismatch between medical education and the newly available knowledge from the laboratory sciences. At the same time, they set in motion changes which have resulted in another mismatch, this time between medical education and society's needs. Five major corrective changes are described, with particular reference to the role of family medicine (general practice) in attaining them: (1) a change in the environment of learning, (2) a reawakening of concern with the subjective aspects of medicine, (3) a shift of emphasis from content to process, (4) a change in our concept of health and (5) a rapprochement between personal and population medicine. New medical schools have had an important influence on the reform of medical education. However, it is important also to study examples of successful adaptive change in older institutions. Changes at the University of Western Ontario are described as an example of successful adaptation. Some reasons are given for the failure of many institutions to adapt. Five conditions are necessary if a medical school is to adapt successfully to change: (1) the school should penetrate the entire health care system, (2) all sections of the profession should be represented on the faculty, (3) the school should be strongly rooted in its region, (4) it should have a flow of information from the ‘grass roots’ and (5) society should have some means of ensuring that its needs are met.     

Observations on some foul papers † on medical education. A referee's whistle

Faults commonly seen in papers on medical education in general and examination techniques in particular include: (a) Inadequate replication and neglect of the novelty effect on the results of experiments, (b) excessive reliance on internal analysis in assessing examination techniques, without seeking external evidence that the right candidates are being passed, (c) uncritical acceptance of the doctrine of a necessary core of knowledge, and of pass levels derived from prior reasoning, (d) assumption that because recall and recognition methods produce different pass levels the one must necessarily be ‘better’ than the other. It is suggested that good examiners look not for specific items of knowledge, but for evidence of a sufficient total quantity combined with sufficient judgment in the choice of what to learn, and that the one common essential attribute of good medical students and good doctors is an exceptionally high but non-specific capacity for information processing.     

Medical education in Spain †

This paper reviews some of the problems confronting medical education in Spain and some of the steps which have been taken to improve the current situation which is of serious concern to the Government, the Medical Colleges, the University, and the community generally.     

Prediction of student clinical performance

The predictive validity of 'traditional' tools utilized in the selection of medical students was evaluated in a 'non-traditional' selection paradigm, where a wide range of previous-academic ability was represented. The validity of the use of pre-academic grades and examination scores in the prediction of success in clinical performance was examined in a medical school which de-emphasizes these indicators and emphasizes personal characteristics assessed via interview ratings in student selection. Grades and examination scores were found to have no relation to clinical ratings which have an added interpersonal and community emphasis during the fourth-sixth years of medical school. A positive trend was found for interview ratings with clinical performance, but the skewed nature of interview scores was seen as limiting investigation of this variable. The meaning of these results vis-à-vis the continued use of academic and examination related selection criteria was discussed.     

Student experience in family medicine at McMaster and Glasgow Universities

The experiences of two small groups of medical students were recorded when they were doing their main teaching in Family Medicine at McMaster University in Canada, and Glasgow University in Scotland. Time-log diaries were completed for 2 weeks with details of the patients seen. The results are compared in the context of two different approaches to medical education.     

Assessment of laboratory exercises in physiology†

Assessment is an integral part of the teaching-learning process. It contributes to the realization of learning objectives by inculcating habits which are conducive to better scores in the examination. A system of assessing laboratory work which combines the performance of experiments by the student with some short questions based on an instrument, experimental data or tracing has been critically examined. The performance of the student in the two parts of the examination is poorly correlated (r=0.36 to 0.72), suggesting that they test different abilities, and that combining them may improve the objectivity of the examination. The overall practical assessment is better correlated with the overall theory assessment (r=0.71, 0.87). The correlation between different forms of examination also improves when only the top 10% and bottom 10% of the class is considered. Since the results quoted are based on only a few examinations at a single medical school, generalizations are not justified.     

Videotaped vs traditional lectures for medical students

Closed-circuit television (CCTV) provides medical departments with alternatives in instructional formats. Concern, however, has been voiced about teaching via TV because the medium itself might cause inattention. This study investigated whether TV will lower the test scores of medical students. Sixty-one students were randomly divided into two groups. The lecture (control) group received the information via traditional lectures, including use of 2”× 2” transparencies. The video group received concurrently the same information via CCTV. Multiple-choice examinations were given after each of the six sessions. The cumulative mean scores were similar: lecture group = 87.56%, video group = 87.99%, i.e., no significant difference (P=0.77). To detect attitudinal differences toward the two formats, the students were surveyed at the end of the series and intragroup agreement on specific questions was calculated. The students rated the lecture format more highly. In response to the question ‘Did the audiovisual materials used by the instructor aid your learning?’, the mean rating from the lecture group was 7.37 (scale of 0–9) compared to a mean rating of 5.93 from the video group (P< 0.0003).     

