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.     

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.     

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.     

Attitude of medical students towards psychiatry

Findings are presented from a survey of all medical students at the College of Medicine, Abha, Saudi Arabia dealing with students' attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned future delivery of services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their specialization after graduation. The Scientific Committee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from medical schools in the nation to discuss this priority topic. A year later, a new course called 'Introduction to Psychosomatic Medicine' was introduced as an elective for medical students with its practice at the general hospital. It tries to introduce students to 'voluntary and active as against passive learning ... and problem-solving rather than imposed memorizing' of medicalized forms of psychiatry, an innovation compared with the previous conventional method. A significant difference in attitude was demonstrated between students who had their exposure to psychiatry from this course and those who followed only the conventional methods of learning.     

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.     

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.     

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.     

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.     

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.     

A comparison of the interviewing skills of first-and final-year medical students

This study compared the communication skills of randomly chosen first- and final-year medical students. The intention was to follow up previous research, conducted over 10 years ago, into the effects of the medical curriculum on communication skills. It was hypothesized that there would be little improvement in such skills over the period of training, with the possibility that the final-year students might be less caring, empathic and supportive, more directive, and less concerned with psychosocial information. All students interviewed a simulated patient in the role of a mother of a child with cerebral palsy, where the main problems were psychological and social. The interviews were recorded on videotape and analysed by an independent observer for the presence or absence of a set of communication behaviours considered important in facilitating an effective relationship and in the exploration and understanding of the problem. The results failed to support the hypotheses. The final-year students were superior to their juniors on several measures, indicating improvements in relating to the patient in a caring, empathic, facilitative and listening manner. They also elicited more information relevant to the problem. The indications were that these final-year students were more skilled than in earlier studies, suggesting that the general change in attitudes to communications skills and the limited, but increased input into the curriculum may be having effect, even though there remains a need for considerably more training.     

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.     

Uncertainties and ambiguities: measuring how medical students cope

Summary: Summary. To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes to wards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.     

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.     

Stress management for clinical medical students

This study evaluates a new stress management course for medical students offered through the Occupational Health Unit, Royal Free Hospital, London. It was offered to students in their first clinical year, which has been shown to be a highly stressful time. The course took place over 3 weeks, with one 2-hour session each week. Students completed questionnaires about mood, attitudes and causes of stress at the beginning of the year, and again one year later. The uptake of this optional course was 17%. Attendees, compared with non-attendees, were more anxious, less satisfied with themselves and their life, and perceived both work and outside functioning to be poorer. Over this first clinical year, non-attendees became significantly more dissatisfied at work and increasingly perceived their functioning at work and outside to be poorer whilst attendees showed no such deterioration over the year. Attendees completed the questionnaires before and after the course, and at two time points prior to starting the course when on the waiting list. Improvements in reported work functioning were found after the course, and this change was significant compared with the waiting list controls. These results are consistent with the attendees' own reports that they found the course helpful. These results show that stress management provides long-term protective effects as well as short-term benefits.     

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.     

Medical students' experiences with and perceptions of chronic illness prior to medical school

Summary. Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.     

Enhancing the psychological health of medical students: the student well-being committee

Summary. Medical schools' emphasis on technical excellence is sometimes at the expense of social and emotional development. This paper describes a programme, orchestrated by a vital Well-Being Committee, that involves students in a wide range of activities to enhance social and emotional well-being. The primary prevention of emotional impairment is the goal.     

Medical students'' attitudes to psychiatry in Chile

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.     

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

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