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Aim To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. Methods A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994−2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. Results Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. Discussion The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process. [ABSTRACT FROM AUTHOR]

Background Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. Purpose To study the longterm effects of problem-based medical training on the professional competencies of graduates. Methods A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. Results The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. Conclusion The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. Methods A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. Results The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. Conclusions Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning. [ABSTRACT FROM AUTHOR]

Background In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of future doctors are also changing. Objectives We aimed to categorise medical students' prevailing career intentions and to examine to what extent newly proposed medical occupations that may be part of the transformation process correspond with these career intentions. Methods We carried out expert interviews and a feedback round to gain input for a survey among students. From the demand perspective, 11 experts proposed non-traditional medical occupations and evaluated these on the basis of job characteristics relevant to a doctor's career choice. Subsequently, students from 5 universities filled out a questionnaire to rate these job characteristics by their importance and the proposed occupations' attractiveness. Results Four different clusters of career intentions were categorised as patient-oriented expert, career-oriented specialist, lifestyle-oriented generalist, and balance-seeking realist. These clusters differ in terms of the ways in which students feel attracted to the proposed occupations. The career-oriented specialists feel least attracted and the lifestyle-oriented generalists most attracted to the occupations. Discussion The experts' call for shorter postgraduate programmes to educate patient-oriented doctors partly matches students' career intentions. Most students share the intention of obtaining a direct care position that provides ample task variation, which may explain the appeal of the occupations ‘emergency doctor’ and ‘basic specialist’. The limited interest in specific patient groups suggests a need for more exposure to the occupations linked to these groups. [ABSTRACT FROM AUTHOR]

Introduction This paper seeks to describe the consultation strengths and weaknesses of senior medical students, the explicit and prioritised strategies for improvement utilised in student feedback, and curriculum developments informed by this work. Methods Prospective, descriptive study of students on clinical placements in general practice. All were observed directly by 2 assessors in consultation with 5 patients in a general practice setting. Performance was judged against 5 categories of consultation competence and 35 component competences as contained in a modified version of the Leicester Assessment Package. Specific strategies for improvement were selected from a list of 69 previously formulated strategies. Results Data from 1116 students were included. The consultation competences identified most frequently as strengths related to interpersonal skills, while weaknesses were mainly in the domain of clinical problem-solving. The median number of key strengths identified per student was 5, with 5 additional but lesser strengths. A median of 3 key and lesser weaknesses were identified. The average number of strategies selected to address an identified weakness was 1.2. Students rated the assessment process and its impact very positively. Conclusion The systematic assessment of the consultation competence of medical students by direct observation involving real patients is feasible and facilitates the ‘educational diagnosis’ of individuals and of their peer group. It has informed development of teaching and generated research hypotheses. [ABSTRACT FROM AUTHOR]

Background Clerkship experiences are considered crucial for the development of clinical competence. Yet whether there is a direct relationship between the nature and volume of patient encounters and learning outcomes is far from clear. Some evidence in the literature points towards the importance of clinical supervision on student learning, but the relationship between clinical supervision, patient encounters and student competence remains unclear. Objectives This study aimed firstly to determine the variation in students' clinical experiences within and across sites; secondly, to identify the causes of this variation, and thirdly, to investigate the consequences of this variation on students' competence. Methods Clerkship students at 12 hospital sites recorded their patient encounters in logbooks. Site characteristics that might influence the variation in patient encounters were collected. Student competence was determined by 3 independent indicators: a practical end-of-clerkship examination; a theoretical end-of-clerkship examination, and an evaluation of professional performance. A model was developed to test the available clerkship data using structural equation modelling (SEM) software. Results Analysis of the logbooks revealed a large variation in the number of patients encountered by students. The average length of patient stay, number of patients admitted, and quality of supervision accounted partly for this variation. An increased number of patient encounters did not directly lead to improved competence. Quality of supervision turned out to be crucially important because it directly impacted student learning and also positively influenced the number of patient encounters. Conclusion Monitoring the effectiveness of clerkship by merely asking students to keep a tally of the problems and diseases they encounter, without paying attention to the quality of supervision, does not contribute towards improving student learning. [ABSTRACT FROM AUTHOR]

