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Context This paper sets out to analyse and interpret the complex events of the last 20 years in order to understand how the teaching and learning of clinical communication has emerged as a core part of the modern undergraduate medical curriculum in most medical schools in the UK. Methods The paper analyses the effects of key political, sociological, historical and policy influences on clinical communication development. Results Political influences include: the effects of neo-liberalism on society and on the professions in general; the challenging of traditional notions of professionalism in medicine; the creation of an internal market within the National Health Service, and the disempowerment of the medical lobby. Sociological influences include: the effects of a ‘marketised’ society on medicine and subtle shifts in the doctor−patient relationship because of this; the emergence of globalised information through the Internet, and the influence of increased litigation against doctors. Historical influences include: the effects of a change in emphasis for medical education away from an inflated factual curriculum towards a curriculum that recognises the importance of student attitudes and the teaching and learning of clinical communication skills. Policy influences include the important effects of Tomorrow's Doctors and the Dearing Report on the modern medical curriculum. Conclusions The paper concludes with a developmental map that charts the complex influences on clinical communication teaching and learning and a brief commentary on the growing body of teachers who deliver and develop the subject today. [ABSTRACT FROM AUTHOR]

ContextPolicy documents about service innovation, education priorities and professional development exhort professions to learn together and work collaboratively. However, the literature suggests that the existence of shared learning in medical and nursing pre-qualifying education is patchy. AimThis paper does not claim to be research. It sets out to reflect on the trends and tensions in key policy directions, relating these to aspirations and a mapping of current intiatives in the sphere of medical and nursing pre-qualifying education. ApproachA limited national information gathering exercise was conducted during the planning phase of seminars hosted by the Centre for the Advancement of Interprofessional Education (CAIPE) in 1996 and 1997. This involved directly contacting all medical schools and departments of nursing and midwifery in geographical proximity, or with an institutional relationship. Information was sought on current or planned activity in shared learning, defined as medical and nursing students and/or working together. Emerging themesThere were a few examples of shared learning identified by the mapping exercise. The paper discusses these and draws on the consensus that emerged from the seminars on objectives and topics for shared learning. It concludes with a discussion of what makes for success or failure in such ventures with suggestions for future educational policy development. [ABSTRACT FROM AUTHOR]

Introduction In 1996 the University of Liverpool introduced an integrated problem-based learning (PBL) medical curriculum incorporating the recommendations of Tomorrow's Doctors. This paper investigates whether the PRHO (pre-registration house officer) educational supervisors who supervise Liverpool graduates believe that the reformed curriculum is producing house officers who have the competencies outlined by the General Medical Council. Methods Forty-one interviews were arranged with a sample of educational supervisors in the Mersey Deanery area to ascertain their views on the competencies of Liverpool PRHOs. The interviews were tape-recorded, transcribed and analysed. Results The supervisors felt that the PRHOs had been well prepared to work as PRHOs, and compared with traditional graduates they were actually better prepared for the job of PRHO. They saw the PRHOs as competent communicators with improved clinical skills, who had good attitudes, were aware of limitations, were team workers, good at history-taking and examination and had different approaches to finding information. There was a very confusing picture regarding basic knowledge, with some consultants expressing concerns, despite saying they had adequate knowledge to work as PRHOs. It emerged that there was little consensus about the knowledge base of the traditional or PBL graduates or what knowledge level was needed at this stage. Discussion Educational supervisors believe that the reformed curriculum in Liverpool is producing competent PRHOs who have been better prepared for the role of PRHO than previous graduates. It could be that uncertainty over knowledge base may be the price paid for reducing the factual burden and improving preparedness for professional practice. [ABSTRACT FROM AUTHOR]

