Search

Objectives: To explore the feasibility and value of using real patients as trigger material in problem-based learning (PBL)., Design: A questionnaire was given to all students participating in a PBL module including a question about 'the added value of using real, as opposed to paper cases', in problem-based learning. Resources used by students and assessment of feasibility were recorded by the course tutors., Setting: A 7-week student-selected problem-based module in general practice in the fourth-year undergraduate medical curriculum, University of Newcastle upon Tyne., Subjects: 69 students participating in the module over 2 years., Results: All students valued the use of real patients. A total of 10 categories were identified, all congruent with accepted educational principles for effective adult learning. Real patients stimulated the use of a very wide range of resources and imaginative presentation of what had been learned., Conclusion: Real patients are potent trigger stimuli in problem-based learning. The use of real patients in this general practice-based module presented no organizational or ethical difficulties. Their use should be considered more widely.

The quality of a multiple true-false (MTF) examination paper in public health medicine for 149 clinical medical students was evaluated using predefined performance criteria to offer guidelines for improvement of such a paper. There were 35 questions, each with five true-false branches, and the performance of the overall best 25% of candidates was compared for individual items with that of the overall worst 25%. To improve discrimination between best and worst candidates, 60% of items needed changes, and several indicators were used to identify how, usually because the branch was too easy (26%), unpopular (16%) or too hard (10%). A number of guidelines for writing good MTF questions and for improving them are suggested. The inequity is illustrated of marking systems which do not allocate a negative mark for incorrect answers equal in size to the positive mark for correct ones, with zero for unanswered questions or 'don't know' answers.

Aim The aim of this paper is to explore what might be gained from collecting and analysing visual data, such as photographs, scans, drawings, video and screen recordings, in clinical educational research. Its focus is on visual research that looks at teaching and learning 'as it naturally occurs' in the work place, in simulation centres and other sites, and also involves the collection and analysis of visual learning materials circulating in these sites. Background With the ubiquity of digital recording devices, video data and visual learning materials are now relatively cheap to collect. Compared to other domains of education research visual materials are not widely used in clinical education research. The paper sets out to identify and reflect on the possibilities for visual research using examples from an ethnographic study on surgical and inter-professional learning in the operating theatres of a London hospital. Main contribution The paper shows how visual research enables recognition, analysis and critical evaluation of (1) the hidden curriculum, such as the meanings implied by embodied, visible actions of clinicians; (2) the ways in which clinical teachers design multimodal learning environments using a range of modes of communication available to them, combining, for instance, gesture and speech; (3) the informal assessment of clinical skills, and the intricate relation between trainee performance and supervisor feedback; (4) the potentialities and limitations of different visual learning materials, such as textbooks and videos, for representing medical knowledge. Discussion and conclusion The paper concludes with theoretical and methodological reflections on what can be made visible, and therefore available for analysis, explanation and evaluation if visual materials are used for clinical education research, and what remains unaccounted for if written language remains the dominant mode in the research cycle. Opportunities for quantitative analysis and ethical implications are also discussed. [ABSTRACT FROM AUTHOR]

Objectives: Although there is much evidence to support the use of simulation‐based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. Methods: Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. Findings: A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy‐in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. Conclusions: Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised. Although "validity" is a central concept for educators, this research outlining the conversion of outcome frameworks to assessment practice illustrates that the concept can easily get lost in translation. [ABSTRACT FROM AUTHOR]

Objectives The new curriculum at King’s College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5␣years of their medical education. Design This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King’s teaching network. Setting King’s College School of Medicine and Dentistry. Subjects Medical undergraduates. Results The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. Conclusions The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise. [ABSTRACT FROM AUTHOR]

Objectives This study set out to answer the following questions. What influences a junior doctor’s response to a judgement call within a clinical setting? What, if any, are the relationships between these influences? Methods This paper describes an interpretivist study based on a grounded theory approach to data analysis. This involved a phased approach to data collection using semi-structured interviews. Analysis was facilitated by observations and group presentations. Participants were doctors in their first year of postgraduate practice who were purposively selected from a range of hospitals in the Northern Deanery. Results The data demonstrated a number of influences on whether junior doctors chose to seek senior assistance. These included the upholding and balancing of tenets that were necessary for ensuring safe practice, and estimating the chance and severity of potential negative consequences to patients, themselves and their teams. In order to make these judgements, junior doctors drew on different forms of knowledge, especially knowledge gained from previous clinical experiences. In judging whether or not to contact a senior, pre-registration house officers (PRHOs) were practising essential clinical attributes, that of independent yet co-operative and discerning practitioners who are able to balance multiple considerations while ensuring patient care. Conclusions This particular judgement of risk, as it was described by those interviewed, was a dynamic process exemplified by the need to create counterbalances between multiple consequences. As a result, no prescriptive action could have allowed PRHOs to deal with the numerous configurations they faced and took into account. [ABSTRACT FROM AUTHOR]

Introduction Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention. Methods The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo© software for qualitative data management. Results Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning. Conclusion Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties. [ABSTRACT FROM AUTHOR]

Objectives In the present state of flux affecting UK medical undergraduate education, there is a pressing need for evaluative methods which will identify relevant outcomes both expected and unanticipated. The student perspective is now legitimately accepted to form part of any evaluative exercise but qualitative methods commonly used for this purpose are expensive in time and analytical skills. The nominal group technique (NGT) has been used for various purposes, including course evaluation, and appears well suited to this application. It combines qualitative and quantitative components in a structured interaction, which minimizes the influences of the researcher, and of group dynamics. The sequence and mechanics of the NGT process are described as applied to an end of first year evaluation in a novel undergraduate course. Doubts have been raised as to whether the results of NGT can be generalized to the larger group. In this paper, this problem is overcome by compiling a questionnaire based on the NGT items which was distributed throughout the class. Design Nominal group technique with questionnaire development. Setting The medical school at The University of Liverpool. Subjects Medical students. Results Previous claims made on behalf of the NGT, such as the focus on the student voice, the minimizing of leadership influence and the richness of the data, are upheld in this report. Broad agreement was found with the NGT items but two items (10%) did not display any consensus. Conclusions The questionnaire extension of the NGT provides back-up evidence of the reliability of the data derived from the technique and enables it to be applied to the larger groups typical of undergraduate medicine. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1251-1261 Objectives Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Methods Semi-structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Results Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Conclusions Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors. [ABSTRACT FROM AUTHOR]