Objective To investigate workforce participation patterns among Australian medical graduates and the extent of cohort differences in these patterns. Design We carried out a retrospective longitudinal cohort study, with data collected by postal survey on current occupation, location, absences from the workforce and occupation since graduation. Participants Graduates who had completed their basic medical training at Monash University, Melbourne, Australia, in 1980, 1985, 1990 and 1995 were invited to participate ( n = 546); 368 took part in the study (69%). Outcome measures The proportion of graduates in the Australian medical workforce, the equivalent full-time contribution to the Australian medical workforce, and the proportion taking temporary absences from the workforce were determined. Results The rate of participation in the Australian medical workforce was 96% 2 years after graduation. It then declined to reach 85% by 10 years and regained slightly to reach 88% by 15 years after graduation. There was no indication that the 1995 cohort made a lower contribution to the Australian medical workforce than the earlier cohorts in their first 7 years after graduation. Conclusion Although there are few indications of differences between these cohorts during the first 7 years after graduation, the main contributing factors to losses from the Australian medical workforce – medical work overseas and parental leave – do not exert their maximum influence until a later timepoint. Longitudinal cohort data are essential for monitoring trends in medical workforce participation and hence for effective workforce planning. [ABSTRACT FROM AUTHOR]

Introduction Medical school is a very stressful environment with multiple sources of stress, including academic, social and other issues. International medical students are exposed to additional stressors such as homesickness and culture shock. Methods In order to assess the influence of cultural background on the level of perceived distress, we examined Israeli and American students studying at the same university during a period of terror. Results We found clear differences between the 2 groups of students, with Americans reporting a higher level of anxiety and a poorer level of social functioning than the Israelis. Although there was no significant difference between the 2 groups in terms of their sense of safety, the American students reported a higher level of fear and more change in their daily activities to a greater extent than did the Israelis. Conclusions These findings underscore the effect of culture on students' responses to the same stressful stimuli and to a perceived dangerous environment. Faculty needs to be aware that cultural factors may affect students' adjustment to the medical school environment. [ABSTRACT FROM AUTHOR]

Objective To describe and discuss Year 5 medical students' perceptions of their own learning about the doctor−patient relationship. Methods We carried out a qualitative study of semi-structured interviews with 16 Year 5 medical students using 3-way analysis at the School of Medicine, Federal University of São Paulo, São Paulo, Brazil. Results For experiences at the pre-clinical stage, the subcategories were: positive aspects of the medical psychology course; great distance between theory and reality, and strong desire for clinical practice. For experiences at the clinical stage, the subcategories were: demand for opportunities to discuss the doctor−patient relationship; teachers as either role models or anti-models; clinical situations favourable for developing empathic relationships, and clinical situations unfavourable for developing empathic relationships. For views about future experiences, the subcategories were: apprehension about ethical behaviour; anxiety about handling patients' psychosocial characteristics, and fear of professional ethics cases or legal action. Discussion To compensate for the lack of practical activities during the pre-clinical stage, students search for extracurricular activities that often overload them. Because teachers function as professional role models, their attitudes towards patients have great importance. Students fear not being able to maintain their empathic capacity in the future because of work-related issues. Knowledge of the psychological aspects of the doctor−patient relationship helps students to comprehend their experiences. Gradual contact between student and medical practice from the beginning of the course is advised. It should be followed by interdisciplinary discussions that deal with the technical aspects of cases and the doctor−patient relationship. [ABSTRACT FROM AUTHOR]

Background Whether teaching portfolios achieve their aim of stimulating teachers' professional development is favourably affected by the incorporation of a balanced structure and effective social interactions, such as coaching. We explored teachers' experiences with a teaching portfolio that was structured by teaching roles, portfolio assignments and conversation protocols. The related social interactions consisted of meetings with peers and personal coaches. Teachers' and coaches' opinions were sought about the benefits and the enabling and disabling factors of the portfolio structure and the social interactions involved. Method Five teachers and their personal coaches were individually interviewed about their experiences with the portfolio. Protocols were analysed using a top-down strategy. Results The teaching roles were helpful in analysing teaching, but the assignments and the conversation protocols were too detailed and directive. The social interactions were perceived as very valuable for professional development, particularly the meetings with personal coaches. Conclusions The portfolio structure and social interactions, especially personal coaching, appeared to be helpful for teachers in analysing their teaching practice. The assignments and protocols, however, were too detailed and directive. This may be resolved by using assignments and conversation protocols more flexibly and enabling adjustment to personal learning needs. The high appreciation of personal coaching might be related to the freedom for teachers to choose their own coach. The results can be used by portfolio designers as guidelines for how to achieve a balanced structure and effective social interactions and how these might be combined to increase the benefits of working with a portfolio to teachers. [ABSTRACT FROM AUTHOR]