The practice of dissection, as part of undergraduate medical education, has recently resurfaced in the public eye. This paper focuses on a number of important learning outcomes that were reported by Year 1–5 medical students in a British medical school, during the dissection sessions in the first 2 years of their training, as part of a wider qualitative research project into undergraduate medical education.A group of 29 students was selected by quota sampling, using the whole student population of the medical school as the sampling frame. Qualitative data were collected by 1 : 1 interviews with students and from formal non-participatory observations of dissection sessions.Apart from learning to cope with the overt‘emotional confrontation’ with the cadavers which assists anatomical learning, 7 additional covert learning outcomes were identified by the students: teamwork, respect for the body, familiarisation of the body, application of practical skills, integration of theory and practice, preparation for clinical work, and appreciation of the status of dissection within the history of medicine.A number of medical schools have either removed the practical, hands-on aspect of dissection in the medical undergraduate curriculum or are seriously considering such a measure, on financial and/or human resource grounds. This study highlights the fact that dissection can impart anatomical knowledge as well as offer other relevant, positive learning opportunities to enhance the skills and attitudes of future doctors. [ABSTRACT FROM AUTHOR]

In the wake of the introduction of graduate entry programmes, this paper aims to promote discussion and debate on student recruitment and selection, with a view to achieving a better match between the medical student population and the health needs of the population as a whole.Government initiatives in the UK and Australia have increased the number of medical school places, with a substantial proportion allocated to graduate entry students. In the UK, a government priority is to widen access to applicants from disadvantaged areas and lower socio-economic groups. In Australia, additional concerns for the government include ensuring medical services for rural and remote areas and improving indigenous health. At the same time, the governments in both countries are shifting costs in the direction of a‘user pays’ system.Graduate entry programmes represent a particular approach to minimising the effects of disadvantage, increasing the representation of students from diverse backgrounds, achieving a better match between the medical student population and the general population, and encouraging more flexible and inclusive selection and admissions policies. They also have certain disadvantages. It is possible to define a set of principles to increase the diversity of the medical school class with respect to both academic and personal qualities, whether in undergraduates or in graduate entrants.Graduate entry programmes can contribute to increased student diversity, but are unlikely to have much impact without other strategies to reinforce this aim. A nationwide collaboration could provide opportunities for research to establish more efficient and effective ways of selecting tomorrow's doctors. [ABSTRACT FROM AUTHOR]

Context The implementation of an assessment system may be facilitated by stakeholder agreement that appropriate qualities are being tested. This study investigated the extent to which stakeholders perceived 8 assessment formats (multiple-choice questions, objective structured clinical examination, video, significant event analysis, criterion audit, multi-source feedback, case analysis and patient satisfaction questionnaire) as able to assess varying qualities of doctors training in UK general practice. Methods Educationalists, general practice trainers and registrars completed a blueprinting style of exercise to rate the extent to which each evaluation format was perceived to assess each of 8 competencies derived primarily from the General Medical Council document Good Medical Practice. Results There were high levels of agreement among stakeholders regarding the perceived qualities tested by the proposed formats ( G = 0.82–0.93). Differences were found in participants’ perceptions of how well qualities were able to be assessed and in the ability of the respective formats to test each quality. Multi-source feedback (MSF) was expected to assess a wide range of qualities, whereas Probity, Health and Ability to work with colleagues were limited in terms of how well they could be tested by the proposed formats. Discussion Awareness of the perceptions of stakeholders should facilitate the development and implementation of workplace-based assessment (WPBA) systems. These data shed light on the acceptability of various formats in a way that will inform further investigation of WPBA formats’ validity and feasibility, while also providing evidence on which to base educational efforts regarding the value of each format. [ABSTRACT FROM AUTHOR]

Recent studies raise concerns over the preparedness of newly qualified doctors for the role of the pre-registration house officer (PRHO). This study aimed to assess self-perception of preparedness, objective assessment of core clinical skills and the effect of an extended clinical induction programme prior to commencing full duties. A group of 26 newly qualified doctors from 1 district general hospital underwent an extended 5-day, ward-based induction programme. The participants completed questionnaires on their own perceptions of their preparedness for PRHO duties and underwent an objective structured clinical examination (OSCE) of 4 core clinical skills prior to induction, on completion of induction and 1 month into working life. At the outset PRHOs had low perceptions of their own capabilities in all clinical scenarios and skills. Most perceptions improved after induction, although in 2 clinical areas they felt even less confident. One month into post there were significant improvements in all areas. Only 1 PRHO passed all 4 clinical skills assessments at the pre-induction assessment. Seven (26%) failed on 1 or more skills at the post-induction assessment. However, all participants were deemed competent in all skills at the 1-month assessment. Newly qualified doctors do not feel prepared for PRHO duties and objectively are not competent in basic clinical skills. An extended induction improves preparedness in some but not all clinical areas and improves performance of objectively assessed clinical skills. [ABSTRACT FROM AUTHOR]

