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Introduction: Globally, people with the academic and personal attributes to successfully study medicine experience disadvantages associated with sociodemographic factors. Governments have attempted to address this issue via macrolevel policies aimed at widening participation (WP) to medicine. These policies differ by country, suggesting much can be learned from examining and comparing international policy discourses of WP. Our question was: How are discourses of WP to higher and medical education positioned in the UK and Australia?, Methods: A systematic search strategy was guided by five a priori themes inspired by United Nations Sustainability Goals (2015). Seventeen policy documents (UK n = 9, Australia n = 8) published between 2008 and 2018 were identified. Analysis involved two over-arching, iterative stages: a document analysis then a Foucauldian critical discourse analysis, the latter with the aim of unveiling the power dynamics at play within policy-related discourses., Results: Discourses of social mobility and individual responsibility within a meritocracy are still paramount in the UK. In contrast, the dominant discourse in Australia is social accountability in achieving equity and workforce diversity, prioritising affirmative action and community values. Similarities between the two countries in terms of WP policy and policy levers have changed over time, linked to the divergence of internal drivers for societal change. Both nations recognise tensions inherent in striving to achieve both local and global goals, but Australia appears to prioritise community values in working towards 'nation building' whereas in the UK the focus on individuality and meritocracy at times seems at odds with achieving parity for disadvantaged individuals., Discussion: WP policies and practices are situated and contextual so caution must be taken when extrapolating lessons from one context to another. The history of a country and the nature of marginalisation in that country must be scrutinised when trying to understand what drives WP policy., (© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background/objectives: With increasing medical student numbers and decreasing clinical teaching opportunities, there has been a need to develop alternative learning resources. The aim of this study was to examine the effectiveness of a new dermatology online teaching resource, from a student perspective., Methods: The Australasian College of Dermatologists developed an undergraduate dermatology curriculum and subsequently created online teaching modules in partnership with the University of Sydney. These modules were introduced to final year medical students at the University of Western Australia in 2010. The dermatology learning experiences of these 142 students were compared with the 2009 medical student cohort who did not have access to this resource. A self-administered questionnaire, with a 5-point rating scale, was used., Results: The 2010 cohort described an improved educational experience using the online modules. Despite a reduction in the number of clinics attended, knowledge and skills gained were scored higher among the 2010 cohort. The student's confidence in their ability to manage common dermatological conditions was also statistically higher in the cohort with the online teaching resource. The learning experience for dermatology compared to other subspecialty teaching in medical school was ranked as a significantly more positive experience in the 2010 cohort., Conclusions: Our results suggest that the introduction of the online modules described in this paper to support learning have improved the perceived educational experience of medical students and should be incorporated as a way to improve student teaching in the face of reduced clinic teaching., (© 2011 The Authors. Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists.)

Context: There is increasing agreement that graduates who finish tertiary education with the full complement of skills and knowledge required for their designated profession are not 'work-ready' unless they also acquire interpersonal, collaborative practice and team-working capabilities. Health workers are unable to contribute to organisational culture in a positive way unless they too attain these capabilities. These capabilities have been shown to improve health care in terms of patient safety, worker satisfaction and health service efficiency. Given the importance of interprofessional learning (IPL) which seeks to address these capabilities, why is IPL not consistently embedded into the education of undergraduates, postgraduates and vocationally qualified personnel through formal assessment?, Methods: This paper offers an argument for the formal assessment of IPL. It illustrates how the interests of the many stakeholders in IPL can benefit from, and contribute to, the integration of IPL into mainstream professional development and tertiary education. It offers practical examples of assessment in IPL which could drive learning and offer authentic, contextual teaching and learning experiences to undergraduates and health workers alike., Conclusions: Assessment drives learning and without formal assessment IPL will continue to be viewed as an optional topic of little relative importance for learners. In order to make the next step forward, IPL needs to be recognised and endorsed through formal assessment, both at the tertiary education level and within the workplace environment. This is supported by workforce initiatives and tertiary education policy which can be used to specify the capabilities or generic skills necessary for effective teamwork and collaborative practice.

Objectives: This study aims to identify whether non-science graduates perform as well as science graduates in Basic and Clinical Sciences (B & CS) assessments during Years 1-3 of a four-year graduate-entry programme at the University of Sydney (the 'USydMP')., Methods: Students were grouped into five categories: Health Professions (HP), Biomedical Sciences (BMS), Other Biology (BIOL), Physical Sciences (PHYS) or Non-Science (NONS). We examined the performance rank of students in each of the five groups for single best answer (SBA) and modified essay (MEQ) assessments separately, and also calculated the relative risk of failure in the summative assessments in Years 2 and 3., Results: Students with science-based prior degrees performed better in the SBA assessments. The same occurred initially in the MEQs, but the effect diminished with time. The HP students performed consistently better but converged with other groups over time, particularly in the MEQs. Relative performance by the NONS students improved with time in both assessment formats. Overall, differences between the highest and lowest groups were small and very few students failed to meet the overall standard for the summative assessments. HP and BMS students had the lowest failure rate. NONS students were more likely to fail the assessments in Year 2 and 3, but their pass rates were still high. Female students performed significantly better overall at the end of Year 2 and in Year 3. There were only minor differences between Australian resident and International students., Conclusion: While there are small differences in performance in B & CS early in the programme, these lessen with time. The study results will inform decisions regarding timing of summative assessments, selection policy and for providing additional support to students who need it to minimize their risk of failure. Readers should note that this paper refers to student performance in only one of the four curriculum themes, where health professional and science graduates would be expected to have a significant advantage.