Introduction The teaching of anatomy remains controversial to the present day. This paper explores the arguments over its merits in medical and scientific education at one of the ancient universities. History Medical professors at Cambridge University relied upon the science departments to provide basic scientific instruction, whilst science professors relied upon medical students to make up numbers for their courses. Discussion Human anatomy became a source of contention: did it really educate the mind, or was it simply a dry subject that medical students had to learn by rote? Could the university even cater for professional education? [ABSTRACT FROM AUTHOR]

Background There is inconclusive debate within the literature as to whether the best problem-based learning (PBL) tutors are subject experts or not. The debate hinges on whether knowledgeable tutors are tempted to intervene too often in PBL discussions compared to non-expert tutors, and whether the latter may not be able to sufficiently challenge the students' level of understanding. Purpose To describe approaches used by tutors in PBL tutorials and to identify differences between tutors from medical and non-medical backgrounds. Methods The research reported in this paper was undertaken during the academic session 1999–2000 at the Univeristy of Liverpool Faculty of Medicine. A qualitative exploratory case study method was used and two PBL groups were observed. One of these groups had a medically qualified tutor and the other had a tutor from a humanities background. The focus of the observation was the discourse between tutor and students, which was analysed using a framework drawn from linguistics. Results were fed back to both the tutors and the students to check their perceptions of the interactions. Results Analysis of the tutorial group interaction revealed that tutors from both backgrounds used similar techniques to raise students' awareness, facilitate the group process and direct students' learning. Differences were noted between the two tutors: the medical tutor set out to raise students' awareness by using questioning techniques herself, whereas the non-medical tutor expected students to question each other. The non-medical tutor was observed to facilitate the group process more often than the medical tutor. Conclusions Qualitative analysis of spoken discourse in PBL tutorials provides valuable insights into the processes involved in PBL, thereby generating material which is useful for both training of and giving feedback to PBL tutors. [ABSTRACT FROM AUTHOR]

Background and objectives The University of Manchester's undergraduate curriculum was reorganised in 1994. Problem-based learning (PBL) was chosen as the central educational method throughout the 5 years. A thematic interdisciplinary style provided a framework around which to select and integrate content. The theme for family, reproductive and child health for the 14-week Families and Children Module (FCM) in year 4 integrated content from obstetrics-gynaecology, paediatrics (including child psychiatry), genetics and public health. This paper focuses on the FCM which has put to test some of the principles of integration. Methods The educational process and outcome of the FCM was evaluated with information from (1) Open Forum feedback sessions (2) student questionnaires and (3) students' performance in an objective structured clinical examination (OSCE). Results Significant problems were encountered during the first year of the FCM (1997–98). An Open Forum for all students and staff was convened after each module in order to address the level of concern. Students' responses to questionnaires reflected the overall impression obtained from the Open Forum. Difficulties appeared to be more than the anxieties and challenges inherent in organisational change and were not simple practical timetabling problems. Tutors perceived a loss of coherence and student contact; students reported difficulties maintaining sufficient continuity of focus in clinical and academic learning experiences. The intended level of integration of paediatrics and obstetrics-gynaecology was unmanageable. Consequently, the FCM (1998–99) was divided into separate attachments for clinical learning and experience in paediatrics and obstetrics-gynaecology, each of 7 weeks' duration. Further open feedback sessions revealed that the modifications implemented in 1998–99 were associated with positive experiences for students and tutors. Comparison of responses to the evaluation... [ABSTRACT FROM AUTHOR]

Introduction This paper describes a study designed to evaluate assessment in postgraduate dental education in England, identifying strengths and weaknesses and focusing specifically on its relevance, consistency and cost-effectiveness. Methods A four-phase qualitative method was used: a mapping of current career paths, assessment policy, and issues (phase 1); more detailed studies of the practice of assessment for a range of courses, and the systemic/management perspective of assessment (i.e. quality assurance) (phases 2 and 3), and analysis and reporting (phase 4). Data were analysed from documents, interviews, group consultations and observations. Results and discussion Five key issues may be distilled from the findings: (i) lack of formal assessment of general professional training; (ii) trainer variation in assessment; (iii) the extent to which assessments are appropriate indicators of later success; (iv) the relationship between assessment and patient care, and (v) data to assess the costs of assessment. Conclusion Current assessment procedures might be improved if consideration is given to: assessment which supports an integrated period of general professional training; training for trainers and inspection procedures to address variation; more authentic assessments, based directly on clinical work and grading cases and posts, and better data on allocation of resources, in particular clinicians’ time given to assessment. [ABSTRACT FROM AUTHOR]

Introduction This paper describes the design (of process and content), implementation and evaluation of a component of the Human Diversity Module developed to teach cultural diversity to undergraduate medical students. The objectives of the teaching were to enable students to gain factual and practical information about other cultures and also for them to examine their own attitudes. Method Students completed a questionnaire, designed in a previous study, at two stages; the first before the component on cultural diversity had been delivered and the second after the sessions on cultural diversity. The time interval between stages 1 and 2 was 1 week. The cultural diversity component was developed using a range of sources. Results Out of 181 students, 140 (77·3%) completed the questionnaire at both stages. There were a number of statistically significant findings, which indicate that the teaching enabled the session objectives to be successfully met. The findings include statistically significant changes that reflect more ‘positive’ attitudes about cultures coming together and about specific cultures. Conclusion The study indicates that attitudes changed over the period of teaching. There is, however, scope for further development of measures to enable attitudinal shifts to be evaluated. [ABSTRACT FROM AUTHOR]

Purpose This paper reports a study which attempted to examine the influence of a varied assessment programme on student motivation to learn in an undergraduate therapy degree course. Methods In March 1997 a questionnaire was distributed to 98 third-year occupational therapy and physiotherapy students at the Southampton University School of Occupational Therapy and Physiotherapy. Using closed and open questions the questionnaire required the students to consider all the assessments they had taken in their 3 years of study and provide information about which type of assessment they found most motivating for their learning, and why. Results and conclusions The results revealed that students found a wide range of assessments motivating. There was some satisfaction with the mix and range of assessments. Three assessments emerged as the most motivating for student learning: Clinical/fieldwork II and III and Methods of inquiry III. In addition, four factors associated with assessment appeared to influence student motivation: perceived relevance and content of the assessment, enthusiastic lecturers and group influences. These factors need to be explored in more detail but in order to do so, educators need to be prepared to engage in an open dialogue with students about the learning climate that is created within higher education. [ABSTRACT FROM AUTHOR]