Objective To investigate the current status of teaching on spirituality in medicine in UK medical schools and to establish if and how medical schools are preparing future doctors to identify patients’ spiritual needs. Methods We carried out a national questionnaire survey using a 2-part questionnaire. Section A contained questions relating to the quantity of teaching on spirituality and the topics covered. Section B contained questions relating to teaching on alternative health practices. Medical educators from each of the 32 medical schools in the UK were invited to participate. Results A response rate of 53% ( n = 17) was achieved. A total of 59% ( n = 10) of respondents stated that there is teaching on spirituality in medicine in their curricula. On extrapolation, at least 31% and a maximum of 78% of UK medical schools currently provide some form of teaching on spirituality. Of the respondents that teach spirituality, 50% ( n = 5) stated that their schools include compulsory teaching on spirituality in medicine, 80% ( n = 8) include optional components, and 88% stated that teaching on complementary and alternative medicine is included in the curriculum. Conclusions Although 59% ( n = 10) of respondent medical schools (the actual UK figure lies between 31% and 78%) currently provide some form of teaching on spirituality, there is significant room for improvement. There is little uniformity between medical schools with regard to content, form, amount or type of staff member delivering the teaching. It would be beneficial to introduce a standardised curriculum on spirituality across all UK medical schools. [ABSTRACT FROM AUTHOR]

Context High-quality learning in the context of medical education can be defined by current conceptions of a deep approach to learning and studying, in combination with metacognitive skills such as personal organisation and reflection on learning. Modern undergraduate education aims to provide an environment that will promote high-quality learning, but this is not as easy to achieve as it might at first seem. Part of the difficulty arises because it is student perceptions of the learning and assessment environment that determine the adopted approach to studying and these are notoriously hard to predict. Objective To generate a detailed understanding of aspects that facilitate and inhibit high-quality learning within an innovative, undergraduate medical programme. Methods We carried out semi-structured interviews with Year 2 undergraduate students. Results Self-directed, problem-based and vocationally relevant activities appeared to promote high-quality learning. Unanticipated barriers to high-quality learning in this setting included a perceived lack of useful feedback on learning, the assessment of applied medical knowledge for a subset of underperforming students, anatomy as a curricular topic and the quantity of information to be assimilated in medicine. Conclusions Only by understanding the barriers as they are perceived by students can we design evidence-based modifications to curricula that are likely to be successful in promoting high-quality learning. [ABSTRACT FROM AUTHOR]

Context In the context of changing admissions criteria and an expanding medical school intake in the UK, we analysed the determinants of the medical school dropout probability. Objectives We aimed to analyse the determinants of the probability that a student will drop out of medical school during Year 1 and to compare the results of this analysis over time. Methods We carried out logistic regression analysis for the 6 intake cohorts of 1990–92 and 1998–2000. Results Between 1990–92 and 1998–2000, there were substantial increases in both the size of the entry cohort and the proportion of students dropping out of medical school. A logit model for the 1990–92 and 1998–2000 cohorts reveals that the probability of dropping out depended on both the medical school attended and the personal characteristics of the student, including academic preparedness. Almost none of the increase in the dropout rate between the 2 cohort groups can be explained by changes in observable characteristics of the students over this period. Instead, most of the increase in the dropout rate is associated with changes at the level of the institution and in unobserved student characteristics. Conclusions University effects, rather than changes in observed student characteristics, explain most of the increased dropout rate over the time period considered. Candidate explanations behind these effects include: less effective admissions policies; changing curricula; greater costs of attending medical school, and a growing mismatch between student and school characteristics. Testing between these competing hypotheses is left for future work. [ABSTRACT FROM AUTHOR]