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

Introduction Observation, including identification of key pieces of data, pattern recognition, and interpretation of significance and meaning, is a key element in medical decision making. Clinical observation is taught primarily through preceptor modelling during the all-important clinical years. No single method exists for communicating these skills, and medical educators have periodically experimented with using arts-based training to hone observational acuity. The purpose of this qualitative study was to better understand the similarities and differences between arts-based and clinical teaching approaches to convey observation and pattern recognition skills. Method A total of 38 Year 3 students participated in either small group training with clinical photographs and paper cases (group 1), or small group training using art plus dance (group 2), both consisting of 3 2-hour sessions over a 6-month period. Findings Students in both conditions found value in the training they received and, by both self- and instructor-report, appeared to hone observation skills and improve pattern recognition. The clinically based condition appeared to have been particularly successful in conveying pattern recognition concepts to students, probably because patterns presented in this condition had specific correspondence with actual clinical situations, whereas patterns in art could not be generalised so easily to patients. In the arts-based conditions, students also developed skills in emotional recognition, cultivation of empathy, identification of story and narrative, and awareness of multiple perspectives. Conclusion The interventions studied were naturally complementary and, taken together, can bring greater texture to the process of teaching clinical medicine by helping us see a more complete ‘picture’ of the patient. [ABSTRACT FROM AUTHOR]

Objective To determine whether the academic performance of medical students learning in rural settings differs from those learning in urban settings. Design Comparison of results of assessment for 2 full cohorts and 1 part cohort of medical students learning in rural and urban settings in 2002 (209 students), 2003 (226 students) and 2004 (220 students), including results for each specialist rotation in the 3rd year and end-of-year examinations in the 2nd and 4th years. Setting University of Queensland School of Medicine, Brisbane. Students spent the whole 3rd year (of a 4-year graduate entry programme) conducting 5 specialist 8-week rotations in either the rural clinical division (rural students) or in Brisbane (urban students), all following the same curriculum and taking the same examinations. Results For the 2002 cohort there were no statistically significant differences in academic performance between rural and urban students. For the 2003 cohort the only significant difference was a higher score for rural students in the end of the 4th-year clinical skills examination (65.7 versus 62.3%, P = 0.025). For the 2004 cohort, rural students scored higher in the 3rd-year mental health rotation (79.3 versus 76.2%, P = 0.038) and lower in the medicine rotation (65.5 versus 68.6%, P = 0.037). Conclusion Academic performance among students studying in rural and urban settings is comparable. [ABSTRACT FROM AUTHOR]

Purpose We investigated the influence of harsh grading by tutors on tutor performance rating by students. Methods A total of 187 tutors assessed students' professional behaviour in tutorial groups. Students rated tutor performance after receiving their grades for professional behaviour. In addition, students were asked to indicate whether they perceived their professional behaviour grades as too positive, adequate or too negative. This was considered to reflect tutors' harshness of grading. Students also rated the quality of the feedback they received from tutors with respect to their grades. Results Professional behaviour grades that students perceived as too negative, adequate or too positive were associated with tutor performance ratings of 7.4 (SD = 0.9, scale 1–10, n = 33), 7.7 (SD = 0.9, scale 1–10, n = 95) and 7.5 (SD = 0.8, scale 1–10, n = 59), respectively. Harshness of grading did not influence tutor performance ratings significantly. Tutor ratings were predicted more effectively by the quality of the feedback tutors provided on grades than by the harshness of grading. Conclusions Tutor performance ratings were not related significantly to harshness of grading. Two explanations can be given: (1) tutor performance ratings were based on rating by groups of students and (2) the percentage of tutors who rated students' professional behaviour as unsatisfactory was low. The strong relationship between tutor performance ratings and the adequacy of the feedback given by tutors suggests that the tutor performance ratings collected in this study are a valid measure of the quality of their teaching, although, for a full picture of teaching quality, more measures will be needed. [ABSTRACT FROM AUTHOR]