The review which this paper outlines aimed to explore whether the ward round of the surgical team at Birmingham Children’s Hospital achieved its objectives and to investigate the attitudes of medical and nursing staff, patients and their parents towards the round. Initial open-ended interviews generated themes from which questionnaires were constructed and administered to 16 members of the surgical team, 30 nurses, 14 patients and 24 parents. The surgical team generally felt that the round plays a valuable role whereas the nursing team expressed dissatisfaction with many aspects of the round. The majority of the surgical and nursing team thought that the round should change from its present form and a number of suggestions were made as to how changes in the round could improve the quality of the teaching experience and promote quality in patient care. Patients tended to express rather neutral feelings towards the round although a significant minority of parents expressed concerns over confidentiality and the level of anxiety felt by children. It is hoped that the results of this review will be used to inform changes in the way the round is carried out. A further review will be initiated in the future to evaluate the efficacy of any such changes. [ABSTRACT FROM AUTHOR]

ObjectivesThe WISDOM project applies Internet technologies to create a virtual classroom in health informatics for primary care professionals. Participants use a facilitated E-mail discussion list supported by a web site which provides on-line resources and an archive of teaching materials. DesignThe project took an adult-learning model in which participants identify their learning needs, emphasized using informatics skills in practice, and focused on skills likely to enhance evidence-based practice. The paper describes the project and an evaluation of the first programme which ran in 1997 with 28 participants. Pre- and post-intervention questionnaires were used to assess perceived skills in informatics and evidence-based practice. SettingUniversity of Sheffield. SubjectsPrimary care professionals. Results Participants reported statistically significant increases in eight informatics skills. There were no significant changes in evidence-based practice skills. The web-site, seminar programme and discussion list were highly rated as useful in delivering informatics training. Conclusions The WISDOM approach is effective for the delivery of informatics training to primary care professionals, and may be used more widely for other subjects and professional groups. There is a need for further research into facilitating virtual classrooms. [ABSTRACT FROM AUTHOR]

Comments on the paper 'Building confidence for work as house officers: student experience in the final year of a new problem-based curriculum.' by C.R. Whitehouse et al. Educational potential of initiative at Manchester Medical School, England; Limitations associated with the evaluation of educational intervention; Lack of clarity about the meaning of self-directed learning among teachers and students.

Replies to Barbara Miflin's comments on the authors' paper 'Building confidence for work as house officers: student expertise in the final year of a new problem-based curriculum.' Initiative at the Manchester Medical School, England; Points of agreement and disagreement regarding self-directed learning.

Examines the changes in assessing the physicians competence in London, England. Introduction of technical reforms; Use of non-standardized patients in qualifying examinations; Application of psychometric measures.

Background Peer-marking has been suggested as a method to enhance self-directed learning and reflection, although whether this improves performance is unclear. This study evaluated the impact of peer-marking on examination performance and investigated its reliability and acceptability to students. Methods First-year medical students were randomised to peer-marking using a model answer or no intervention (control arm). Student scores were compared with tutor-marked scores. Two months later, students completed a summative assessment and performance was compared between students randomised to peer-marking and the control arm. A focus group was held with students in the intervention arm to capture their experiences and attitudes. Results A total of 289 of 568 students consented to participate and 147 were randomised to peer-marking (142 controls). Students randomised to peer-marking achieved marginally higher examination marks (1.5% difference, 95% CI −0.8% to 3.9%, P = 0.19) than controls (adjusting for year and in-course assessment), although this may have been due to chance. Students were harsher markers than the tutors. Focus group analysis suggested that students valued peer-marking, although concerns about passing judgement on a colleague's work were expressed. Conclusions Peer-marking did not have a substantial effect on examination performance, although a modest effect cannot be excluded. Students gained insight into examination technique but may not have gained deeper knowledge. Given its potential positive educational value, further work is required to understand how peer-marking can be used more effectively to enhance the learning experience. [ABSTRACT FROM AUTHOR]

Objectives To describe the ways in which the doctor–patient relationship experienced by newly qualified pre-registration house officers (PRHOs) differed from their undergraduate expectations. Design Qualitative study in which in-depth semistructured interviews were carried out with each PRHO within 4–6 weeks of the start of their first job. Setting Three teaching hospitals, three district general hospitals and four general practices in south-east England. Participants 24 newly qualified PRHOs. Results A number of differences were identified by PRHOs. These were caused in part by the impact of factors such as the shortage of time, which could lead to emotional ‘blunting’. Some PRHOs were changing their ideas about what constitutes a ‘good’ doctor, and were redefining the meaning of a ‘professional’ relationship. The relationships of PRHOs with patients were also affected by the attitudes of their senior colleagues. For example, where PRHOs tried to maintain a patient-centred relationship, they could be identified by colleagues as working too slowly. PRHOs working in general practice were able to utilize and improve their communication skills with patients, but found it difficult to transfer these skills back into the hospital setting. Conclusions Despite receiving substantial undergraduate education on how best to communicate with patients, a variety of factors conspired to prevent hospital-based PRHOs from utilizing this information. Building on these findings, a number of recommendations are made to help improve practice. [ABSTRACT FROM AUTHOR]

Aims To describe aspects of the clinical experience and educational supervision gained by pre-registration house officers (PRHOs) in general practice, and to relate these to the current General Medical Council (GMC) aims for general clinical training in general practice. Design Qualitative evaluation, part of which involved semistructured interviews with 12 PRHOs who were experiencing a general practice rotation. Interviews were conducted at the beginning and the end of the pre-registration year, and following return to hospital work after completion of the general practice placement. Settings Three teaching hospitals, two district general hospitals and six general practices in south-east England. Participants 12 PRHOs who were involved in rotations incorporating a general practice placement. Results To varying degrees, the GMC aims for training in general practice were met for all the participants. All PRHOs recognized the value of the clinical experience and educational supervision they received in general practice. They particularly valued aspects such as having an individual training programme based on their own needs, and the interlinking of theory and practice, which aided learning. Most felt that having responsibility for their own patients acted as an important incentive for learning, and in general, PRHOs appreciated having the time to learn which general practice allowed. Conclusions For the majority of PRHOs, the time spent in general practice was seen as a positive clinical and educational experience. In a variety of ways, the general practice placement encouraged PRHOs to develop the self-directed learning skills seen as essential to the lifelong learning advocated by the GMC. A number of recommendations are made to help improve the integration of the hospital and general practice components of these rotations. [ABSTRACT FROM AUTHOR]

Objective To identify what students can learn from studying medicine and literature as part of a final-year special study module in general practice. Method The project reports and evaluation forms completed by all eight students who had chosen to study medicine and literature as part of their special study module in general practice at Nottingham University Medical School were analysed qualitatively. Results Students said that they gained a greater understanding of the patient’s experience of illness, as a result of the texts they had read. They learned how illness can affect family or friends of the patient and about the psychological impact of physical illness. Most students thought their future care of patients would be influenced by what they had learned. Studying medicine in literature during a clinical attachment allowed students to draw comparisons between literature and their clinical experience. Discussion This study is based on a small number of students who chose to study medicine in literature. The results may not be generalizable to all medical students and not all students may be receptive to this method of learning. However, we recommend that students who are interested should be given the opportunity to study medicine in literature during their clinical years. This can enable them to reflect on their clinical experience and can provide a more profound understanding of the consequences of illness for the patient and their family. [ABSTRACT FROM AUTHOR]

