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Objectives The need to address cultural and ethnic diversity issues in medical education as a means to improve the quality of care for all has been widely emphasised. Cultural competence has been suggested as an instrument with which to deal with diversity issues. However, the implementation of culturally competent curricula appears to be difficult. We believe the development of curricula would profit from a framework that provides a practical translation of abstract educational objectives and that is related to competencies underlying the medical curriculum in general. This paper proposes such a framework. Methods The framework illustrates the following cultural competencies: knowledge of epidemiology and the differential effects of treatment in various ethnic groups; awareness of how culture shapes individual behaviour and thinking; awareness of the social context in which specific ethnic groups live; awareness of one’s own prejudices and tendency to stereotype; ability to transfer information in a way the patient can understand and to use external help (e.g. interpreters) when needed, and ability to adapt to new situations flexibly and creatively. Discussion The framework indicates important aspects in taking care of an ethnically diverse patient population. It shows that there are more dimensions to delivering high-quality care than merely the cultural. Most cultural competencies emphasise a specific aspect of a generic competency that is of extra importance when dealing with patients from different ethnic groups. We hope our framework contributes to the further development of cultural competency in medical curricula. [ABSTRACT FROM AUTHOR]

Objectives The practice of having medical students see patients in a general practice setting, in their own consulting rooms, prior to the GP preceptor joining the consultation does not increase general practitioner (GP) consultation time. How do GPs meet the needs of both patient and student without extending consultation time? This study sought to quantify and compare GP consultation activities with and without students. Methods This was a prospective cohort study of 523 videotaped consultations. Consultations were analysed in 15-second intervals using a modified Davis observation code to define GP activity. Estimated marginal means were calculated using mixed model analysis accounting for confounding factors. Results In comparison with consulting alone, GPs precepting a student spent 37 seconds less time examining patients ( P = 0.001), 41 seconds less on patient management, and 1 minute, 31 seconds less on clerical and other activities ( P < 0.001). This created time for GPs to take a history from both the student and patient (39 seconds longer; P = 0.002) and to teach students (1 minute, 10 seconds; P < 0.001). Discussion General practitioner activity in the consultation changes significantly when precepting a student; GPs spend longer exploring the history in order to unpack the student’s clinical reasoning, verify the patient’s story and resynthesise the information. They spend less time on examination, management and clerical activities and presumably delegate or defer these activities. Conclusions This organising of clinical activities in order to meet the needs of both patient and student is likely to require different processing skills to solo consulting. [ABSTRACT FROM AUTHOR]

Objectives Students from lower socio-economic circumstances remain under-represented in UK medical schools despite recent shifts in other demographic variables and specific policy emphasis on widening participation (WP). This study aimed to further understanding of the reasons for this. Methods Volunteer participants at three English medical schools took part in narrative-style, in-depth interviews examining their pathways into medicine and the relationships between these pathways and participants’ socio-cultural, educational and family backgrounds. This analysis uses findings from interviews with 12 mature students from working-class backgrounds. It employs theoretical work from the wider field of education sociology that has investigated the relationship between higher education decision making and class. Results This study demonstrates how ‘normal working-class biographies’, constructed by the majority of students targeted by WP activity, result from the influences of socio-cultural context, as well as familial and institutional habitus. The resultant influence on habitus as identity and, in particular, the disjuncture between working-class perceptions of medicine and individual identities are key to understanding the reasons behind the low number of working-class applicants to medical school. Conclusions Interventions that aim to increase participation rates in medicine must address this disjuncture. This might be achieved by re-orienting working-class identities and perceptions of medicine as a profession. However, it should be acknowledged that ‘identity conflict’ is related to the elite image that medicine maintains within contemporary society and, as such, efforts to re-orient individual working-class identities may have only a limited impact on overall participation rates. [ABSTRACT FROM AUTHOR]

Objectives Communication skills training in undergraduate medical education is considered to play an important role in medical students’ formation of their professional identity. This qualitative study explores Year 1 students’ perceptions of their identities when practising communication skills with real patients. Methods A total of 23 individual semi-structured interviews and two focus group discussions were conducted with 10 students during their first year of communication skills training. All interviews and discussions were audio-recorded, transcribed and analysed for emergent themes relating to identity. Results Students struggled to communicate professionally with patients because of a lack of clinical knowledge and skills. Consequently, students enacted other identities, yet patients perceived them differently, causing conversational ambiguities. Discussion Students’ perceptions challenge educational goals, suggesting that there is limited potential for the formation of professional identity through early training. Teacher-doctors must acknowledge how students’ low levels of clinical competence and patients’ behaviour complicate students’ identity formation. [ABSTRACT FROM AUTHOR]

Objectives Internationally, there are a number of universities at which medical and dental education programmes share common elements. There are no studies about the experiences of medical and dental students enrolled in different programmes who share significant amounts of learning and teaching. Methods Semi-structured interviews and focus groups were conducted with 36 students and staff in a learning programme shared between separate medical and dental faculties. They were transcribed and an iterative process of interpretation and analysis within the theoretical framework of the contact hypothesis and social identity theory was used to group data into themes and sub-themes. Results Dental students felt ‘marginalised’ and felt they were treated as ‘second-class citizens’ by medical students and medical staff in the shared aspects of their programmes. Contextual factors such as the geographical location of the two schools, a medical : dental student ratio of almost 3 : 1, along with organisational factors such as curriculum overload, propagated negative attitudes towards and professional stereotyping of the dental students. Lack of understanding by medical students and faculty of dental professional roles contributed further. Conclusions Recommendations for reducing the marginalisation of dental students in this setting include improving communication between faculties and facilitating experiential contact. This might be achieved through initiating a common orientation session, stronger social networks and integrated learning activities, such as interprofessional problem-based learning and shared clinical experiences. [ABSTRACT FROM AUTHOR]

Objectives Little is known about specific personal and professional factors influencing student distress. The authors conducted a comprehensive assessment of how learning environment, clinical rotation factors, workload, demographics and personal life events relate to student burnout. Methods All medical students ( n = 3080) at five medical schools were surveyed in the spring of 2006 using a validated instrument to assess burnout. Students were also asked about the aforementioned factors. Results A total of 1701 medical students (response rate 55%) completed the survey. Learning climate factors were associated with student burnout on univariate analysis (odds ratio [OR] 1.36–2.07; all P ≤ 0.02). Being on a hospital ward rotation or a rotation requiring overnight call was also associated with burnout (ORs 1.69 and 1.48, respectively; both P ≤ 0.02). Other workload characteristics (e.g. number of admissions) had no relation to student burnout. Students who experienced a positive personal life event had a lower frequency of burnout (OR 0.70; P ≤ 0.02), whereas those who experienced negative personal life events did not have a higher frequency of burnout than students who did not experience a negative personal life event. On multivariate analysis personal characteristics, learning environment and personal life events were all independently related to student burnout. Conclusions Although a complex array of personal and professional factors influence student well-being, student satisfaction with specific characteristics of the learning environment appears to be a critical factor. Studies determining how to create a learning environment that cultivates student well-being are needed. [ABSTRACT FROM AUTHOR]