Objective In order to inform discussions about possible changes to Medical Education's blinding policy, members of the journal's editorial board were interested in discovering reviewers' and authors' preferences with regard to the current double-blind policy and various alternatives. Methods In September 2005, an 8-question, web-based survey was sent to all authors and reviewers who had submitted or reviewed a manuscript for Medical Education in 2003 and 2004 ( n = 2632). The questions asked about authorship and reviewing experiences and preferences regarding 5 types of blinding procedure, from double-blinding to fully unblinded, open reviews. Results Following 2 electronic mailings, 838 surveys were completed. There was a range of experience among respondents, with a high proportion of experienced authors (49% with over 20 publications) and reviewers (41% with over 20 reviews). Overall, 68% of respondents preferred a review process that concealed author names and 72% preferred a process that allowed for concealment of reviewer names. Less experienced authors and reviewers were significantly more likely to prefer concealing author names, but even the most experienced respondents had a 54% preference for author concealment. Reasons for concealing identities included facilitating fairness and honesty in reviews and acknowledging the need to avoid personal conflicts or rivalries. Reasons for revealing identities included facilitating greater transparency and accountability, and a better understanding of the author's and reviewer's contexts and credentials. Conclusions The Medical Education authors and reviewers who chose to respond to the survey voted strongly in favour of continuing the double-blinding procedure of concealing both author and reviewer identities during the review process. [ABSTRACT FROM AUTHOR]

Introduction Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them. Methods We undertook a cross-sectional survey; questionnaires were sent electronically to 28 teaching leads in academic departments of public health in UK medical schools. These were followed-up by telephone interviews. Results We obtained a 75% response rate. We found a great deal of variability between schools in teaching methods, curricular content and resources used. In 76% of medical schools, public health and clinical teaching were integrated to some extent. The proportion of teaching delivered as lectures is decreasing and that of self-directed learning is increasing. A range of methods is used to assess students and in 33% of schools these assessments contributed to final Medical School marks. More than half the medical schools had difficulty finding teachers and staffing levels had deteriorated in 55% of schools. Many interviewees felt that their contributions were undervalued. Few were aware of the level of funding received to support teaching. Discussion There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative, problem-based approaches. Faculties need to share ‘learning about what works’ and teaching resources across medical schools as well as addressing a culture of neglect of teaching in some departments. Suggestions are made as to how undergraduate public health teaching can be strengthened. [ABSTRACT FROM AUTHOR]

To evaluate the development, validity and reliability of a multimodality objective structured clinical examination (OSCE) in undergraduate psychiatry, integrating interactive face-to-face and telephone history taking and communication skills stations, videotape mental state examinations and problem-oriented written stations.The development of the OSCE on a restricted budget is described. This study evaluates the validity and reliability of 4 15–18-station OSCEs for 128 students over 1 year. Face and content validity were assessed by a panel of clinicians and from feedback from OSCE participants. Correlations with consultant clinical‘firm grades’ were performed. Interrater reliability and internal consistency (interstation reliability) were assessed using generalisability theory.The OSCE was feasible to conduct and had a high level of high perceived face and content validity. Consultant firm grades correlated moderately with scores on interactive stations and poorly with written and video stations. Overall reliability was moderate to good, with G-coefficients in the range 0.55–0.68 for the 4 OSCEs.Integrating a range of modalities into an OSCE in psychiatry appears to represent a feasible, generally valid and reliable method of examination on a restricted budget. Different types of stations appear to have different advantages and disadvantages, supporting the integration of both interactive and written components into the OSCE format. [ABSTRACT FROM AUTHOR]

To compare the relative importance of social, academic and application form factors at admission in predicting performance in the first 3 years of a medicine course. Retrospective cohort study. A single UK medical school. A total of 738 students who entered medical school between 1994 and 1997. Performance in Year 3 objective structured clinical examination (OSCE). School-leaving grades were significant predictors of success in the OSCE. Non-academic activities as assessed from the application form were associated with poorer performance. Mature students performed extremely well, and male and ethnic minority students performed less well. Socioeconomic status and type of school attended were not found to affect performance on the course. The relatively poor performance of male and ethnic minority students urgently needs further investigation. Our results carry no suggestion that, other things being equal, widening access to medical school for mature students and those from less affluent backgrounds would result in poorer performance. [ABSTRACT FROM AUTHOR]