The present paper briefly describes a growing trend in continuing professional development (CPD) for medical practitioners, examines some recent published contributions related to professionalism in medicine and describes the theoretical platform of a CPD framework based on medical professionalism that has been developed for use in a variety of medical specialties. The work arises from a project funded by The Commonwealth Department of Health and Ageing and conducted by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on behalf of the Committee of Presidents of Medical Colleges. Overall, the aim of the project was to design and develop a framework that can be considered 'best practice' in the field of medical specialist CPD, and which could be applicable to a wide variety of medical specialties and practice environments. The project was informed by available literature in areas such as the ways in which medical practitioners learn and the effectiveness of CPD, as well as consultations with a variety of stakeholders in the health-care field, including medical boards, medical defence organisations, health complaints organisations, specialist medical colleges and practising specialists. Overwhelmingly, the primary purpose of specialists participating in ongoing CPD was, according to the project consultations conducted, the maintenance, development and improvement of skills that enable consumers of healthcare to be confident of the level of care that they receive. Coupled with the need to recognise CPD as contributing to the wider context of professional practice, the resulting framework is underpinned by a theoretical platform based on the concept of medical professionalism. It is this theoretical platform, which articulates the nature of and responsibilities associated with the practice of specialist medicine, that enables a CPD framework to be constructed that can accommodate a wide range of specialist disciplines and practice settings, while also framing ongoing education expectations from the viewpoint of a range of stakeholders, rather than a single perspective; that of practitioners themselves.

Context and Objectives: Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching., Methods: Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional., Results: The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can 'teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others., Conclusion: Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers.

This paper reviews the recent literature on learning styles and approaches to learning. It identifies two separate streams of research, one originating from mainstream cognitive and psychometric psychology and one from research undertaken within the everyday learning environment. The latter is dealt with in greater detail as it seems to have more immediate practical relevance. A simple model of the teaching-learning process is presented showing how students learn in different ways which are partly attributable to their preferred learning style and partly to the context in which the learning takes place. Three basic approaches have been identified: surface, deep and strategic, each resulting in a different learning outcome. The most desirable and successful is the deep approach. The way in which the teaching and the policies of the department and school influence the students' approach to learning are reviewed in some detail. A consideration of these characteristics in medical schools suggested that many may hinder rather than assist in the development of the desired approach. The work reviewed here suggests that the remedy will require not only substantial changes in the teaching, curriculum and, particularly, assessment, but also a new strategy based on identifying and assisting individual students whose approaches to study are not those expected of a competent university-educated doctor.

This paper reports a study which compared the performance of different groups of students and doctors on identical and equivalent tests set in an objective-type format and in a free-response format. The tests were designed to ensure that the content was relevant to clinical practice at the hospital intern level. In all test situations candidates' scores were significantly higher in the objective tests than in the free-response tests. This difference was greater for the more junior and less competent students than for the more competent doctors. The cueing effect of the options was thought to be the main factor responsible for the difference in performance. The results of a questionnaire survey demonstrated that students were aware of the deficiencies in multiple-choice tests. A large majority of the students believed that the free-response tests gave a more accurate assessment of their clinical ability. It was found that in these tests, aimed at measuring aspects of clinical competence, multiple-choice questions appeared to overestimate the candidate's ability to an extent that made them less suitable than free-response questions for this purpose. It was also found that free-response tests, of the type used in this study, provide a suitable alternative to multiple-choice tests for use in the written section of clinical examinations. It was concluded that the written component of the final examination in the medical course should have a preponderance of free-response items over multiple-choice items.

Evaluation of a number of courses in clinical decision-making (CDM) indicates that there are well-defined problems in teaching this subject. This paper describes some of the difficulties and proposes appropriate remedies. Problems in teaching undergraduates are different from those in the postgraduate years. Three areas where the principles of CDM are particularly useful to undergraduates relate to the structuring of clinical problems, clarifying the place of value judgements and developing new concepts regarding test ordering, particularly the importance of false positive rates and the overwhelming power of prior probabilities. In postgraduate teaching the most important areas relate to the origin of probability and of utility estimates. The complexity of decision analysis also needs critical comment. Two remedies are suggested which will help course developers when faced with these problems. Firstly, the early introduction of concepts regarding sensitivity analysis, making it clear that with the aid of CDM we are able to deal with a wide range of probability estimates, precision rarely being required in clinical medicine. Secondly, the availability of educational support systems will help expert clinicians teach CDM concepts within their own field.