Objectives Although peer-assisted learning (PAL) is widely employed throughout medical education, its effectiveness for training in technical procedures in skills laboratories has been subject to little systematic investigation. We conducted a prospective, randomised trial to evaluate the hypotheses that PAL is effective in technical skills training in a skills laboratory setting, and PAL is as effective as faculty staff-led training. Methods Volunteer Year 3 medical students were randomly assigned to one of three groups. Two of these received regular skills training from either cross-year peer tutors or experienced faculty staff. Following training, both groups were assessed using an objective structured clinical examination (OSCE) (three stations assessing various injection techniques) which was video-recorded. Two independent video assessors scored the OSCEs using binary checklists and global ranking forms. A third student group was assessed prior to training and served as a control group. Results A total of 89 students (mean age 23.0 ± 0.2 years; 41 male, 48 female) agreed to participate in the trial. Confounding variables including prior training as a paramedic or previous experience in performing the technical procedures did not significantly differ between the three study groups. In the OSCE, PAL (58.1 ± 1 binary points, 4.9 ± 0.1 global ranking points) and faculty-led groups (58.3 ± 1 binary points, 4.7 ± 0.1 global ranking points) scored significantly higher than the control group (33.3 ± 1 binary points, 2.7 ± 0.1 global ranking points; all P < 0.0001). There was no significant difference between the PAL and faculty-led groups ( P = 0.92 for binary checklists, P = 0.11 for global rankings). Conclusions Peer-assisted learning is a successful method for learning technical procedures in a skills laboratory setting and can be just as effective as the training provided by experienced faculty staff. [ABSTRACT FROM AUTHOR]

Objectives Depression is more frequently experienced and induces more severe consequences in medical students than in the general population. However, treatment rates for depression in medical students are still low. In this study, the authors investigated factors that affect treatment for depression and dispositions towards treating depression among South Korean medical students. Methods A nationwide, cross-sectional survey was administered to medical students attending all 41 medical schools in South Korea (14 095 students). The questionnaire included the Beck Depression Inventory (BDI) and asked for data on socio-demographic variables, history of diagnosis or treatment for depression, knowledge of mental health problems and disposition to use mental health care. Results A total of 7357 students (52.2%) from 36 schools responded to the survey. Of these, 689 (9.4%) were identified as being depressed via a BDI score higher than 16. Of the depressed respondents, only 61 (8.9%) had been diagnosed with depression and 67 (9.7%) had been treated for depression. Age was significantly associated with treatment behaviour for depression. Correct knowledge about the aetiology of depression and psychiatric medicine was significantly related to students’ disposition to use psychiatric services and to receive psychopharmacotherapy as an option to resolve depression. Conclusions Accurate knowledge of depression and appropriate medication seems to be relevant to students seeking appropriate treatment for depression. The development of education programmes designed to improve medical students’ knowledge of mental health problems and treatments would facilitate treatment seeking in medical students. [ABSTRACT FROM AUTHOR]

Objectives We aimed to discover, through a controlled experiment, whether cognitive and non-cognitive assessment would select higher-achieving applicants to medical school than selection by lottery. Methods We carried out a prospective cohort study to compare 389 medical students who had been admitted by selection and 938 students who had been admitted by weighted lottery, between 2001 and 2004. Main outcome measures were dropout rates, study rate (credits per year) and mean grade per first examination attempt per year. Study rates in the 4 pre-clinical years of medical school were used to categorise students’ performance as average or optimal. Results Pre-admission variables did not differ between the two groups. The main outcome of the selection experiment was that relative risk for dropping out of medical school was 2.6 times lower for selected students than for lottery-admitted controls (95% confidence interval 1.59–4.17). Significant differences between the groups in the percentage of optimally performing students and grade point average for first examination attempts were found only in the 2001 cohort, when results favoured the selected group. The results of the selection process took into account both the assessment procedure involved and the number of students who withdrew voluntarily. Conclusions This is the first controlled study to show that assessing applicants’ non-cognitive and cognitive abilities makes it possible to select students whose dropout rate will be lower than that of students admitted by lottery. The dropout rate in our overall cohort was 2.6 times lower in the selected group. [ABSTRACT FROM AUTHOR]

Objectives The lack of published studies into effective skills teaching in clinical skills centres inspired this study of student views of the teaching behaviours of skills teachers. Methods We organised focus group discussions with students from Years 1–3 of a 6-year undergraduate medical curriculum. A total of 30 randomly selected students, divided into three groups, took part in two sessions. They discussed what teaching skills helped them to acquire physical examination skills. Results Students’ opinions related to didactic skills, interpersonal and communication skills and preconditions. Students appreciated didactic skills that stimulate deep and active learning. Another significant set of findings referred to teachers’ attitudes towards students. Students wanted teachers to be considerate and to take them seriously. This was reflected in student descriptions of positive behaviours, such as: ‘responding to students’ questions’; ‘not exposing students’ weaknesses in front of the group’, and ‘[not] putting students in an embarrassing position in skill demonstrations’. They also appreciated enthusiasm in teachers. Important preconditions included: the integration of skills training with basic science teaching; linking of skills training to clinical practice; the presence of clear goals and well-structured sessions; good time management; consistency of teaching, and the appropriate personal appearance of teachers and students. Conclusions The teaching skills and behaviours that most facilitate student acquisition of physical examination skills are interpersonal and communication skills, followed by a number of didactic interventions, embedded in several preconditions. Findings related to interpersonal and communication skills are comparable with findings pertaining to the teaching roles of tutors and clinical teachers; however, the didactic skills merit separate attention as teaching skills for use in skills laboratories. The results of this study should be complemented by a study performed in a larger population and a study exploring teachers’ views. [ABSTRACT FROM AUTHOR]

Context A study of medical students’ perspectives on derogatory and cynical humour was published in 2006. The current study examines residents’ and attending doctors’ perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. Methods Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors, during the 2006–07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use. All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. Results Three categories that appeared in the first study with medical students – locations for humour, the humour game, and not-funny humour – emerged as virtually identical, whereas two others – objects of humour and motives for humour – were more fully elaborated. Discussion Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process, particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon. [ABSTRACT FROM AUTHOR]

Context Many countries now use call centres as an integral part of out-of-hours primary care. Although some research has been carried out on safety issues pertaining to telephone consultations, there has been no published research on how to train and use standardised patients calling for medical advice or on the accuracy of their role-play. Objectives This study aimed to assess the feasibility and validity of using telephone incognito standardised patients (TISPs), the accuracy of their role-play and the rate of detection. Further objectives included exploring the experiences of TISPs and the difficulties encountered in self-recording calls. Methods Twelve TISPs were trained in role-play by presenting their problem to a general practitioner and a nurse. They were also trained in self-recording calls. Calls were made to 17 different out-of-hours centres (OOHCs) from home. Of the four or five calls made per evening, one call was assessed for accuracy of role play. Retrospectively, the OOHCs were asked whether they had detected any calls made by a TISP. The TISPs filled in a questionnaire concerning their training, the self-recording technique and their personal experiences. Results The TISPs made 375 calls over 84 evenings. The accuracy of role-play was close to 100%. A TISP was called back the same evening for additional information in 11 cases. Self-recording caused extra tension for some TISPs. All fictitious calls remained undetected. Conclusions Using the method described, TISPs can be valuable both for training and assessment of performance in telephone consultation carried out by doctors, trainees and other personnel involved in medical services. [ABSTRACT FROM AUTHOR]