We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course ‘Principles of Ambulatory Paediatrics’, taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME). Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002. During this rotation residents were required to complete 4 modules in asthma, otitis media, gastroenteritis and fever, respectively. Each module was evaluated using a standard questionnaire. Completion rates for the required modules ranged from 64−72%. Residents in all 3 years of training showed improvement between the pre- and post-test scores for each module, except for postgraduate Year 2 residents in the asthma module. Most residents somewhat agreed, agreed or strongly agreed that the module components were useful and that the experience of completing the modules would improve their ability to take care of patients. The LMS WebCT is an innovative and adaptable approach for designing a web-based course for primary care education in paediatrics. The LMS addresses the educational needs of both a clinical division and a residency programme. The LMS also provides an information technology infrastructure to measure the medical knowledge competency required by the ACGME. [ABSTRACT FROM AUTHOR]

Graduate medical education in the UK is in danger of being subsumed in a minimalist discourse of competency. While accepting that competence in a doctor is a sine qua non, the author criticises the construction of a graduate and specialist medical education based solely upon a competency model. Many competency models follow the concepts of either academic competence or operational competence, both of which have lately been subject to criticism. The author discusses the need for replacing such criterion-referenced models in favour of a model that engages the higher order competence, performance and understanding which represent professional practice at its best. [ABSTRACT FROM AUTHOR]

Objectives To assess any recent change in the commitment to teaching of occupational medicine in UK undergraduate medical curricula. Design A questionnaire survey of the teaching of occupational medicine to undergraduates in all medical schools listed in the UK Universities and Colleges Admissions Service prospectus for 1999–2000 (n = 24). Results Nineteen UK medical schools returned a completed questionnaire, giving a response rate of 79%. A comparison of results from this survey with previous surveys of teaching of occupational medicine to undergraduates in the UK shows that fewer schools now provide lectures, project work or ward-based tuition in the subject. Workplace visits were not undertaken by any institution. Only two of the schools setting an examination question also had a syllabus. Conclusion Despite the prominence given to issues related to occupational health in recent UK government policy, this study suggests a declining commitment to occupational medicine on the part of UK medical schools. Urgent action needs to be taken to address the lack of training in occupational medicine in UK medical schools. [ABSTRACT FROM AUTHOR]

ContextResearch on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem-based learning courses. ObjectiveThis study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants’ experiences. MethodsSix focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained. ResultsParticipants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants’ experiences demonstrated a relationship between sense of ‘belongingness’ to the medical school community, participation in learning opportunities and progress through the course. ConclusionsThe results suggest that interventions aimed at reducing barriers to progress need to promote students’ confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from diverse backgrounds. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore an approach for informing the development of regional policy by eliciting the considered views of GP participants at an educational event. In particular we discuss the reaction of GP participants to this approach. (In this instance our GP participants were trainers and the evolving policy under discussion was that of ‘clinical governance’.) MethodAn educational event was planned to facilitate discussion and the recording of the considered views of GP trainer participants. The acceptability of this approach to the participants was evaluated via observation and through feedback forms. ResultsWhile observation suggested that the participants were involved in many lively and constructive discussions, the feedback generated showed that many participants felt uncomfortable about the use of an educational event to inform development. DiscussionWe recognize the need to inform and facilitate change through the involvement of those who will be participants in the change process. The rapid timescales imposed by change and the ‘burden’ of additional research involvement on practitioners are issues. Approaches based on action research and participatory research principles may have potential and can throw light on the difficulties we experienced. ConclusionWe need to identify approaches which will allow us to ground development within the views of those to be affected by change. Our own attempt demonstrated difficulties. We would welcome further debate over methods and approaches applicable in this border territory between research, development and education. [ABSTRACT FROM AUTHOR]