Introduction In current constructivist paradigms, learners' previous subject-matter knowledge, or cognitive models, provide the foundations for the construction of new knowledge. Learners' cognitive models about learning also mediate students' capacities to learn in their chosen topics of study. The diverse backgrounds of students entering medicine suggest that they might come to medical studies equipped with a wide variety of cognitive models about learning. Some current theories tend to reduce students' cognitions about learning to parsimonious representations, such as surface-deep approaches or mastery-performance goals. It is possible that such reduced representations underrepresent, or misrepresent, the complexity of students' cognitive models about learning. Good quality teaching needs to take account of learners' cognitive models, not just about subject matter, but also about learning. This study investigated the diversity and complexity of medical students' cognitive models about learning. Methods A total of 7 graduate entry, clinical-year medical students volunteered for in-depth interviews about learning. NUD*IST text analysis software and correspondence analysis were employed to identify dimensions and to profile students' responses. Results The correspondence analysis identified a significant 4-dimensional solution that illustrates the contributions of multiple variables to students' cognitive models about learning. Individual profiles highlight diversity between participants. Discussion This study provides evidence that students' cognitive models about learning are complex and highly differentiated. Representations of what students know about learning need to take account of such complexity in order to inform instructional practice more adequately. [ABSTRACT FROM AUTHOR]

Objective To follow the progress of young female adolescents, as risk-taking standardised patients (SPs), and to monitor for adverse affects that role-playing may have on the adolescents. Methods A prospective design was used in which 11 female adolescents, aged 13–15 years, were recruited from 2 schools. The adolescents were trained to portray risk-taking individuals with a medical condition and were interviewed with their SP mother by final-year medical students 1–3 times a month over 6–14 months. A control group was selected from both schools ( n = 6). Main outcome measures were pre- and post-interviews using standardised questionnaires [ Achenbach's Youth Self-Report (YSR) and Piers Harris Children's Self Concept Scale (SCS),] and focus groups. Results The adolescent group simulated 111 interviews (mean per adolescent 10.1, SD = 6.2) each lasting 60–70 minutes. Quantitative data The pre- and post-scores from the YSR and SCS demonstrated no significant differences within the SP study participants or between the control group vs. the study group. Focus group findings The initial focus group acted as a debriefing exercise and prompted the adolescents to request that they come out of their role when giving feedback. Subsequent focus group discussion was around the medical student performance and their family doctors. Conclusion Adolescent females showed no adverse effects when used extensively to portray risk-taking SPs. The focus groups provided the adolescents with an opportunity to debrief together. The adolescent SPs reported benefiting from this study but requested unanimously that they come ‘out of character’ when giving feedback to the medical students. [ABSTRACT FROM AUTHOR]

Purpose A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient–doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area. Methods A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes. Results Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes. Conclusions Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further. [ABSTRACT FROM AUTHOR]

Introduction Recently, there has been a shift away from practising procedures on patients for the first time and towards bench model teaching of clinical skills to undergraduate medical students. However, guidelines for the most effective instructor : student ratio for technical skills training are unclear. This has important implications for staffing laboratory based teaching sessions. The purpose of this study was to assess the optimal ratio of teachers to learners during the teaching of a simulated wound closure. Methods A total of 108 undergraduate medical students participated in a 1-hour course on wound closure. They were randomised to 3 groups, each with a different instructor : student ratio (Group A: 6–12; Group B: 3–12; Group C: 1–12). Students were evaluated on a pre-test, an immediate post-test and a delayed retention test using an objective, computer-based technical skills assessment method. Collectively termed the ‘economy of movements’, the total time taken to complete the task and the number of movements executed were the primary outcome measures. Results Improvements in the economy of movements were the same for Groups A and B and were better than in Group C ( P < 0.005). Discussion The optimal instructor : student ratio was 1 instructor for 4 students. Higher ratios of instructors to students resulted in no improvements in learning, and lower ratios of instructors to students resulted in significantly less learning. These findings are in keeping with current motor learning theories. [ABSTRACT FROM AUTHOR]