Objectives To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates. Design A multifaceted approach employing quantitative and qualitative techniques. Setting All medical schools in North Thames Region. Subjects Students, GP tutors and hospital specialists. Results The model was successfully adopted in a broad range of clinical specialties in all of the participating medical schools, resulting in a doubling of the involvement of general practice in clinical teaching. Participating students provided an overwhelmingly positive evaluation of the attachments and there was a clear perception of benefit amongst the participating GPs. However, the views of the participating hospital clinicians were less positive and the true nature and extent of the educational impact proved difficult to assess. Conclusions This model of collaborative clinical teaching between hospital and general practice can be implemented in accordance with the project’s key aims, but the enthusiastic involvement of hospital clinicians may be difficult to secure. [ABSTRACT FROM AUTHOR]

Description of courseIn 1994, a new problem-based leaning (PBL) curriculum for year 1 medical students was introduced at the University of Manchester. The use of PBL has continued into the clinical clerkships. Year 3 of the curriculum is based entirely in a clinical environment with PBL groups meeting in three teaching hospitals. During this year, all students undertake two integrated 14-week modules with overarching themes. Each week, groups of eight students discuss a trigger problem connected to the relevant theme. The steps the groups use in the PBL process have been amended to encourage students to link their discussion with clinical experience. EvaluationAt the end of each module, all 309 students were requested to complete an evaluation questionnaire. The response rates were 80% (n=247) and 89% (n=275) for the two core modules. ResultsThe students have remained ‘happy with the way the course is going’ (83% at the end of module 2). They were also asked to rate a number of statements on a 5-point Likert scale (5=strongly agree). Concerning PBL, the students remained confident about working in a group (median 4), producing a set of learning objectives (median 4) and linking clinical experience with other knowledge (median 4). However, there were changes over the year. Fewer students agreed at the end of module 2 that ‘the working problems were stimulating’ (P=0·002) or ‘motivated them to learn’ (P < 0·001), but the clinical firms were seen as providing more appropriate experience (P=0·01) and being aware of the new curriculum and responding to it (P=0·018). We also surveyed the PBL tutors and had 65 returns from 78 people involved in the 38 PBL groups in year 3. The great majority of these are doctors employed by the National Health service. Virtually all the responders were happy to continue being a tutor (97%) and would recommend it to a colleague (93%). ConclusionsThe evaluation has been positive with PBL having been successfully implemented in a clinical environment. We have identified significant changes over the year, which we need to address as we consolidate the curriculum. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the teaching techniques of educators on medical students in England. Importance of acquiring student feedback; Expression of the humanistic side of the learning of students; Role of tutors as role models for students.

Comments on an article which examined the assessment methods used in postgraduate dental education in England, published in the June 2001 issue of `Medical Education.' Impact of the standards set by the health care systems on the assessment methods; Difficulties posed by the diversity of dental education to the assessment process.

Context Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. Objectives This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Methods Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Results Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Conclusions Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. [ABSTRACT FROM AUTHOR]

Context There is little room in clerkship curricula for students to express emotions, particularly those associated with the development of a caring identity. Yet it is recognised that competence, alone, does not make a good doctor. We therefore set out to explore the relationship between emotions and identity in clerkship education. Our exploration was conceptually oriented towards Figured Worlds theory, which is linked to Bakhtin's theory of dialogism. Methods Nine female and one male member of a mixed student cohort kept audio-diaries and participated in both semi-structured and cognitive individual interviews. The researchers identified 43 emotionally salient utterances in the dataset and subjected them to critical discourse analysis. They applied Figured Worlds constructs to within-case and cross-case analyses, supporting one another's reflexivity and openness to different interpretations, and constantly comparing their evolving interpretation against the complete set of transcripts. Results Students' emotions were closely related to their identity development in the world of medicine. Patients were disempowered by their illnesses. Doctors were powerful because they could treat those illnesses. Students expressed positive emotions when they were granted positions in the world of medicine and were able to identify with the figures of doctors or other health professionals. They identified with doctors who behaved in caring and professionally appropriate ways towards patients and supportively towards students. Students expressed negative emotions when they were unable to develop their identities. Conclusions Critical discourse analysis has uncovered a link between students' emotions and their identity development in the powerful world of becoming and being a doctor. At present, identity development, emotions and power are mostly tacit in undergraduate clinical curricula. We speculate that helping students to express emotions and exercise power in the most effective ways might help them to develop caring identities. [ABSTRACT FROM AUTHOR]

Context In a previous study, we found that emotional intelligence ( EI) mediates the negative influences of Year 1 medical students' attachment styles on their provider-patient communication ( PPC). However, in that study, students were examined on a relatively straightforward PPC skill set and were not assessed on their abilities to elicit relevant clinical information from standardised patients. The influence of these psychological variables in more demanding and realistic clinical scenarios warrants investigation. Objectives This study aimed to validate previous research findings by exploring the mediating effect of EI on the relationship between medical students' attachment styles and their PPC across an ecologically valid PPC objective structured clinical examination ( OSCE). Methods Year 2 medical students completed measures of attachment (the Experiences in Close Relationships-Short Form [ ECR- SF], a 12-item measure which provides attachment avoidance and attachment anxiety dimensional scores) and EI (the Mayer-Salovey-Caruso Emotional Intelligence Test [ MSCEIT], a 141-item measure on the perception, use, understanding and management of emotions), prior to their summative PPC OSCE. Provider-patient communication was assessed using OSCE scores. Structural equation modelling ( SEM) was used to validate our earlier model of the relationships between attachment style, EI and PPC. Results A total of 296 of 382 (77.5%) students participated. Attachment avoidance was significantly negatively correlated with total EI scores ( r = −0.23, p < 0.01); total EI was significantly positively correlated with OSCE scores ( r = 0.32, p < 0.01). Parsimonious SEM confirmed that EI mediated the negative influence of attachment avoidance on OSCE scores. It significantly predicted 14% of the variance in OSCE scores, twice as much as the 7% observed in the previous study. Conclusions In more demanding and realistic clinical scenarios, EI makes a greater contribution towards effective PPC. Attachment is perceived to be stable from early adulthood, whereas EI can be developed using targeted educational interventions. The validation of this theoretical model of PPC in Year 2 medical students strengthens the potential educational implications of EI. [ABSTRACT FROM AUTHOR]