Objectives Participants in faculty development workshops often comment that ‘those who need faculty development the most attend the least’. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers’ needs. Methods In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation. Results Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university. Conclusions Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of ‘belonging’. Faculty development programmes should try to address these organisational issues as well as teachers’ personal and professional needs. [ABSTRACT FROM AUTHOR]

Context Peer physical examination (PPE) has been employed for several decades as part of the formal curriculum for learning clinical skills. Most of the existing studies exploring students’ attitudes towards PPE are single-site and use quantitative methods. Currently, there is a lack of theoretical underpinning to PPE as a learning method. Methods Using an adaptation of the Examining Fellow Students questionnaire, we captured qualitative data from Year 1 medical students about their views and concerns around learning using PPE. The study was set in six schools across five countries (the UK, Australia, New Zealand, Japan and Hong Kong). Students provided free text comments that were later transcribed and analysed using framework analysis. Results A total of 617 students provided comments for analysis. This paper focuses on several related themes about the complexities of students’ relationships within the context of PPE and their reflections on peer examination in comparison with genuine patient examination. Students drew parallels and differences between the peer examiner–examinee relationship and the doctor–patient relationship. They explained how these two types of relationship differed in nature and in terms of their levels of interaction. Discussion Our findings illuminate the interactional and complex nature of PPE, drawing out concerns and ambiguities around relationships, community and rules. We discuss our results in light of Engeström’s model of activity theory (AT) and provide recommendations for educational practice and further research based on the principles of AT. [ABSTRACT FROM AUTHOR]

Context There is little empirical evidence in the literature regarding the nature of the experiences of medical students during war. In this study we set out to assess and analyse the experiences of medical students and residents in Beirut, Lebanon during the 2006 Lebanon–Israel war. Methods Students and residents working at the American University of Beirut Medical Center and the Beirut Government University Hospital during the July 2006 war were invited to participate. A total of 21 students or residents took part in either a focus group or one of 11 semi-structured interviews. These were recorded, transcribed and analysed to bring out common themes. Results Although the wartime experience was stressful, medical students and residents reported many largely positive effects of war on their medical training. Students adapted to the difficult conditions and became more resourceful. Participants connected emotionally with their patients and were able to show more compassion. They felt pride in their chosen profession and had higher levels of motivation for dealing with the normally irksome aspects of medical practice. Practical skills associated with the treatment of wartime injuries were learned, as were more general lessons about life priorities. Conclusions Despite the curtailing of formal educational activities, participants benefited from positive learning experiences in a wartime environment. Strikingly, participants ‘cared’ more for their patients. Further research looking at the underlying cause of this increased level of compassion may be useful in the education of all medical students, not just those involved in conflict. [ABSTRACT FROM AUTHOR]

Context The Reporter–Interpreter–Manager–Educator (RIME) evaluation framework is intuitive and reliable. Our preceptors’ frustration with using summative tools for formative feedback and the hypothesis that the RIME vocabulary might improve students’ and preceptors’ experiences with feedback prompted us to develop and pilot a RIME-based feedback tool. Methods The tool was based on the RIME vocabulary, which has previously been used for evaluation. As interpersonal skills and professionalism are difficult areas in which to give feedback, we added these as explicit categories. We piloted the tool in a longitudinal, 5-month, multi-specialty clerkship. Preceptors completed pre- and post-introductory workshop surveys. Students completed post-workshop and post-clerkship surveys. Results Preceptors ( n = 14) and students ( n = 8) preferred RIME-based feedback to ‘usual feedback’ (previously given using end-of-clerkship evaluation forms). After the initial workshop, preceptors expected that giving feedback, including critical feedback, would be easier. After the 5-month clerkship, students reported receiving more feedback than in previous clerkships and rated feedback given using this tool more highly ( P = 0.002; effect size 1.2). Students also felt it helped them understand specifically how to improve their performance ( P = 0.003; effect size 1.2). Discussion In this pilot study, preceptors and students preferred feedback with a specific RIME-based tool. Students felt such feedback was more useful and helped them identify specifically how to improve. Whether this method can improve student performance through improved feedback remains an area for further research. [ABSTRACT FROM AUTHOR]

Context Medical students have long been perceived as socially segregated from other students. However, the evidence for this is mainly anecdotal. This study investigates this issue by comparing medical students with economics students. Methods Questionnaires measuring objective and subjective social life patterns were completed by 149 medical and 149 economics students at a campus-based university in the UK. Results Medical students drew significantly more of their close friends and housemates from among students on the same course than economics students. Significantly more medical than economics students had a partner on the same course, participated in departmental sports clubs and societies, and felt separated from the rest of university life. Commonly reported reasons for this separation among medical students were high workloads, that the medical school was located outside the main campus, and high numbers of contact hours, some of which took place at sites outside the university. Discussion Medical students are more socially exclusive than economics students, which may lead to ‘in-group’ attitudes and behaviours. This is educationally important and may affect their future professionalism. Universities should be aware of the issues involved when planning curricula, timetables, welfare initiatives and campus design. Prospective medical students should be informed of the social consequences of studying medicine. [ABSTRACT FROM AUTHOR]

Context Patient-centredness is an accepted guiding principle for health system reform, patient care and medical education. Although these attitudes are strongly linked with cultural values, few studies have examined attitudes towards patient-centredness in a cross-cultural setting. Objectives This prospective study evaluated attitudes towards patient-centredness in a cohort of Asian medical students and examined changes in these attitudes in the same students on completion of their junior clinical clerkships. Methods The study was conducted in a cohort of 228 medical students entering Year 3 in medical school. The Patient–Practitioner Orientation Scale (PPOS), a validated instrument which scores an individual’s level of patient-centredness, was used. Results Being female and having personal experience of continuing care were significantly associated with higher scores. Students in the USA were previously reported to have similar ‘caring’ but higher ‘sharing’ scores on the same scale. At the end of the junior clinical clerkship, there were improvements in the ‘caring’ subscale, but no change or a reduction in ‘sharing’. Students who did not have previous personal experience with continuing care experienced a greater increase in overall PPOS score. Conclusions When compared with students in the USA, the students in our study appear to have a lower propensity to view the doctor–patient relationship as a partnership. This may be a reflection of differences in cultural norms and expectations of doctor–patient interaction in different societies. Our finding that attitudes towards patient-centredness did not decline over the course of the year, which contrasts with findings of other studies, may be attributed to various factors and warrants further study. [ABSTRACT FROM AUTHOR]