Background Ethnographic research methods have a considerable history of use in medical settings. This paper provides a personal account of conducting ethnography in medical environments and focuses on some of the practical and ethical issues encountered in such settings. Discussion and Conclusion The paper describes particular issues that arise when undertaking ethnographic work, such as gaining access, recording data, research roles and researching elite groups, and recounts some of the dilemmas posed by doing this type of research in a medical setting. The paper concludes by reflecting on what ethnography might offer to medicine in return for the rich data medicine provides. [ABSTRACT FROM AUTHOR]

Background We are unaware of any hypothesis-driven studies showing that teaching assessments are comprised solely of interpersonal and cognitive domains. Moreover, previous teaching assessments have been biased by heterogeneous samples of evaluators. Consequently, we investigated the construct validity of faculty assessments comprised of interpersonal and cognitive domains, utilising evaluations obtained from resident doctors on an internal medicine hospital service. Methods A total of 1000 inpatient evaluations were completed on 60 general internal medicine faculty members. Education theory supported a 2-dimensional, 14-item scale. Principal factor analysis was used to explore the scale's dimensionality. Internal reliability and interobserver agreement were determined. Relationships between domains and instructor characteristics were also examined. Results Principal factor analysis revealed interpersonal, clinical teaching and efficiency domains. Internal reliabilities of all domains are high (alpha > 0.90). Interobserver agreement is good (range 0.64–0.83). In the interpersonal domain there is a trend towards higher scores for lower ranking faculty. Significant findings are higher overall scores in the interpersonal domain ( P < 0.001), higher scores for assistant professors in the interpersonal domain ( P = 0.008) and higher scores for male than female faculty in the interpersonal ( P = 0.041) and clinical teaching ( P = 0.008) domains. Conclusions Clinical teaching evaluations are reducible to interpersonal, clinical teaching and efficiency domains. Evidence for construct validity includes predicted domains and high internal and interobserver reliabilities. Utilising a homogenous sample of evaluators minimised variance. Interestingly, lower ranking faculty scored higher in the interpersonal domain, suggesting that lower ranking faculty may focus more attention on teaching activities than full professors do. [ABSTRACT FROM AUTHOR]

Introduction Medical programmes across Canada recognise the increased need for Aboriginal doctors. This study aimed to determine Canadian medical programmes' commitment towards Aboriginal health issues, recruitment, admission policies, educational opportunities and support offered to Aboriginal medical undergraduate students. Methods Medical school websites were initially reviewed to identify recruitment initiatives, admission policies and curriculum activities related to Aboriginal health. A questionnaire was sent to each dean of medicine to collect additional data on the programmes' recruitment strategies, admission policies, educational opportunities and the type of support offered to Aboriginal medical students. Results Sixteen medical programmes completed the questionnaire (return rate = 100%). There were 56 Aboriginal medical students enrolled across these medical programmes. More than 75% of students were completing their training in a western province. Over half of the medical programmes had recruitment initiatives and admission policies specific to Aboriginal applicants and the majority reported that their programmes' curricula included learning objectives specific to Aboriginal health. Most offered lectures and training opportunities to medical students and few offered core curriculum activities focusing on Aboriginal health. Discussion This descriptive paper offers a snapshot of initiatives across medical programmes aimed at increasing the number of Aboriginal applicants and medical students and at supporting their journeys towards the attainment of medical degrees. More research is needed to evaluate these initiatives' effectiveness. The results of such studies would not only provide needed information aimed at meeting the specific health needs of Aboriginal people, but may also contribute towards the laying of a framework to help narrow the gaps that exist within health care delivery to other minority groups. [ABSTRACT FROM AUTHOR]

Introduction In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context, adjustments aimed at incorporating gender issues were proposed. The aim of this study was to evaluate those adjustments, as well as to investigate whether gender had been successfully incorporated into the basic medical curriculum, and to identify the factors that played a role in this. Methods The education material of 9 curricular blocks was re-evaluated and interviews were held with block co-ordinators. Results Since the beginning of the project, gender has increasingly been brought to the attention of the students. Various factors have played a role: concrete and directly executable content-oriented proposals for adjustment; adequate translation of gender differences into actual patient care; motivated block co-ordinators; the presence of a ‘trigger person’ in the faculty; incorporation into the existing education programme; the involvement of block co-ordinators in decision making, and the provision of practical support. Discussion Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties. [ABSTRACT FROM AUTHOR]