Context Peer-assisted learning ( PAL) is recognised as an effective learning tool and its benefits are well documented in a range of educational settings. Learners find it enjoyable and their performances in assessments are comparable with those of students taught by faculty tutors. In addition, PAL tutors themselves report the development of improved clinical skills and confidence through tutoring. However, whether tutoring leads to actual improvement in performance has not been fully investigated. Objectives As high-achieving students are already en route to succeeding in final examinations, we wanted to examine whether participation in a peer-tutoring programme in itself leads to better final-year examination performance. Methods We conducted a retrospective analysis of results on final-year written and clinical examinations at University College London Medical School during 2010-2012. Z-scores were calculated and the performances of PAL tutors and students who were not PAL tutors were compared using analysis of covariance (ancova). Year 4 examination results were used as indicators of previous academic attainment. Results Of the 1050 students who attempted the final examination, 172 were PAL tutors in the final year. Students who acted as PAL tutors outperformed students who did not in all examination components by 1-3%. Z-scores differed by approximately 0.2 and this was statistically significant, although the significance of this difference diminished when controlling for Year 4 results. Students who acted as PAL tutors who had scored in the top quartile in Year 4 examinations scored significantly better in a long-station objective structured clinical examination ( LSO). Conclusions Although students who acted as PAL tutors performed better than students who did not in final-year examinations, this difference was small and attributable to the students' background academic abilities. High-achieving students appear to be self-selecting as peer-tutors and their enhanced performance in LSOs may reflect their inherent academic abilities. Although peer-tutoring in itself did not lead to enhanced examination performance, further studies are required as many factors, such as the proximity of examinations and previous tutoring, can potentially affect the relationship between peer-tutoring experience and examination performance. [ABSTRACT FROM AUTHOR]

Objectives Attachment style has been shown to influence both emotional intelligence (EI) and the clinical communication of medical students and doctors. No research has assessed the relationships among attachment, EI and clinical communication in medical students. This study was conducted to evaluate the effect of EI on the relationship between medical students' attachment style and clinical communication. Methods Medical students were invited to complete measures of attachment (using the Experiences in Close Relationships-Short Form [ECR-SF], a 12-item measure that provides attachment avoidance and attachment anxiety dimensional scores) and EI (using the Mayer-Salovey-Caruso Emotional Intelligence Test [MSCEIT], a 141-item measure of the perception, use, understanding and management of emotions) at the end of Year 1, prior to a summative objective structured clinical examination (OSCE). Clinical communication was assessed using OSCE scores. Structural equation modelling (SEM) was used to analyse a hypothetical model of the relationships among attachment style, EI and clinical communication. Results A total of 200 of 358 (55.9%) students participated. Attachment avoidance was significantly negatively correlated with total EI scores ( r = − 0.28, p < 0.01); total EI was significantly positively correlated with OSCE scores ( r = 0.23, p < 0.01). A parsimonious SEM revealed that attachment avoidance accounted for 13% of the variance in students' total EI scores but did not directly predict OSCE scores, whereas total EI significantly predicted 7% of the variance in OSCE scores. Conclusions Attachment is perceived to be stable from early adulthood, whereas the literature suggests that EI can be developed through the use of targeted interventions. This has potential implications for the training of medical students in clinical communication. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 261-272 This study aimed to explore medical students' explanations of their behaviour when instructed to observe or perform intimate examinations or procedures without valid patient consent. We used a qualitative design employing individual and group interviews to elicit narratives of dilemmas associated with professionalism. Qualitative thematic analyses of narratives were followed by a qualitative and quantitative analysis using a validated coding scheme of students' explanations of their behaviours within dilemmas involving intimate examinations carried out without valid consent. Participants ( n = 200) were medical students drawn from each academic year of three medical schools, representing two 5-year undergraduate programmes and one 4-year graduate-entry programme in England, Wales and Australia. Of 833 narratives collected, 112 involved dilemmas associated with intimate examinations. Of these, 63% ( n = 71) described dilemmas which came about because students were instructed to observe or perform intimate examinations or procedures without valid consent. A total of 82% ( n = 58) involved students complying with instructions and contained 349 distinct explanations. Thirteen narratives described cases in which students had refused to comply and contained 84 explanations. A high proportion of explanations of compliance included statements by students that they 'had to' observe or perform the examination or procedure. Explanations of compliance behaviours significantly downplayed the intentionality of actions, whereas explanations of refusal emphasised intentionality (χ = 14.225, d.f. = 2, p = 0.001). Despite clear policies at each school, students in all schools observed or performed intimate examinations or procedures without having gained valid consent from the patient. Faculty development initiatives are clearly essential to help clinical teachers put intimate examination policy into practice. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 1084-1094 CONTEXT Increasingly, medical schools are considering mature applicants, including graduate entrants. At present, the majority of mature students are in their early or mid-20s and are entering medicine immediately or soon after completing a first degree. However, 'older' mature students, who have worked in other occupations for a number of years, are also applying to study medicine. Although it is likely that these students have particular needs, their experiences of applying to study medicine and related decision-making processes have not been examined in detail to date. METHODS Participants at three English medical schools took part in in-depth interviews examining their pathways into medical school. This analysis uses the findings from interviews with 15 older mature students. RESULTS This study demonstrates how older mature students' decision-making processes and experiences of application processes are heavily influenced by their personal circumstances and backgrounds. Their choices are constrained geographically and in terms of their identity, and also by perceptions of the openness of some medical schools to their applications. There are negative implications for some students who are unable to secure places at their preferred 'local' schools. CONCLUSIONS Although the choice of medical school may be limited for this group of applicants as a result of their pre-existing personal circumstances, medical schools are perceived to differ substantially in their willingness to consider older students from varied working and educational backgrounds. The ability of these applicants to join the medical profession may partly depend on geographical location. The provision of a central information facility outlining institutional requirements and preferences would be a useful starting point, although it would be unable to address the broad and complex range of issues that face older mature students. [ABSTRACT FROM AUTHOR]

