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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]

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]

Context The University of Liverpool has always been innovative in its approach to medical education. The medical faculty's decision to switch to a full problem-based learning (PBL) medical curriculum from September 1996 represented an opportune moment for history of medicine to put a foot in the curricular door. Discussion The history of medicine component was launched with an initial team of 3 staff members, although some 16 people have been involved in its development and delivery over the 10 years since it began. This paper is an attempt to construct and discuss the history of the course over the past decade, examining both the proactive and reactive aspects of its evolution, and how it has been perceived by students, the university and staff who have taught on it. [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]

Context A special study module (SSM) option was introduced for medical students at Leicester Warwick Medical School in January 2000. Its aim was to enhance students' knowledge and understanding of people's experiences and emotions in relation to health and sickness through study of the arts. The module was set up and run through collaboration between the medical school and the University of Leicester's Department of English. This paper describes the context of SSMs in the arts and their relevance to medicine, and examines student perceptions of the benefits gained from this particular course. Method Students were exposed to a core series of arts-based seminars, and were given time to research a chosen study topic looking at an artist or art form in relation to health and sickness issue(s). They were assessed on their written submissions on these study topics according to the module objectives. Students were encouraged to develop a reflective style of learning by keeping learning journals. Conclusions Evaluation demonstrated that the students considered that their professional development had been enhanced by taking time to study the arts. Students also felt that they would continue to use the arts to this end after the module had finished. Summative assessment showed that the objectives were achievable by the great majority of students. [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]

To date, no studies have examined preclinical medical students' views about portfolios. Since portfolios are becoming increasingly valued in medical education, this study explores second-year medical students' views about a reflective portfolio assessment of their communication skills. 178 second-year medical students at the University of Nottingham completed the 18-item reflective portfolio questionnaire (RPQ) (α = 0.716) and a personal details questionnaire three days before submitting their portfolio assessment for communication skills. Data were analysed using univariate and multivariate statistics on SPSS Version 10.0. Total scores on the RPQ ranged from 40 to 75 (mean 58.28, SD 7.08). Significant relationships existed between RPQ total scores and students' ratings of their reflection skills ( rs = 0.322, P < 0.001), RPQ total scores and students' confidence building another portfolio (T = 4.381, d.f. = 176, P < 0.001), and RPQ total scores and students' marks for their reflective portfolio assessment ( rs = 0.167, P = 0.029). Students with more positive views about reflective portfolios were more likely to rate their reflection skills as good, receive better marks for their portfolio assessment, and be more confident building another portfolio. This study begins to highlight preclinical medical students' views about reflective portfolios. However, further research is required using qualitative studies to explore students' views in depth. Medical educators should be encouraged to consider introducing portfolios as a method of formative and summative assessment earlier in the medical curriculum. [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]

Objective This study set out to establish why some new doctors view their training as a valuable period in their professional development, whereas others see it as a year to be endured and survived. Methods This multi-method case study focused on the interaction of key participants within 1 deanery, sampling the 237 pre-registration house officers (PRHOs) and 166 educational supervisors populating the associated 12 National Health Service trusts at the time (2001). The design of the case study was predicated on gathering the views of both teachers and learners in a way that allowed each stage of the data collection process to inform and influence the next phase. Results Lack of formal guidance and support were common characteristics associated with the first few days in post. The first day in post as a doctor is, for most, an experience that is hard to prepare for, even after a useful induction period. Those PRHOs who felt they were not guided or advised on how to undertake their new professional responsibilities tended to feel undervalued and under-recognised as individuals. Conclusions Without the support of senior colleagues who can help the new doctor reflect on quite difficult and uncertain situations, new doctors will almost certainly perceive the first year of the new Foundation Programme as a survival exercise. If new doctors are working in an environment where their learning is properly facilitated, they are more likely to recognise their progress in their professional development and be more proactive in addressing concerns about professional expectations. [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]

Objective To describe the effects of a voluntary intervention using reflective learning techniques on students' learning. Design An interventional study with reflective learning techniques offered to medical students. Setting Year 3 of undergraduate medicine at Cardiff University where the curriculum is integrated with early clinical contact. Participants All 232 Year 3 students were invited to participate. A total of 65 attended an introductory lecture. After the lecture 35 students agreed to take part; 15 of these subsequently dropped out (some before attending tutorial groups, others after taking part for some weeks). Interventions Participants kept learning journals for 2 terms and attended fortnightly, facilitated tutorial groups where they discussed their reflective journal entries . Main outcome measures were qualitative interviews and examination results. Results Interviews were carried out with 19 full participants, 4 initial participants and 7 non-participants. Participants perceived that they gained a greater ability to identify learning objectives and to integrate learning. The tutorial groups encouraged students to compare progress with their peers. Some students did not take part because they thought that the large factual content of the curriculum would make reflective learning less useful. There were no differences between the groups in examination results. Conclusions Students among the small, self-selected group of participants were better able to identify what they needed to learn although there was no improvement in examination results. Students appear unlikely to take up voluntary reflective learning if they do not think it relates to the curriculum and assessments. Student culture exerts a potent effect on willingness to attend extra tutorial groups. [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]

Some educators have argued that portfolios should not be assessed summatively because there is little evidence supporting the reliability of their assessment. This study aims to determine the reliability of assessment criteria used for a portfolio at the University of Nottingham. Two independent analysts assessed a random sample of portfolios ( n = 100, 49.5%) using criterion-referenced assessment. Students' performances were examined against subjective items in five areas: 1) portfolio structure, 2) level of critical reflection, 3) level of skills development, 4) use of documentary evidence, and 5) use of relevant literature. These subjective judgements were later converted into quantitative scales ranging from 0 to 3 so that interrater reliability could be established. The level of agreement between the two analysts for the total percentage score was established using an intraclass correlation coefficient and for the individual items using weighted kappa coefficients. The level of agreement between the two raters for the total percentage score was 0.771 (95% CI = 0.678, 0.840), as measured by an intraclass correlation coefficient. The levels of agreement between the two raters for the individual items of the assessment criteria ranged from κ = 0.359 (item 3) to κ = 0.693 (item 4). This study provides some support for the summative assessment of portfolios. The findings suggest that discussion and negotiation between independent assessors can enhance the reliability of assessment criteria. Therefore, medical educators are encouraged to use such procedures in the summative assessment of portfolios. [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]