Objective To explore attitudes among National Health Service consultants responsible for delivering basic clinical teaching to medical students. Design Postal questionnaire. Subjects and setting A total of 308 acute hospital trust consultants working in 4 ‘new’ and 4 ‘established’ teaching hospitals in the West Midlands metropolitan area, and involved in the delivery of clinical teaching to Year 3 medical students at the University of Birmingham Medical School during 2002−03. Main outcome measure(s) The questionnaire explored contractual requirements, actual teaching commitments and perceptions of medical students' knowledge and attitudes. Responses from doctors and surgeons and from respondents working in established and new teaching hospitals were compared. Results A total of 249 responses were received (response rate 80.8%). Although many consultants enjoy teaching students, their enjoyment and their ability to deliver high standards of teaching are compromised by time and resource constraints. For many the situation is aggravated by the perceived inappropriate organisation of the clinical teaching curriculum and the inadequate preparation of students for clinical practice. Linking these themes is the overarching perception among teachers that neither service nor educational establishments afford teaching the levels of recognition and reward associated with clinical work or research. Conclusion To overcome barriers to teaching requires more reciprocal links between hospital staff and medical schools, opportunities for consultants to understand and to comment on curricular and timetable developments, and, perhaps most importantly, recognition (in contractual, financial, managerial and personal terms) of the importance of undergraduate teaching in the competing triad of service, research and education. [ABSTRACT FROM AUTHOR]

Purpose Team-based learning (TBL) has been successfully used in non-medical curricula, but its effectiveness in medical education has not been studied extensively. We evaluated the impact of TBL on the academic performance of Year 2 medical students at Wright State University by comparing this active learning strategy against a traditional method of case-based group discussion (CBGD). Methods A prospective crossover design assigned 83 Year 2 medical students to either CBGD or TBL for 8 pathology modules in the systems-based curriculum. The effectiveness of both learning methods was assessed by performance on pathology-based examination questions contained in end-of-course examinations. The highest and lowest academic quartiles of students were evaluated separately. Students' opinions of both methods were surveyed. Results No significant differences in whole group performance on pathology-based examination questions were observed as a consequence of experiencing TBL versus CBGD. However, students in the lowest academic quartile showed better examination performance after experiencing TBL than CBGD in 4 of 8 modules ( P = 0.035). Students perceived that the contributions of peers to learning were more helpful during TBL than CBGD ( P = 0.003). Conclusion This study demonstrates that TBL and CBGD are equally effective active learning strategies when employed in a systems-based pre-clinical pathology curriculum, but students with lower academic performance may benefit more from TBL than CBGD. [ABSTRACT FROM AUTHOR]

Objectives To examine whether changing initial answers during a multiple-choice question (MCQ) test in medicine brings about better overall test results, as has been shown in other academic fields. Methods A total of 36 answer books from the German Second National Medical Board Examination, with 580 MCQs (where 1 answer out of 5 must be selected), were used for analysis. Results We confirmed that high-stakes MCQ test scores in medicine did indeed improve when students changed their answers once. Further changes of answers did not improve the scores. Conclusions In written, high-stakes medical examinations, we recommend that students be encouraged, after further reflection, to change their answers in MCQ tests for questions for which they had previously had doubts about the answers. [ABSTRACT FROM AUTHOR]

Objective To explore the factorial composition of an instrument developed to assess value orientations in tertiary students, the Tertiary Student Values Scale (TSVS), using data from culturally diverse undergraduate dental students. Methods A 68-item questionnaire was used to collect the data. The questionnaire included 15 3-item subscales developed in a manner consistent with the Kluckhohn and Strodtbeck value orientation model. The psychometric properties were evaluated using a sample of students from 4 Australian dental schools. The questionnaire was administered to 364 students aged 18–50 years, mean age 21.3 years (SD 3.45 years), using a convenience sampling method. Scores on the 45 items were factor analysed using the maximum-likelihood estimation method for factor extraction with oblique rotation (oblimin). Internal consistency was examined on all of the 3-item subscales, using Cronbach's alpha. Results The analysis indicates that the TSVS reflects the hypothesised 15-dimension construct of value orientation. Furthermore, the analysis showed that the identified 15 factors were independent of one another and were sufficiently reliable for group comparisons. With 1 exception, all subscales yielded a Cronbach's alpha ≥ 0.55, the exception being 1 subscale with alpha = 0.40 (range 0.40–0.80). Conclusion Results indicated that value orientation is a complex construct, but that it is quantifiable along multiple dimensions in a psychometrically valid manner. Further refinement of this instrument would increase its value as a tool for policy makers designing educational programmes and services for culturally diverse student groups. [ABSTRACT FROM AUTHOR]