Context Although there are increasing numbers of studies of outcomes of high-fidelity patient simulators, few contrast their instruction with that provided by equivalent low-fidelity, inexpensive simulators. Further, examination of decays in learning and application (transfer) to real patient problems is rare. In this study, we compared the effects of training using a high-fidelity heart sound simulator (Harvey) and a low-fidelity simulator (a CD) on recognition of both simulated heart sounds and those in actual patients. Methods A pilot study with 10 students was conducted to show the feasibility of the methods and some evidence of modality-specific learning (the Harvey-trained group scored 72% correct on Harvey and 36% correct on CD test examples; the CD-trained group scored 60% correct on both CD and Harvey test examples). A main study was then initiated involving 37 Year 3 medical students from the University of Leeds. They received 1 hour of common instruction, after which one group received 3 hours of specific instruction on Harvey. The second group received 3 hours of instruction using a CD. Six weeks later, both groups were tested blind with real patients with stable heart sounds. Stations were observed by an examiner who scored communication skills and examination skills using 5-point scales. Results The Harvey-trained group was slightly but not significantly better than the CD-trained group at identifying heart sounds (3.11 versus 2.47, respectively; P = 0.06). However, there was no difference between the Harvey and CD-trained groups in diagnosis (2.94 versus 2.84, respectively), communication skills (18.9 versus 19.6, respectively) or examination skills (17.4 versus 17.5, respectively). Conclusions The study found little evidence that students trained with a high-fidelity simulator were more able to transfer skills to real patients than a control group. Although there was some suggestion that the Harvey-trained group was better at recognising heart sounds, there was no difference between groups in diagnostic accuracy or clinical skills. [ABSTRACT FROM AUTHOR]

Objectives The mini-clinical evaluation exercise (mini-CEX) is widely used in the UK to assess clinical competence, but there is little evidence regarding its implementation in the undergraduate setting. This study aimed to estimate the validity and reliability of the undergraduate mini-CEX and discuss the challenges involved in its implementation. Methods A total of 3499 mini-CEX forms were completed. Validity was assessed by estimating associations between mini-CEX score and a number of external variables, examining the internal structure of the instrument, checking competency domain response rates and profiles against expectations, and by qualitative evaluation of stakeholder interviews. Reliability was evaluated by overall reliability coefficient ( R), estimation of the standard error of measurement (SEM), and from stakeholders’ perceptions. Variance component analysis examined the contribution of relevant factors to students’ scores. Results Validity was threatened by various confounding variables, including: examiner status; case complexity; attachment specialty; patient gender, and case focus. Factor analysis suggested that competency domains reflect a single latent variable. Maximum reliability can be achieved by aggregating scores over 15 encounters ( R = 0.73; 95% confidence interval [CI] ± 0.28 based on a 6-point assessment scale). Examiner stringency contributed 29% of score variation and student attachment aptitude 13%. Stakeholder interviews revealed staff development needs but the majority perceived the mini-CEX as more reliable and valid than the previous long case. Conclusions The mini-CEX has good overall utility for assessing aspects of the clinical encounter in an undergraduate setting. Strengths include fidelity, wide sampling, perceived validity, and formative observation and feedback. Reliability is limited by variable examiner stringency, and validity by confounding variables, but these should be viewed within the context of overall assessment strategies. [ABSTRACT FROM AUTHOR]

Objectives This study represents an initial evaluation of the first year (F1) of the Foundation Assessment Programme (FAP), in line with Postgraduate Medical Education and Training Board (PMETB) assessment principles. Methods Descriptive analyses were undertaken for total number of encounters, assessors and trainees, mean number of assessments per trainee, mean number of assessments per assessor, time taken for the assessments, mean score and standard deviation for each method. Reliability was estimated using generalisability coefficients. Pearson correlations were used to explore relationships between instruments. The study sample included 3640 F1 trainees from 10 English deaneries. Results A total of 2929 trainees submitted at least one of all four methods. A mean of 16.6 case-focused assessments were submitted per F1 trainee. Based on a return per trainee of six of each of the case-focused assessments, and eight assessors for multi-source feedback, 95% confidence intervals (CIs) ranged between 0.4 and 0.48. The estimated time required for this is 9 hours per trainee per year. Scores increased over time for all instruments and correlations between methods were in keeping with their intended focus of assessment, providing evidence of validity. Conclusions The FAP is feasible and achieves acceptable reliability. There is some evidence to support its validity. Collated assessment data should form part of the evidence considered for selection and career progression decisions although work is needed to further develop the FAP. It is in any case of critical importance for the profession’s accountability to the public. [ABSTRACT FROM AUTHOR]

Context Medical student numbers in England have increased by more than 60% over the last decade. The capacity of universities and the National Health Service (NHS) to deliver education and training to these expanded cohorts is not clear. Methods We carried out an interview study in three English medical schools, involving 60 academic, administrative, clinical and managerial staff, sampled across disciplines. Results Given the expansion in medical student numbers, capacity in medical schools must increase. This requirement has become even more immediate in light of the shift towards more resource-intensive curricula. However, the aims of the Research Assessment Exercise and NHS policies are at odds with attempts to build teaching capacity. Although monies have been made available to recruit new staff and to backfill clinical time spent teaching, the success of these strategies is questioned by interviewees. Other initiatives, such as the new consultant contract and educational quality assurance processes, have the potential to promote the importance of teaching but are presently perceived as being inadequate so to do. As was consistently expressed by interviewees, within the competing triad of research, service delivery and teaching, the latter is perceived as taking a poor third place. Conclusions That research, service delivery and education are in competition will come as no surprise to UK academic staff. However, our results show a striking uniformity of opinion. We would question whether existing NHS and higher education policies enable medical schools and health care organisations to deliver education of the highest quality to the enlarged student population. [ABSTRACT FROM AUTHOR]

Objectives To investigate the reactions experienced by hospital doctors following a recent memorable patient death, defined as a patient death that had occurred in the previous few months that the doctor recollected for any particular reason, the coping strategies employed to deal with these reactions, the impact of training, and the need for support in future situations. Methods We carried out a descriptive survey in 2 teaching hospitals and 1 district general hospital in West Yorkshire, UK. Subjects comprised 188 hospital doctors of all grades (from pre-registration house officer to consultant) who were attending 12 educational lunchtime meetings. Main outcome measures included the associations between the intensity of emotional and physical reactions measured using a categorical rating scale, and exposure to previous training, gender, seniority and medical specialty. Results Reactions of moderate to severe intensity to a patient death were experienced by 5.0–17.5% of doctors, regardless of gender, seniority or medical specialty. Perceived need for both training and increased support from team members was significantly associated with more intense reactions. Common coping strategies included talking, spending time alone and exercise. There was no relationship between respondents' exposure to previous training and the intensity of emotional or physical responses. Conclusions Many doctors perceive that they deal with death well. In a minority of doctors, more supportive approaches are necessary that may include both proactive and reactive measures. Examples include raising awareness of support services and establishing formal training programmes, and increasing awareness among senior clinicians of the need to support some team members after a patient's death, which may include ensuring that timely access to a counsellor is provided. [ABSTRACT FROM AUTHOR]

