What matters most? Predictors of student satisfaction in public health educational courses

The development of primary care trusts, the health protection agency, and non-medical public health (PH) specialists' pathways requires a competent PH workforce to be in place. Hence, the quality of education and training of PH workers is increasingly critical. With the diversity of courses and programmes that contribute to building a competent PH workforce, few studies have examined the satisfaction of students (and reasons for it) on educational PH programmes. The present study investigated the influences that four demographic variables (gender, disability, ethnicity and age bracket) and seven education-related variables (mode of study, academic term, academic level, pre-/postregistration status, entry qualification, qualification aim and class size) have on PH students' perceptions of satisfaction with 18 aspects of their learning. After controlling for the effects of the other variables, five variables explained 32% of the reported satisfaction levels. These were class size, study mode, qualification aim, pre-/postregistration status and academic level. Part-time students on postgraduate programmes are a particularly vulnerable group who may need extra support from PH educators and trainers. For these students, smaller class sizes could be beneficial, and if larger classes are inevitable, smaller group work sessions within the classes is advocated. Equally important is the availability of library resources required for learning, and course materials, handbooks and briefs need to be clear, informative, user friendly and available early in the course. Satisfied students achieved better final grades, reflecting an increased amount of transferable knowledge. The implications of the study findings for research and practice are discussed.     

Quantification of process measures in laparoscopic suturing

Background Process measures describing the generation of movement are useful for evaluation and performance feedback purposes. This study aimed to identify process measures that differ between novice and advanced laparoscopists while completing a suturing skill. Methods A group of junior and a group of senior residents and fellows in surgery (n = 6) placed 10 laparoscopic sutures in a synthetic model. Process measures were quantified using an opto-electric motion/force sensor assembly that recorded: instrument rotation, applied forces, time, and time delays between force application and instrument rotation. Results Advanced trainees showed increased instrument rotation, higher peak applied force, and faster performance compared to novices (all p < .01). However, over trials, only novices showed adaptations for instrument rotation and total time (interactions at p < .01) with no adaptation for the force application. The difference between the moments of force application and instrument rotation was not sensitive to participant training. Conclusions Movement process measures can enhance our understanding of early adaptation processes and how such factors might be used as feedback to facilitate skill acquisition.     

Evaluating learning and knowledge retention after a continuing medical education course on total mesorectal excision for surgeons

The purpose of this study was to determine whether knowledge gained (as determined by a formal course test) by surgeons in a continuing education course on total mesorectal excision and rectal cancer management is retained 1 year later. A formal course test had been previously developed and validated. The test evaluated course content including pelvic anatomy, surgical techniques, imaging, pathology, adjuvant therapies, and cancer and functional outcomes. Validation was determined by the absence of change in pre- and posttest scores of the "expert" course instructors (n = 8, P = .6) and by a linear correlation in test scores with increasing level of general-surgery resident training (n = 16, P = .001). Significant learning by the 58 surgeons taking the course had been shown by improvement in test scores from before the course (mean score 19) to after the course (mean score 25.3, P = .001, out of a possible 33 total mark). At 1 year after the course, those course participants (n = 44, 76%) who had provided postcourse contact information were asked to complete the course test again. Responses were received from 18 surgeons (41% of those surveyed, 31% of the original course participants). The mean score on the test after 1 year was 23.8. Compared with the immediate posttest scores, there was no significant knowledge loss over the year (P = .09). We conclude that knowledge acquired during a continuing education course for surgeons on total mesorectal excision and rectal-cancer management is retained 1 year later.     

Die Evaluation gemeindenaher psychiatrischer Dienste

Zusammenfassung Wir akzeptieren heutzutage, daß jede neue pharmakologische Behandlungsform intensiv und umfassend erprobt werden muß, bevor sie klinisch allgemein eingeführt wird. Die Contergantragödie hat die Gefahren unzureichender Prüfung deutlich gemacht. Weniger offensichtlich ist es jedoch, daß psychosoziale Behandlungsformen genauso streng beurteilt werden müssen. Neue Formen sozialer Behandlung und neue Formen der Versorgung werden mit Nachdruck gefordert. Die Folgen, die z. B. aus der Verwandlung einer Krankenhaus-orientierten Versorgung in eine gemeindenahe Versorgung entstehen, deren Funktionieren von der Koordination zahlreicher kleinerer Einrichtungen abhängig ist, sind möglicherweise um vieles größer als die, die von der Einführung einer neuen Droge zu erwarten sind. Es ist wesentlich, daß Psychiater ihre angemessene Rolle in diesem neuen und schnell expandierendem Forschungsgebiet übernehmen.Nach einem Vortrag, gehalten auf dem Kongreß der Deutschen Gesellschaft für Psychiatrie und Nervenheilkunde, München, Oktober 1974.     

Multidisciplinary training in family planning

A review of 3 years' experience with multidisciplinary training in Family Planning involving representatives from nursing, medical, social work and education professions is presented. The multidisciplinary principle has been shown to be of value in this field, particularly in respect of improved communication.     

Intensive bedside teaching of physical examination to medical undergraduates: evaluation including the effect of group size

The effectiveness of intensive bedside teaching of techniques of physical examination of the alimentary system to students commencing their clinical training was assessed. All students viewed a videotape demonstrating these techniques and then participated in a morning practice examination session but only half of the class received afternoon bedside teaching of physical examination in addition. Teaching in history taking was used as a 'placebo' for the control group, and half the students in each of the study and control groups were taught in units of four, the other half in units of eight. Thus the effect of group size could also be estimated. After 1 week, the Students' performance of a physical examination was assessed using a standardized scoring chart which demonstrated good reliability. The study group performed significantly better than the control and within the study group there was a trend for the students taught in smaller units to perform better.     

Medical interviewing: initial student problems

Although every lecturer in a department of medical education would endorse the importance of sound medical interviewing the position of courses on this subject is generally unstressed. In the past few years a course has been developed in the Department of Internal Medicine at the University hospital of Utrecht in which special attention is paid to the sort of problems students experience in the initial phase of medical interviewing. Use is made of simulated patients. At the same time attention is given to both the medical and communicative aspects. This approach is specially appreciated by the students. Self assessment shows that they report a considerably enhanced proficiency. Observations and questionnaires show that the students have problems mostly on the emotional level, both in coping with their own emotions and in discussing personal and emotional topics with a patient.