Student evaluation: its worth for course tutors

As part of their evaluation of the 9-week 'Medicine in the Community' course, final-year medical students completed a terminal evaluation questionnaire. Items and subject groupings were scored using a scale of 1–5 for 'value', 'interest', and 'presentation', and mean evaluations were calculated for each group of students. The results, summarized in tabular form, were posted to the seventy-three course tutors together with the mean evaluations of the course as a whole. It was hoped that this feedback on the course would help tutors to improve the standard of their contributions.
After 2 years of this evaluation, a questionnaire was sent to the course tutors to examine whether student opinion is useful to them in the planning of teaching. Findings indicate that student opinion is actively sought and the results are useful, but only if tutors can identify their individual contributions from the tabulated summary.     

Elaborated learning in undergraduate medical education

Southampton Medical School holds its major examination of basic knowledge after rather than before students enter their first clinical attachments. An interview survey investigated its educational effects, and found that students adopt one of four revision approaches. The most successful, not just in terms of examination grade but more particularly in students' subsequent ability to retrieve and use the knowledge gained, occurred when students related their preclinical revision to their clinical experiences. One of these approaches, an elaboration of knowledge, is considered to be essential for effective clinical thinking yet is probably rare elsewhere in medical education since it appears to be a consequence of a particular curricular arrangement. An explanation is given in terms of current thinking in cognitive psychology, and this challenges the theoretical assumptions on which other research in medical education has been uncritically based. Some implications for medical education and further research are discussed.     

Oral examinations in medical education

A questionnaire survey was conducted on the nature of the oral examinations in different disciplines in the medical schools in Sri Lanka. A total of 352 students from Peradeniya and Jaffna medical faculties and pre-registration house officers, including Colombo faculty graduates of the two teaching hospitals, responded to the questionnaire. The results of the survey, which included twelve disciplines, reveal that the time duration of the oral encounter ranged from 10 to 20 minutes. The number of questions asked ranged from five to nine. Detailed analysis of the intellectual level of the questions showed that more than 63% of the questioning was at simple recall level and none at the level of problem-solving. These results show that the oral examination in addition to its inherent weakness of low reliability and objectivity also lacks validity in terms of content sampling. Its predictive validity of professional competence, which requires problem-solving skills, is questionable. Content analysis of the items also revealed that all the abilities tested in the orals could best be tested in a pen-and-paper examination or a structured practical or clinical examination.     

Hospital postgraduate medical education facilities

A survey of facilities made available to support the training requirements of junior hospital doctors within the North Western Region of England revealed a general under-provision of certain facilities, significantly greater provision of some facilities in teaching hospitals as compared with other hospitals, significant evidence in some cases of special effort in non-teaching hospitals to improve facilities, and significant differences between specialties regarding efforts made to provide training facilities.     

Problems of undergraduate medical education in Saudi Arabia

Throughout the world there are problems associated with undergraduate medical education, and likewise in Saudi Arabia. In this paper, some of these problems are discussed and solutions suggested, in the context of a survey conducted at the Faculty of Medicine of King Abdulaziz University with fourth-year medical students dealing with the language of medical instruction.     

Ethics and animal issues in US medical education

Increasing public and regulatory agency concern about a variety of animal protection issues that affect the field of medicine have made these issues increasingly relevant to medical school curricula. The purpose of this study was to assess the availability and forms of medical school training relating to ethical, conceptual, and societal concerns in the use of animals within the field of medicine and the perceived need for such training.
Questionnaire surveys were mailed to the Deans of the 125 accredited US medical schools, and completed by Deans or their designees within the same medical institution. Questionnaire recipients were informed that results would be compiled in a fashion that did not identify specific individuals or institutions.
Survey responses were obtained from 84 medical institutions (67% response). Sixty respondents (71%) indicated that their medical school offered or sponsored some type of activity related to ethical and conceptual concerns in the use of animals in medical research and training. Most schools (43) offered informal discussions/seminars relating to these issues, but nine schools offered full formal courses with up to 15 lectures on these topics. Programme content and perceived need for additional instruction varied greatly amongst respondents.
The results suggest a wide diversity amongst US medical schools in the availability and perceived importance of medical school training relating to ethical and conceptual concerns in the uses of animals in medicine. It is proposed that instruction in these areas be pursued with more concerted efforts to address the growing body of knowledge about non-human beings and the ethical implications of such knowledge.     

Information technology in postgraduate medical education

Summary. Information technology in postgraduate medical education has developed rapidly over the last 5 years. This report describes the experience of setting up a computer-based information system in postgraduate centres in the West of Scotland. It includes a viewdata service, library facilities, computer-assisted learning, word processing, and statistics. An electronic mail system provides rapid communication between users. The costing and some of the problems in setting up such systems are discussed.