Context Self-reflection, the practice of inspecting and evaluating one’s own thoughts, feelings and behaviour, and insight, the ability to understand one’s own thoughts, feelings and behaviour, are central to the self-regulation of behaviours. The Self-Reflection and Insight Scale (SRIS) measures three factors in the self-regulation cycle: need for reflection; engagement in reflection, and insight. Methods We used structural equation modelling to undertake a confirmatory factor analysis of the SRIS. We re-specified our model to analyse all of the data to explain relationships between the SRIS, medical student characteristics, and responses to issues of teaching and learning in professionalism. Results The factorial validity of a modified SRIS showed all items loading significantly on their expected factors, with a good fit to the data. Each subscale had good internal reliability (> 0.8). There was a strong relationship between the need for reflection and engagement in reflection ( r = 0.77). Insight was related to need for reflection (0.22) and age (0.21), but not to the process of engaging in reflection (0.06). Conclusions Validation of the SRIS provides researchers with a new instrument with which to measure and investigate the processes of self-reflection and insight in the context of students’ self-regulation of their professionalism. Insight is related to the motive or need for reflection, but the process of reflection does not lead to insight. Attending to feelings is an important and integral aspect of self-reflection and insight. Effective strategies are needed to develop students’ insight as they reflect on their professionalism. [ABSTRACT FROM AUTHOR]

Context Historically, medical students report receiving little formative feedback. Reports of feedback processes are generally limited to a single course or specialty. There is a paucity of research detailing feedback across the core clerkship year. Objectives We aimed to determine the feasibility of a cross-clerkship feedback encounter card system, describe the content of feedback requested and received during the core clerkships, and examine student satisfaction with the feedback card system. Methods Students ( n = 127) enrolled in six mandatory clerkships were required to complete feedback cards, twice weekly during inpatient rotations and once weekly during outpatient rotations. Students checked-off areas in which they wanted to receive feedback and gave the card to a supervisor, who indicated areas in which feedback was provided. Descriptive statistics summarised completeness and feedback content. A two-factoranova estimated differences between students’ perceptions of feedback usefulness pre- and post-feedback card implementation. Results A total of 5369 feedback cards were completed in 2006 (78% of the target). Feedback about presentation skills (57% of cards) and fund of knowledge (48% of cards) were most frequently requested. On approximately 80% of the cards, students received feedback in the area(s) they had requested. During each clerkship, students requested feedback in most areas at least once. The mean rating of feedback usefulness was significantly lower after feedback card implementation (mean 3.6, standard deviation [SD] 1.1) than before implementation (mean 3.7, SD 1.0) ( F = 11.022, P < 0.001, effect size = − 17). Conclusions Despite evidence that students received feedback multiple times, satisfaction was low. Research identifying factors that improve satisfaction with feedback during clinical training is needed. [ABSTRACT FROM AUTHOR]

Context The reflective practice module in the physiotherapy programme at the University of Limerick, Ireland represents the first incidence of the inclusion of such a module within physiotherapy curricula in Ireland. However, research examining the contribution of reflection as a means of learning is limited, particularly from the student perspective. Objectives This study sought to explore students’ perceptions of reflection and its potential contribution to their development before and after the module. Methods A qualitative research methodology using focus groups was employed to evaluate physiotherapy undergraduate students’ perceptions of the module. Three focus groups were held in total. Two were held with Year 3 students, before and after their reflective practice module, respectively, to examine any changes in their perceptions of reflection. A third was held with Year 4 students to determine their perceptions after both the module and subsequent clinical placements. Sessions were audiotaped, transcribed and subjected to in-depth thematic analysis to resolve the significant themes that emerged from the data. Results Students reported a more advanced level of reflective ability post-module completion. They perceived personal and professional benefits to practising reflection and recognised these skills as strategies with which they could continue to facilitate their professional development. For students, time constraints in the clinical setting represented a barrier to reflection. Conclusions Students support inclusion of the module in their training, acknowledging its role in improving their confidence and clinical reasoning, and facilitating continuing professional development. Further studies are required to generalise these findings to a wider population. [ABSTRACT FROM AUTHOR]

Context Previous research has shown that general practitioners (GPs) hold negative attitudes towards patients with schizophrenia, which do not simply reflect the nature or chronic aspects of the illness. This study aimed to describe the attitudes and predicted behaviour of medical students towards patients with mental illness in a primary care setting and to investigate whether these were affected by the students’ level of training. Methods A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette. Results A total of 1081 (88%) students responded to the questionnaire. Students were generally less favourable in their responses to patients with either schizophrenia or depression. They would not be as happy to have them on their list, believed they would consume more time and considered they would be less likely to comply with advice and treatment. They expressed more concern about the risk of violence, the potential welfare of children and the possibility of illegal drug and excessive alcohol use. General clinical and psychiatric training had little effect on these reactions. Conclusions Patients with mental illness provoke less favourable responses in medical students, which are not altered by furthering education. Undergraduate primary care-based mental health education should be re-evaluated to ensure that students develop an empathetic and positive approach to mental health patients and their treatment. [ABSTRACT FROM AUTHOR]

Objectives We aimed to investigate experiences of, and responses to, medical error amongst junior doctors and to examine the challenges junior doctors face and the support they receive. Methods We carried out a qualitative study of 38 randomly selected pre-registration house officers (PRHOs) in 10 hospitals. All 38 had graduated in 2000 or 2001 from a single medical school. Results Errors were common and sometimes serious. In relation to disclosure and learning from error, four main themes emerged: a norm of selective disclosure; the effects of the team; individualised blame and responsibility, and the ‘learning moment’. Trainees reported disclosing errors informally, particularly when teams were seen as supportive, but were reluctant to criticise colleagues. Formal reports and disclosure to patients were very rare. Patient care was compromised when juniors did not access senior help, often when working outside their usual team environment. Lack of cooperation between teams and poor continuity of care also contributed to errors. Learning was maximised when errors were formally discussed and constructive feedback offered. However, both blame and the prioritisation of reassurance over learning and structured feedback appeared to inhibit reflection on the experience of error. Conclusions Junior doctors need help to reflect on their experiences and to recognise where they may have made mistakes, particularly in the contexts of shift-work and fragmented teams. Formal reporting systems alone will not facilitate learning from error. Juniors require individual clinical supervision from seniors with appropriate training. Such expertise may benefit the whole team and the training environment. [ABSTRACT FROM AUTHOR]

Context This paper examines the criterion validity of the Graduate Medical School Admissions Test (GAMSAT), which has been used since 1996 in Australia and more recently in the UK and Ireland. The study provides evidence on the extent to which GAMSAT, in combination with grade point average (GPA) and interview scores, adds value to determining an individual’s capability for medical study. The study responds to increasing demand for information on the validity of selection processes. Criterion validity is important because it helps to empirically situate selection tests within their broader contexts by, for instance, providing an assurance to educators and the public that test results are valid and add value to selection decisions. Methods After introducing the rationale and focus of the study, the paper summarises the data and research methods, presents statistical results and draws conclusions that advance current insight into medical school admissions processes. The results are based on data from six institutions and 351 students. Results Analyses of GAMSAT, interview and GPA scores show, in summary, that: there are fairly high levels of divergence between these three measures; that relationships between the measures and Year 1 marks vary across institutions, and that a combination of GAMSAT and GPA scores provides the best means of predicting Year 1 performance. [ABSTRACT FROM AUTHOR]