Introduction The Clinical Teaching Effectiveness Instrument (CTEI) was developed to evaluate the quality of the clinical teaching of educators. Its authors reported evidence supporting content and criterion validity and found favourable reliability findings. We tested the validity and reliability of this instrument in a European context and investigated its reliability as an instrument to evaluate the quality of clinical teaching at group level rather than at the level of the individual teacher. Methods Students participating in a surgical clerkship were asked to fill in a questionnaire reflecting a student−teacher encounter with a staff member or a resident. We calculated variance components using the ur genova program. For individual score interpretation of the quality of clinical teaching the standard error of estimate was calculated. For group interpretation we calculated the root mean square error. Results The results did not differ statistically between staff and residents. The average score was 3.42. The largest variance component was associated with rater variance. For individual score interpretation a reliability of > 0.80 was reached with 7 ratings or more. To reach reliable outcomes at group level, 15 educators or more were needed with a single rater per educator. Discussion The required sample size for appraisal of individual teaching is easily achievable. Reliable findings can also be obtained at group level with a feasible sample size. The results provide additional evidence of the reliability of the CTEI in undergraduate medical education in a European setting. The results also showed that the instrument can be used to measure the quality of teaching at group level. [ABSTRACT FROM AUTHOR]

Background Medical literature has documented a high prevalence of intimidation and harassment in the educational context. However, the research has failed to adequately delineate the nature of these phenomena as well as the different ways in which diverse actors perceive the behaviours in question. Methods Based on qualitative methodology anchored in a social constructionism framework, how teachers (staff surgeons) and learners (surgical residents) define intimidation and harassment were documented and compared. In addition, teachers' and learners' perceptions of the impact of these behaviours on the learning environment, including their effects on the socialisation of surgeons in training, were examined. Findings Five group interviews and 22 individual interviews were conducted across 2 university departments of surgery with a total of 22 faculty and 14 resident participants. Interviewees acknowledged the existence of intimidation and harassment, while at the same time rationalising its occurrence. This paradox was encapsulated in participant descriptions using terms such as ‘good intimidation’. Our examination of the data helped us to understand that participants sustained the paradox of beneficial intimidation and harassment by rationalising questionable behaviours on 3 specific dimensions, namely: whether an acceptable purpose could be attributed to the perpetrator; whether positive effects of the behaviour existed, and whether there was a perceived necessity for the behaviour. Interpretations Even while their dysfunctional characteristics are recognised, intimidation and harassment are often seen as functional educational tools. The cultural value currently accorded these behaviours needs to be taken into account in educational interventions designed to shift attitudes and actions in this domain. [ABSTRACT FROM AUTHOR]

Background Curriculum-wide implementation of computer-based learning (CBL) in undergraduate medical education remains elusive. Unlike many pilot tests of singular learning programmes, dropout rates are high and acceptance seems low in the long run. We studied the effect of a new CBL programme, suitable for curriculum-wide implementation, on Year 3 medical students' attitudes towards CBL. Methods Students from 2 universities participating in a mandatory pharmacology course were given access to a CBL programme covering cardiovascular drug therapy in a controlled randomised study ( n = 167). Learner properties and attitude towards CBL were measured using psychometric scales, and knowledge by multiple-choice questions (pre- and post-test). Results Attitude towards CBL worsened in the CBL group ( n = 70). Individual learners' properties did not explain this effect. The perceived programme quality was rated only ‘average’, which may contribute to the lower post-test values of attitude towards CBL. Learning outcomes were similar between the control group ( n = 97) and students using CBL ( n = 44). Learning efforts were shifted from self-study towards CBL. Conclusion The initial enthusiasm of students was not maintained when using a programme designed to complement or even replace traditional teaching. Curriculum-wide implementation of CBL might be hampered by the discouragement of users. [ABSTRACT FROM AUTHOR]