Context Breaking bad news is a difficult task for health professionals. Senior hospital doctors acknowledge the importance of breaking bad news well, but previous surveys have found them to be sceptical of formal training and disinclined to seek courses in this area. We sought to ascertain if this view was still held. Methods A postal questionnaire was sent to 285 consultants across 3 acute hospital trusts in the Midlands, UK. Questions included items on the frequency and types of breaking bad news situations encountered, and the timing and modality of previous training. Open comment on what forms of education would be useful, and when, was requested. Results Eleven consultants were no longer in post. Of the remainder, 173/274 (63%) replied; 153 (56%) returned questionnaires of which 150 (55%) were useable. Respondents represented 32/33 (97%) of the surveyed specialties. The majority reported breaking bad news frequently (> 1–2 times weekly); however, almost half (49%) had received no formal training in this specific area, although 53% described having received experiential training in either clinical, training or management contexts. Of 118 respondents who commented, only 5 believed no form of training was useful, whereas 47 specifically recommended some form of role play. Regarding timing, 72 thought it desirable at postgraduate level or at all stages of training, with 44 explicitly stating at consultant level. Conclusions Consultants in clinical specialties break bad news frequently. Although many have not received formal training, the majority believe it is useful and are increasingly willing to undertake experiential approaches. This augurs well for future training programmes. [ABSTRACT FROM AUTHOR]

Objective To investigate whether the observational skills of doctors and nurses can be improved by arts-based observational skills training. Methods We carried out a cluster design, controlled trial involving 42 general practitioners and 26 primary care nurses in 12 primary care practices in London. Six practices were allocated to the intervention arm and 6 to the control arm. The intervention group received 90 minutes of arts-based observational skills training. The control group received practical training in the management of psoriasis. Before and after this, control and intervention participants were asked to describe 3 dermatological photographs. Descriptions were scored blindly against a predetermined marking key. Participants completed a questionnaire about the intervention, and about their own confidence in diagnosing and referring suspicious pigmented skin lesions. Results Post-intervention scores were significantly higher in the intervention group compared with the control group ( P < 0.001). The majority of participants judged the intervention relevant, enjoyable and valuable. A majority lacked confidence in their dermatological knowledge and skills. Discussion This study provides statistically significant evidence that arts-based observational skills training can improve the observational skills of doctors and nurses. It is important not to overstate the clinical significance of these findings, and to recognise that observational skills are just one of many complex and subtle factors affecting the quality of the clinical process. Further research is needed to assess the existence, nature and clinical significance of longer-term benefits, and to identify differences between professional groups. [ABSTRACT FROM AUTHOR]

Context Self-assessment promotes reflective practice, helps students identify gaps in their learning and is used in curricular evaluations. Currently, there is a dearth of validated self-assessment tools in rheumatology. We present a new musculoskeletal self-assessment tool (MSAT) that allows students to assess their confidence in their skills in and knowledge of knee and shoulder examination. Objectives We aimed to validate the 15-item MSAT, addressing its construct validity, internal consistency, responsiveness, repeatability and relationship with competence. Methods Participants were 241 Year 3 students in Newcastle upon Tyne and 113 Year 3 students at University College London, who were starting their musculoskeletal skills placement. Factor analysis explored the construct validity of the MSAT; Cronbach's α assessed its internal consistency; standardised response mean (SRM) evaluated its responsiveness, and test-retest, before and after a pathology lecture, assessed its repeatability. Its relationship with competence was explored by evaluating its correlation with shoulder and knee objective structured clinical examinations (OSCEs). Results The MSAT was valid in distinguishing the 5 domains it intended to measure: clinical examination of the knee; clinical examination of the shoulder; clinical anatomy of the knee and shoulder; history taking, and generic musculoskeletal anatomical and clinical terms. It was internally consistent (α = 0.93), responsive (SRM 0.6 in Newcastle and 2.2 in London) and repeatable (intraclass correlation coefficient 0.97). Correlations between MSAT scores and OSCE scores were weak ( r < 0.2). Conclusions The MSAT has strong psychometric properties, thereby offering a valid approach to evaluating the self-assessment of confidence in examination skills by students. Confidence does not necessarily reflect competence; future research should clarify what underpins confidence. [ABSTRACT FROM AUTHOR]

Objective To compare Year 1 medical students' perceptions of their educational environment at the end of Year 1, with their expectations at the beginning of the year using the Dundee Ready Education Environment Measure (DREEM). Methods Year 1 students ( n = 130) at the University of East Anglia Medical School were asked to complete the DREEM during their induction week at the beginning of Year 1, thinking about the educational environment they expected to encounter (Expected DREEM), and again as part of a compulsory evaluation at the end of Year 1, thinking about the educational environment they had actually experienced (Actual DREEM). A total of 87 students (66.92% of the starting cohort) completed the DREEM on both occasions and gave permission for their data to be published. Results The Expected DREEM score was 153 out of a maximum of 200, and the Actual DREEM score was 143. Student's expected perceptions of learning and teachers, and their expected academic self- and social self-perceptions were all more positive than their actual perceptions. There was no difference between expected and actual perceptions of atmosphere. Specific aspects of the educational environment showing dissonance were identified. In some areas students' low expectations had been matched by their actual experience. Conclusions Medical students had started Year 1 with expectations about the educational environment that had not been met. However, areas showing dissonance received low item scores on the Actual DREEM and as such would be picked up for remediation, even without information about student expectations. [ABSTRACT FROM AUTHOR]