Context Ber’s Comprehensive Integrative Puzzle aims to assess analytical clinical thinking in medical students. We developed a paediatric version, the MATCH test, in which we added two irrelevant options to each question in order to reduce guessing behaviour. We tested its construct validity and studied the development of integrative skills over time. Methods We administered a test (MATCH 1) to subjects from two universities, both with a 6-year medical training course. Subjects included 30 students from university 1 who had completed a paediatric clerkship in Year 4, 23 students from university 2 who had completed a paediatric clerkship in Year 5, 13 students from both universities who had completed an advanced paediatric clerkship in Year 6, 28 paediatric residents and 17 paediatricians. We repeated this procedure using a second test with different domains in a new, comparable group of subjects (MATCH 2). Results Mean MATCH 1 scores for the respective groups were: Year 4 students: 61.2% (standard deviation [SD] 1.3); Year 5 students: 71.3% (SD 1.6); Year 6 students: 76.2% (SD 1.5); paediatric residents: 88.5% (SD 0.7), and paediatricians: 92.2% (SD 1.1) (one-wayanova F = 104.00, P < 0.0001). Students of both universities had comparable scores. MATCH 1 and 2 scores were comparable. Cronbach’s α-values in MATCH 1 and 2 were 0.92 and 0.91, respectively, for all subjects, and 0.82 and 0.87, respectively, for all students. Conclusions Analytical clinical thinking develops over time, independently of the factual content of the course. This implies that shortened medical training programmes could produce less skilled graduates. [ABSTRACT FROM AUTHOR]

Context The white paper ‘Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century’ proposes a single, generic multi-source feedback (MSF) instrument in the UK. Multi-source feedback was proposed as part of the assessment programme for Year 1 specialty training in histopathology. Methods An existing instrument was modified following blueprinting against the histopathology curriculum to establish content validity. Trainees were also assessed using an objective structured practical examination (OSPE). Factor analysis and correlation between trainees’ OSPE performance and the MSF were used to explore validity. All 92 trainees participated and the assessor response rate was 93%. Reliability was acceptable with eight assessors (95% confidence interval 0.38). Factor analysis revealed two factors: ‘generic’ and ‘histopathology’. Pearson correlation of MSF scores with OSPE performances was 0.48 ( P = 0.001) and the histopathology factor correlated more highly (histopathology r = 0.54, generic r = 0.42; t = − 2.76, d.f. = 89, P < 0.01). Trainees scored least highly in relation to ability to use histopathology to solve clinical problems (mean = 4.39) and provision of good reports (mean = 4.39). Three of six doctors whose means were < 4.0 received free text comments about report writing. There were 83 forms with aggregate scores of < 4. Of these, 19.2% included comments about report writing. Results Specialty-specific MSF is feasible and achieves satisfactory reliability. The higher correlation of the ‘histopathology’ factor with the OSPE supports validity. This paper highlights the importance of validating an MSF instrument within the specialty-specific context as, in addition to assuring content validity, the PATH–SPRAT (Histopathology–Sheffield Peer Review Assessment Tool) also demonstrates the potential to inform training as part of a quality improvement model. [ABSTRACT FROM AUTHOR]

Objectives Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL. Methods Year 2 students were randomly allocated to one of two groups for skills training. Group 1 ( n = 64) were tutored by volunteer Year 6 students, and Group 2 ( n = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t-test. Qualitative data, obtained from Year 2 students ( n = 125) by written questionnaire and Year 6 students ( n = 11) and SPs ( n = 3) by focus group interviews, were analysed for themes. Results Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval − 3.8 to 2.4). The PAL environment was perceived as ‘comfortable’ and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching. Conclusions With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad. [ABSTRACT FROM AUTHOR]

Context Apprenticeship learning is common in medical education, but is often situated in theoretical frameworks which highlight its cognitive but not its social dimension. Methods We conducted an ethnographic case study of paediatric residents’ learning relationships with their preceptors in a community-based paediatric continuity site. It included 5 months (100 hours) of direct observation, and semi-structured interviews with 10 residents (before and after observation) and 10 primary care paediatricians who served as their continuity preceptors (after observation). Interview transcripts and notes from observations were inductively coded and analysed for major themes. Results Our observations and reports of resident learning trajectories fit well with the concept of legitimate peripheral participation. Residents learned the everyday practice of primary care as they worked alongside experienced paediatricians in the continuity clinic. Although the direction of learning was towards central participation in patient care, residents learned during transient shifts to the periphery of practice. As a function of residents’ increased participation, preceptors moved into more supportive roles. Residents were not only learners; at times they were teachers who facilitated preceptors’ learning. Conclusions Legitimate peripheral participation is a concept that helps to explain apprenticeship as a dynamic social relationship which shapes, and is shaped by, learning that takes place in clinical practice. Other concepts shed light on the bidirectional nature of apprenticeship learning. [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]

Context There is both qualitative and quantitative variation in the research methods training provided for Masters and doctoral students on medical education programmes across the UK. Unlike other higher-degree programmes, there are no requirements for higher-degree medical education students to have studied the subject at degree level or for their supervisors to have training in social science research methods. This study explores the ways in which a panel of experts responded to novices’ presentations of their research in progress. Methods This qualitative, case-based study of a 1-day education research consortium generated data in two phases. The author collected detailed field notes as a non-participant observer and subsequently analysed the data they contained. A second set of data was generated from written reflexive accounts of the day e-mailed to the author by all participants 1 month after the event and was subsequently analysed. Results Thematic coding revealed wide degrees of variance between the research experiences and abilities of the novices and the expectations of the experts. These levels of dissonance are ascribed to the limited amounts of research training undertaken by students and the variable guidance provided by research supervisors, some of whom were themselves novices in this area. Conclusions If medical education research is to thrive, it requires a properly developed infrastructure with training and support for research supervisors and students alike. Communities of practice need to be fostered to enable researchers to collaborate and disseminate good practice. This will ensure that medical education research practitioners can produce theoretically sound, rigorously designed and executed studies that can contribute to the evidence base for medical education. [ABSTRACT FROM AUTHOR]