Background Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress test aimed at the medical core knowledge that every graduating doctor should possess. This study was conducted to validate the level of knowledge tested in this progress test. Aim We designed a questionnaire to investigate whether postgraduate trainees and experienced specialists agree with item writers on what is required core knowledge. Methods Postgraduates and specialists received a questionnaire with 80 items designed to test core knowledge. Respondents were asked to indicate to what extent the items actually represented the core knowledge required of a recently graduated medical student. Results Of the clinical questions, 82.4% were judged to reflect core knowledge, whereas only 42.4% of the basic science questions were judged to reflect core knowledge. There was a strikingly high correlation on the mean judgements per item of postgraduate trainees versus medical specialists ( r = 0.975). Conclusion Many items, written to reflect core knowledge, appear to be judged by postgraduates and clinicians as pertaining to non-core knowledge. Postgraduate trainees appear to be as capable as experienced specialists of making judgements regarding core knowledge. Fewer basic science items are regarded as core knowledge than clinical items. This may suggest that, specifically, basic science teachers do not agree with physicians on what is to be considered medical core knowledge for graduating doctors. [ABSTRACT FROM AUTHOR]

Background This study was directed at illuminating a well known phenomenon in the medical expertise literature, the ‘intermediate effect’ in clinical case recall. This robust phenomenon consists of the finding that medical students of intermediate levels of expertise outperform both experts and novices in clinical case recall after diagnosing cases. It deals in particular with the findings of OME researchers who have reported a monotonically increasing recall with level of expertise. Purpose To address possible causes for this anomaly in medical expertise and to experimentally demonstrate how data elaboration can cause expertise effects in clinical case recall. Method Expert nephrologists, intermediate level students and novices were presented with 6 medical cases under 3 different conditions: laboratory data cases without special instructions, laboratory data cases with instructions to elaborate, and cases with laboratory data and a relevant clinical context. Results Only when participants were required to elaborate on each of the information units presented to them did case recall show an expertise effect. If laboratory data are framed within the context of a patient's history and physical examination data, the ‘intermediate effect’ appears. Conclusions The instructions used in the elaboration condition seem to have induced a deeper, more detailed, analysis of the patient case. It is therefore interesting to note that these instructions only affected the recall of the experts and had no effect on the novices' or intermediates' recall. We might conclude from this that expertise effects in clinical case recall are only produced when the normal processing of patient information is disrupted. [ABSTRACT FROM AUTHOR]

Multidisciplinary and interprofessional working is currently a priority in health care policy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied. This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care. Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis. Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement. Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for policy, for practice and for interprofessional education. [ABSTRACT FROM AUTHOR]

Objective This study aimed to monitor which undergraduate students collected formative feedback on their degree essays and to quantify any correlations between gender or summative mark achieved and whether formative feedback was sought. Methods We carried out a study at the University of Aberdeen Medical School, involving a total of 360 Year 3 students, comprising all 177 students in the 2004 cohort and 183 in 2005. Data on gender and summative mark were routinely collected during the degree assessment processes in March 2004 and 2005. Students signed on receipt of their feedback. Results Less than half the students (46%) collected their formative feedback: 47% in 2004, and 45% in 2005. Overall, females were significantly more likely than males to seek formative feedback ( P = 0.004). Higher achievers were significantly more likely than lower achievers to seek their feedback ( P = 0.020). Conclusions Our findings indicate that these medical students, particularly males and poor students, may not use assessment feedback as a learning experience. Female and better students are keener to seek out formative feedback that might be expected to help them continue to do well. We need to explore further why so many students do not access formative feedback, and develop strategies for addressing this issue effectively. [ABSTRACT FROM AUTHOR]

Objective To assess the effect of ethnicity and gender on medical student examination performance. Design Cohort study of Year 3 medical students in 2002 and 2003. Setting Royal Free and University College Medical School, Imperial College School of Medicine. Subjects A total of 1216 Year 3 medical students, of whom 528 were male and 688 female, and 737 were white European and 479 Asian. Outcome measure Performance in summative written and objective structured clinical examinations (OSCEs) in July 2002 and 2003. Results White females performed best in all OSCEs and in 3 out of 4 written examinations. Mean scores for each OSCE and 2 out of 4 written examinations were higher for white students than for Asian students. The overall size of the effect is relatively small, being around 1–2%. Conclusion Students of Asian origin, of both genders, educated in the UK, using English as their first language, continue to perform less well in OSCEs and written assessments than their white European peers. [ABSTRACT FROM AUTHOR]