Context In 1996 the University of Liverpool introduced a new curriculum based on the recommendations published in Tomorrow's Doctors. This work examines how graduates of that course view their undergraduate curriculum and whether they consider it prepared them well for the pre-registration year. Methods Five focus groups were arranged with a selection of graduates from the first cohort to graduate from the reformed curriculum in order to ascertain their views on the course and how it had prepared them to work as pre-registration house officers (PRHOs). The focus groups were tape-recorded, transcribed and analysed. Results The PRHOs felt they had been well prepared for the PRHO year, citing the clinical experience of the final year, communication skills classes and the Clinical Skills Resource Centre as having been particularly beneficial. There were concerns about their basic science knowledge base although this had not affected their ability to work as PRHOs. They had criticisms of the way part of their course had been structured but overall they were happy with the content of the course. Discussion A reformed medical curriculum in the UK can prepare graduates well to work as junior doctors and can take away some of the anxiety associated with graduation; therefore, to that extent curriculum reform has worked. However, anxiety about undertaking the role of junior doctor seems to have been replaced by anxiety about knowledge base, despite having adequate knowledge to work as PRHOs. Students undertaking a reformed curriculum are wary about being the first people to use their training in the workplace. This factor may need to be considered when further reforms are introduced. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to explore patterns of attendance at classroom-based, taught education programmes for pre-registration house officers (PRHOs) and to identify reasons for non-attendance, and to consider implications for Foundation Programme curriculum delivery and suggest strategies for improving delivery. Method We analysed registers of attendance for education sessions for 3 local teaching hospitals in the Leicestershire, Northamptonshire and Rutland (LNR) Healthcare Workforce Deanery, along with PRHO exit questionnaire returns (from 2001 to 2005). Results Despite a trend for attendance to fall slightly over the course of a rotation, attendance rates have, in general, remained relatively stable at around two-thirds. However, during most 4-month posts, a fifth or more of PRHOs missed half or more of all sessions. Two types of barrier to attendance were identified: ‘routine barriers’, which relate to hospital working patterns, and ‘contextual barriers’, which refer to the particularities of each hospital post. There was no evidence that doctors' motivation and commitment towards the education programme is a main determinant of attendance. Conclusions Contextual barriers to attendance, such as pressure being placed on PRHOs to remain on the ward, can be addressed. However, routine barriers to attendance, including on-call working patterns and annual leave, render it impossible to avoid significant numbers of education sessions being missed by PRHOs in each post during a rotation. En bloc teaching of basic generic skills prior to the start of the rotation plus greater use of online learning resources are examples of ways in which reliance on in-post, classroom-based programmes can be reduced. [ABSTRACT FROM AUTHOR]

Introduction This article is concerned with medical education in London during 1939–41. It is set against the London Blitz, an event that was then unique in its subjecting of civilians to an intense and prolonged aerial bombardment. Its very uniqueness ensured that medical students, like others in the capital, had no set rules of conduct with which to govern their response to death and destruction on such an unprecedented scale in an urban area. Evacuation For students at London's world-famous medical schools, the outbreak of war in 1939 resulted in the execution of evacuation plans formulated during the 1930s; these are outlined in the text. The London teaching hospitals and their attached medical schools were removed to sector hospitals and, in the case of the medical schools, to universities and colleges in areas deemed to be safe. Medical teaching during the war Just as the schooling of children evacuated from Britain's big cities was subject to considerable disruption during this period, so was medical education. This article attempts to both chart the effects of these difficulties and study the manner in which the medical schools and, more particularly, London medical students, overcame them. Emphasis is placed on the dramatic months of the Blitz, not least because of the moulding effect such a sudden experience of warfare must have had on the very young, mainly male, students who lived through it. Finally, mention is made of some of the medical innovations the improvisations of the Blitz brought about. [ABSTRACT FROM AUTHOR]

Background As well as hearing a story at the start of an interaction, listening in medicine involves picking up and checking out patients' cues. Despite this, cues are frequently missed or ignored by doctors. Aim To explore the perceptions of general practitioners (GPs) about initiating listening and choosing not to listen during interactions. Study design Qualitative study constant comparison. Methods General practitioners with over 5 years' experience in practice in a semi-rural area of England took part in a single, semistructured, audiotaped interview which was piloted initially. Interviews were transcribed and analysed according to the precepts of constant comparison. Results In total, 23 of 24 eligible doctors participated. The data emphasise the importance of spotting cues during interactions. Factors influencing judgements on whether or not to attend to cues included pressure of work, the doctor's mood or feelings about the patient, and the context of the interaction. Methods of limiting, blocking or resisting listening included reassuring, changing the subject, interrupting, being directive or making a plan, reducing sympathy and using body language. A tramline metaphor of choice in listening emerged (the listening loop: a definite period of listening by the GP within the interaction, generally separate to hearing the patient's initial story). Conclusion The listening loop offers a simple model of listening that emphasises choice and judgement in response to patients' cues within interactions. Emphasising this choice highlights both picking up cues and pragmatic limits and resistance to attending to them, with implications for teaching. [ABSTRACT FROM AUTHOR]

Patients in inner-city areas come from increasingly diverse language and cultural backgrounds. Neither communications training modelled on local English speakers nor the provision of interpreters offer adequate solutions.To identify how patients with limited English and culturally different communication styles consult with general practitioners (GPs) in English, and to develop training strategies from both good practice and observed misunderstandings.Randomly selected routine and emergency surgeries in 19 inner London general practices were video-recorded. The videos were viewed independently by 2 discourse analysts. Key consultations, across a wide range of English language ability, were selected and transcribed to analyse misunderstandings resulting from language/cultural differences.Of the 232 video recordings that were made, 20% were with patients with limited English and contained major and often extended misunderstandings.Four main categories of patient‘talk’ contributing to misunderstandings are identified: (1) pronunciation and word stress; (2) intonation and speech delivery; (3) grammar, vocabulary and lack of contextual information; and (4) style of presentation. The importance of different styles of self-presentation by patients as the reason for misunderstandings is highlighted. On only 3 occasions were culturally specific health beliefs raised.It is routine for GPs in inner London practices to manage consultations with patients with culturally different communicative styles from their own. Specific training in identifying these problems and preventing/repairing them in the consultation is essential. This level of awareness-raising is more crucial than general discussions of culturally different health belief models. [ABSTRACT FROM AUTHOR]

Medical students have traditionally received little education in palliative care. However, in 1999, as part of a revised medical curriculum, Year 4 undergraduates at Liverpool University participated in a 2-week programme of education in palliative care. To assess the effect of the education programme, 2 assessment scales were identified: the Self-efficacy in Palliative Care Scale (SEPC) (assessing efficacy in communication, patient management and multiprofessional teamworking) and the Thanatophobia Scale (assessing attitudes towards palliative care). The aim of this study was to examine the psychometric properties of these scales.The scales were examined by 5 palliative care doctors for content validity and appropriate wording. Following this, the SEPC and Thanatophobia Scales were completed by the undergraduates (n = 139) prior to and after completion of the education programme.Both scales were analysed independently on pre- and post-test scores. Cronbach's alphas of 0.84−0.85 and 0.92–0.95 were recorded, respectively, indicating high reliability. Varimax rotated principal components analysis of the SEPC Scale suggested 3 distinct factors, as theoretically expected, with high factor loadings of 0.45–0.89 at pre- and post-test. Principal components analysis of the Thanatophobia Scale suggested only 1 factor underlies the scale, as theoretically expected. All 7 items had high factor loadings of 0.60–0.81 at pre- and post-test.The results suggest that the SEPC and Thanatophobia Scales are valid and reliable assessment scales that may be of use when evaluating the impact of an education programme. [ABSTRACT FROM AUTHOR]