Objectives Working with doctors to develop their identities as technically skilled as well as caring, compassionate and ethical practitioners is a challenge in medical education. One way of resolving this derives from a narrative reflective practice approach to working with residents. We examine the use of such an approach. Methods This paper draws on a 2006 study carried out with four family medicine residents into the potential of writing, sharing and inquiring into parallel charts in order to help develop doctor identity. Each resident wrote 10 parallel charts over 10 weeks. All residents met bi-weekly as a group with two researchers to narratively inquire into the stories told in their charts. Results One parallel chart and the ensuing group inquiry about the chart are described. In the narrative reflective practice process, one resident tells of working with a patient and, through writing, sharing and inquiry, integrates her practice and how she learned to be a doctor in one cultural setting into another cultural setting; another resident affirms her relational way of practising medicine, and a third resident begins to see the complexity of attending to patients’ experiences. Conclusions The process shows the importance of creating pedagogical spaces to allow doctors to tell and retell, through narrative inquiry, their stories of their experiences. This pedagogical approach creates spaces for doctors to individually develop their own stories by which to live as doctors through narrative reflection on their interwoven personal, professional and cultural stories as they are shaped by, and enacted within, their professional contexts. [ABSTRACT FROM AUTHOR]

Context Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students’ progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transition influences student performance during the first 2 weeks of clerkships; whether it influences students’ overall performance in their first clerkship, and the degree to which the difficulty of transition is influenced by students’ pre-clinical knowledge and skills levels. Methods Clerks ( n = 83) from a university hospital and eight affiliated hospitals completed a questionnaire measuring the perceived difficulty of the transition period. Data collected included student scores on pre-clinical knowledge and skills, their performance during the second week of the first clerkship, and their overall performance in the first clerkship. Univariate and multivariate multiple regression analyses were used to analyse the data. Results The perceived difficulty of transition was neither predictive of student performance during the transition period (adjusted R2 = 11.8%, P = NS), nor of their overall clerkship performance (adjusted R2 = 8.6%, P = NS). Students’ pre-clinical knowledge and skills played a minor role in the perceived difficulty of the transition period. Conclusions The negative effect of the transition period on student progress suggested in the literature was not found in this study. A possible explanation for the limited influence of students’ knowledge and skills on performance during the transition period is that the workload in this period causes a cognitive overload, interfering with students’ abilities to apply their pre-clinical knowledge and skills. [ABSTRACT FROM AUTHOR]

Context Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. Objectives This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students’ implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. Discussion We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students’ perceived control over their behaviours. [ABSTRACT FROM AUTHOR]

Objective Timely intervention, based on early identification of poor performance, is likely to help weaker medical students improve their performance. We wished to identify if poor performance in degree assessments early in the medical degree predicts later undergraduate grades. If it does, this information could be used to signpost strategically placed supportive interventions for our students. Methods We carried out a retrospective, observational study of anonymised databases of student assessment outcomes at the University of Aberdeen Medical School. Data were accessed for students who graduated in the years 2003−07 ( n = 861). The main outcome measure was marks for summative degree assessments from the end of Year 2 to the end of Year 5. Results After adjustment for cohort, maturity, gender, funding source, intercalation and graduate status, poor performance (fail and borderline pass) in the Year 2 first semester written examination Principles of Medicine II was found to be a significant predictor of poor performance in all subsequent written examinations (all P < 0.001). Poor performance in the Year 3 objective structured clinical examination (OSCE) was a significant predictor of poor performance in Year 4 and 5 OSCEs. Relationships between essay-based summative assessments were not significantly predictive. Male gender appeared to significantly predict poor performance. Discussion Examinations taken as early as mid-Year 2 can be used to identify medical students who would benefit from intervention and support. Strategic delivery of appropriate intervention at this time may enable poorer students to perform better in subsequent examinations. We can then monitor the impact of remedial support on subsequent performance. [ABSTRACT FROM AUTHOR]

Objective To identify how medical student learning experiences in a new longitudinally integrated clinical clerkship (LICC) programme impacted students’ learning. Methods We conducted semi-structured interviews with 12 medical students at three points in their training. We used an inductive, thematic analytic approach to data. Interviews ( n = 35) were iteratively and independently coded by research team members to identify and corroborate key emergent themes. Results Students in the LICC programme reported slow but ongoing increases in patient responsibility, examination-driven learning, programme flexibility to address educational gaps, and a strong and positive perception of educational continuity through a longitudinal primary care educator and similar case mix throughout the year. Conclusions Student learning experiences in an LICC programme are both similar to and different from those in a traditional rotational clerkship programme. Students in the integrated clerkship were clear and unequivocal about the benefits of working with one teacher across time and caring for patients at different stages of the same disease in multiple settings. These findings have implications for clinical education development and design. [ABSTRACT FROM AUTHOR]

Context Current studies have found limited evidence for an association between doctor emotional intelligence (EI) and the patient−doctor relationship (PDR). This study explored the associations among doctor EI, patient trust and the PDR using multi-source and multi-level approaches. Methods A total of 994 outpatients and 39 doctors representing 11 specialties were surveyed. Results Doctors’ self-rated EI was not significantly correlated with any variables rated by the patients. The nurse-rated PDR and the EI score for the doctor were positively associated with patient trust at a significant level. Conclusions Multi-sources for assessment of doctor EI may be more objective and predictive than doctor self-ratings in ascertaining the associations among patient trust, the PDR, and patient satisfaction. Emotional intelligence coaching for doctors and interdisciplinary collaboration among clinicians are needed to optimise the efficient and therapeutic function of the PDR for patients. [ABSTRACT FROM AUTHOR]

Objective This study examined reciprocity in medical residents’ relationships with supervisors, fellow residents, nurses and patients, and associations between reciprocity and burnout. Furthermore, we considered if a discrepancy between the perceived and preferred levels of reciprocity influenced the level of burnout complaints. Methods In 2003, self-report questionnaires were sent to the homes of all 292 medical residents at the University Medical Centre Groningen (UMCG), Groningen, the Netherlands. Reciprocity was measured with a single-item reciprocity scale based on the Hatfield Global Measure of Equity Scale. The Utrecht Burn-Out Scale (UBOS/MBI-HHS) was used to measure burnout. Results A total of 158 residents participated in the study. Those who reported under-benefiting in the relationship with supervisors perceived significantly more emotional exhaustion and depersonalisation than those who perceived a reciprocal relationship. Residents who indicated that they over-benefited in the relationship with nurses reported more emotional exhaustion than residents who perceived a reciprocal relationship and less personal accomplishment than residents who perceived a reciprocal relationship or under-benefit. No differences on the burnout subscales were found between residents who perceived their relationships with patients and fellow residents to be reciprocal and those who considered they under- or over-benefited. The greater the discrepancy between perceived and preferred reciprocity in the relationship with the supervisor, the more emotional exhaustion residents reported. Conclusions Perceptions of reciprocity in relationships with supervisors and nurses had particular influence on the level of burnout complaints among residents. The discrepancy between the impacts of perceived and preferred reciprocity on burnout was negligible and the only significant relationship to emerge concerned that with emotional exhaustion. [ABSTRACT FROM AUTHOR]

Context Interprofessional collaboration is gaining increasing prominence as a team-based approach to health care delivery that synergistically maximises the strengths of each health professional to enhance patient care, decrease medical errors and optimise efficiency. The often neglected role that student leaders have in preparing their peers, as the health professionals of the future, for collaboration in health care should not be overlooked. Objective This paper offers the foundational arguments supporting the integral role that student leadership in interprofessional education (IPE) can play and its comparative advantages. Methods Evidence from previous literature and the National Health Science Students’ Association in Canada was reviewed and a questionnaire on student-initiated IPE was administered among Canada’s top student leaders in this area. Results Student leadership is essential to the success of IPE because it enhances students’ willingness to collaborate and facilitates the longterm sustainability of IPE efforts. Student-initiated IPE, a subset of student leadership, is particularly important to achieving the aforementioned goals and offers a number of benefits, comparative advantages and associated challenges. Conclusions Successful student leadership in IPE will yield significant benefits for everyone in the years to come. However, it requires the support of educators, researchers and policymakers in fostering an enabling environment that will facilitate the efforts and contributions of student leaders. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine medical students’ experiences with medical errors. Methods In 2001 and 2002, 172 fourth-year medical students wrote an anonymous description of a significant medical error they had witnessed or committed during their clinical clerkships. The assignment represented part of a required medical ethics course. We analysed 147 of these essays using thematic content analysis. Results Many medical students made or observed significant errors. In either situation, some students experienced distress that seemingly went unaddressed. Furthermore, this distress was sometimes severe and persisted after the initial event. Some students also experienced considerable uncertainty as to whether an error had occurred and how to prevent future errors. Many errors may not have been disclosed to patients, and some students who desired to discuss or disclose errors were apparently discouraged from doing so by senior doctors. Some students criticised senior doctors who attempted to hide errors or avoid responsibility. By contrast, students who witnessed senior doctors take responsibility for errors and candidly disclose errors to patients appeared to recognise the importance of honesty and integrity and said they aspired to these standards. Conclusions There are many missed opportunities to teach students how to respond to and learn from errors. Some faculty members and housestaff may at times respond to errors in ways that appear to contradict professional standards. Medical educators should increase exposure to exemplary responses to errors and help students to learn from and cope with errors. [ABSTRACT FROM AUTHOR]

Context Subjective rating scales for communication skills may yield more personally meaningful responses than more standardised rating schemes. It is unclear, however, whether such evaluations may be overly biased by respondents’ rating styles, which may lead to unreliable measurement of examinees’ communication skills. Methods Our study involved 212 students from the classes of 2005 and 2006 at the University of Rochester School of Medicine and Dentistry. All students were rated by actors depicting standardised patients (SPs) on the same seven cases using the 19-item Rochester Communication Rating Scale (RCRS). Different students were assigned to different actors playing the same SP. We assessed the extent to which actors’ personal rating styles influenced the scores they assigned to students. Main outcome measures were: between-actor variability in responses; the degree to which actors’ response styles contribute to overall scores, and improvements in reliability achieved by standardising actors’ ratings. Results There were statistically significant differences between actors in their mean assigned scores. Scores aggregated over 18 separate SP cases have an expected generalisability coefficient of 0.79. If raw RCRS scores are used, a total of 27 replications of the RCRS are required to achieve a Cronbach’s alpha of 0.8; standardisation reduces this number to 18. Conclusions Although actors are variable in their use of a standardised subjective scale of communication, such differences contribute to an acceptably small proportion of the total variance if scores are combined across a large number of cases. Reliability can be markedly improved by standardising scores across raters. [ABSTRACT FROM AUTHOR]

Context Medical students are at risk of occupational exposure to blood-borne viruses following needlestick injuries (NSIs) during medical school. The reporting of NSIs is an important step in the prevention of further injuries and in the initiation of early prophylaxis or treatment. The objective of this study was to describe the mechanisms whereby medical students experience occupational percutaneous blood exposure through NSIs and to discuss rational strategies for prevention. Methods Incidents of exposure to blood-borne pathogens among medical students at a large German university were analysed. Year 6 medical students completed a written survey immediately before the clinical part of their training began, describing incidents that had occurred during the previous 5 years. Results In our study, 58.8% (183/311) of participating medical students recalled at least one NSI that had occurred during their studies. Overall, 284 NSIs were reported via an anonymous questionnaire. Discussion Occupational exposure to blood is a common problem among medical students. Efforts are required to ensure greater awareness of the risks associated with blood-borne pathogens among German medical students. Proper training in percutaneous procedures and how to act in the event of injury should be given in order to reduce the number of injuries. [ABSTRACT FROM AUTHOR]

Objective High-stakes assessments of doctors’ physical examination skills often employ standardised patients (SPs) who lack physical abnormalities. Simulation technology provides additional opportunities to assess these skills by mimicking physical abnormalities. The current study examined the relationship between internists’ cardiac physical examination competence as assessed with simulation technology compared with that assessed with real patients (RPs). Methods The cardiac physical examination skills and bedside diagnostic accuracy of 28 internists were assessed during an objective structured clinical examination (OSCE). The OSCE included 3 modalities of cardiac patients: RPs with cardiac abnormalities; SPs combined with computer-based, audio-video simulations of auscultatory abnormalities, and a cardiac patient simulator (CPS) manikin. Four cardiac diagnoses and their associated cardiac findings were matched across modalities. At each station, 2 examiners independently rated a participant’s physical examination technique and global clinical competence. Two investigators separately scored diagnostic accuracy. Results Inter-rater reliability between examiners for global ratings (GRs) ranged from 0.75–0.78 for the different modalities. Although there was no significant difference between participants’ mean GRs for each modality, the correlations between participants’ performances on each modality were low to modest: RP versus SP, r = 0.19; RP versus CPS, r = 0.22; SP versus CPS, r = 0.57 ( P < 0.01). Conclusions Methodological limitations included variability between modalities in the components contributing to examiners’ GRs, a paucity of objective outcome measures and restricted case sampling. No modality provided a clear ‘gold standard’ for the assessment of cardiac physical examination competence. These limitations need to be addressed before determining the optimal patient modality for high-stakes assessment purposes. [ABSTRACT FROM AUTHOR]

Context Maintenance fluid therapy is a protean topic but is clinically often mismanaged. Our teaching of medical students led us to suspect that textbooks provide limited information about the topic, so we set out to verify this possibility by reviewing the content of books written in English that covered perioperative care. Methods We reviewed publishers’ lists of textbooks and found 22 suitable books. After compiling a standard list of questions on intravenous therapy, we read each book to find out to what extent it delivered the answers, and listed the information obtained. Results Only 13 books answered more than half of the questions. The information varied considerably. Suggested quantities of daily fluid, sodium and potassium requirements varied hugely. Conclusions Information provided in standard textbooks to guide fluid prescription is scant and variable. This could be a cogent reason why junior doctors prescribe postoperative fluids badly: the information in textbooks is inadequate and varies from book to book. The reasons for the poor coverage are not clear. Perhaps other common topics that are often poorly managed are also badly addressed by standard books. [ABSTRACT FROM AUTHOR]

Objective Clinical experiences and gender have been shown to influence medical students’ specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice and to identify explanatory factors. Methods We carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery ( n = 200), internal medicine ( n = 277) and general practice ( n = 184). Regression analyses were performed to identify the determinants of career choice and the role of gender. Results Exposure to clinical settings encourages students to opt for a career in the corresponding specialty. Men were more stimulated than women by the general practice clerkship. Gender had no clear role as a predictor of career preference. The major predictor of career choice in all 3 specialties was positive evaluation of work-intrinsic factors. A preference for working with acute patients and technology-oriented work, prestige orientation and insignificance of a controllable lifestyle were determinants of a preference for surgery. Students with a preference for general practice had almost opposite preferences. Those who chose internal medicine favoured a controllable lifestyle. Discussion Factors other than gender appear to drive specialty decisions. Work content, type of patients and lifestyle options play major roles. Consequently, along with teaching about the practice of medicine, the matching of specialty preferences with reality is an essential outcome of clerkships. [ABSTRACT FROM AUTHOR]

Objective This study sought to determine the relative contributions made by transferable skills and content-specific skills to Year 2 medical student performance in a clinical skills examination. Methods Correlated trait-correlated method models were constructed to describe the performance of 2 year groups of students in examinations held in the summers of 2004 and 2005 at Peninsula Medical School in the UK. The transferable skills components of the models were then removed to indicate the contribution made to the fit of the models to the data. Results Although content-specific skills made the greater contribution to the 2 models of student performance (accounting for averages of 54% and 43% of the variance, respectively), transferable skills did make an important but smaller contribution (averages of 13% and 16%, respectively). When the transferable skills components of the models were removed, the fit was not as good. Conclusions Both content-specific skills and transferable skills contributed to performance in the clinical skills examination. This challenges current thinking and has important implications, not just for those involved in clinical skills examinations, but for all medical educators. [ABSTRACT FROM AUTHOR]

Context There is ongoing discussion within the medical education community about dissection as an educational strategy and as a professional training tool in technical and emotional skills training. Objectives This study aimed to discover the emotional reactions, attitudes and beliefs of new students faced with human cadaver dissection; to evaluate the changes produced in these variables by the exhibition and practice of dissection; to analyse the level of anxiety students feel when faced with death, and to elucidate the possible relationships between these items. Methods The study used a sample of 425 students who were first-time enrolees in a human anatomy course. Three new instruments were designed, with items covering emotional reactions (cognitive, physiological and motor reactions), beliefs and attitudes related to what the student expects to experience or has experienced in dissection. Death anxiety was measured using the Death Anxiety Inventory. Results As students gained more experience of dissection, their emotional reactions were reduced and their attitudes and beliefs changed. Statistically significant differences in the level of death anxiety emerged, depending on the perceptions students had of their degree of preparation for dissection, and emotional control and deeper thoughts about life and death during dissection. Discussion The practice of anatomy allows the student to learn how to face up to and adapt his or her emotional reactions and attitudes; this gives human cadaver dissection great importance as an educational strategy and as a professional training tool in technical and emotional skills training. [ABSTRACT FROM AUTHOR]

Objective This study investigated the relationship between perceived family support and coping efficacy in premedical (i.e. prior to entering medical school) students, an understudied subset of undergraduate students who are particularly at risk for academia- related stress. The relationships between students’ perceived academic coping abilities and their academic behaviours and experiences of stress have been considered within the vocational literature. However, an understanding of factors that inform coping efficacy beliefs is lacking. Methods A total of 238 premedical students provided demographic information regarding themselves and their parents. Students also completed a paper questionnaire containing a coping efficacy scale and items assessing their level of family support. Results Correlational analyses revealed significant positive relationships between family support and students’ perceived abilities to cope with anticipated academic barriers as hypothesised. Bivariate comparisons of mean coping efficacy scores revealed that racial or ethnic minority students reported significantly higher coping efficacy beliefs than did White students. Students with doctor mothers also reported significantly higher coping efficacy than students with mothers employed in other health-related fields. No significant differences in coping efficacy were found when those with doctor fathers versus those with fathers in other health-related fields were compared. Conclusions Findings from the present study indicate that perceived family support plays a key role in establishing premedical students’ confidence in their ability to cope with the challenges of academic life. These findings have important implications for further studies on coping and stress in premedical students. [ABSTRACT FROM AUTHOR]

Context Sexual harassment of medical students has been the focus of many international studies. Prevalence rates from 18% to over 60% have been reported. However, a Dutch study at Nijmegen Medical School found the prevalence rate to be lower (13.3% in the total group; 20% among female students only). Objectives We aimed to identify whether Nijmegen constitutes a positive sample of Dutch medical schools or whether incidents of sexual harassment are less prevalent in the Netherlands than elsewhere, and to establish if and how these experiences impact the professional lives of students. Methods Students received a semi-structured questionnaire containing questions about their experiences of sexual harassment during clerkships. The questions referred to students’ reactions to any incidents, the possible consequences for their wellbeing or professional functioning and the way cases of sexual harassment were handled. Results The prevalence of sexual harassment was significantly higher in Utrecht than in Nijmegen. In both studies rates were relatively low compared with international data. Nevertheless, 1 in 3–5 Dutch female medical students had experienced unwelcome sexual attention from patients, colleagues or supervisors. Three of 10 students who had experienced such an incident stated that it had a negative impact on their functioning afterwards. Conclusions Prevalence rates of sexual harassment in medical schools in the Netherlands are low compared with international rates. However, the number of women students who experience sexual harassment is still 1 in 3–5. The occurrence of and ways to deal with these incidents should be important topics in the training of medical students and supervisors. [ABSTRACT FROM AUTHOR]

Objective Resident work hour restrictions have been mandated in the USA largely out of concern that sleep deprivation compromises doctor performance and patient care. However, individuals’ ability to recognise the effects of sleep deprivation has not been studied in medical education. We examined the perceived impact of sleep deprivation among different groups of postgraduate medical trainees. Methods A survey addressing work hours, sleepiness and daily functioning was mailed to all residents in the internal medicine, surgery and psychiatry programmes at the University of Toronto who were working at 6 different teaching hospitals. The mailing included the Epworth Sleepiness Scale (ESS), measuring acute sleepiness, and a new Sleep Deprivation Impact (SDI) scale, consisting of 12 items designed to measure the perceived impact of sleep deprivation on an individual’s own performance. Results Overall, 62.5% of surgery (95/152) and 59.5% of non-surgery residents (194/326) completed the survey. Surgery residents reported working longer hours per week (83.0 versus 62.5 hours; P < 0.01), and scored higher on the ESS (12.8 versus 9.2; P < 0.01) compared with other residents. Surgery residents scored significantly lower than others on the SDI scale (45.2 versus 51.5, P < 0.01), indicating less perceived impact of sleep deprivation on performance. Conclusions These results are consistent with the presence of an underlying culture within surgery in which individuals may be less willing to accept a natural limitation of individual performance. Whether these findings represent an actual resilience to sleep deprivation among surgery residents or a misperception within this group remains to be determined. [ABSTRACT FROM AUTHOR]

Objectives We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. Methods Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 full-immersion simulations of critical events using a high-fidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. Results We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. Conclusions Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff. [ABSTRACT FROM AUTHOR]