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Supervisors' ratings of psychology trainees' competence in field settings are a critical component of training assessment. There has been little systematic research regarding the validity of these assessments, but the available evidence suggests we have a problem! Supervisors' judgments may be affected by systemic biases that pose a serious threat to assessment credibility. The current study is part of a research collaboration among six universities that endeavors to develop and evaluate a new method the use of vignettes against outcomes derived from a conventional rating scale. Individual vignettes were designed and subjected to a rigorous process of peer-review and revisions, before final vignettes were assigned calibration scores by a group of experts. A catalogue of vignettes (n = 41) that represent various domains of competence across several developmental stages was compiled. University and field supervisors used the conventional rating scale and the vignette-matching procedure (VMP) to evaluate competencies at end-placement. Data from a pilot (n = 20) and a follow-up study (n = 57) suggest that compared with a conventional rating scale, the VMP reduced leniency and halo biases. The VMP has the potential to improve outcomes of competency assessments in field placements and merits further research and development.

Objective Studies show discrepancies between self- and observer-ratings of empathy among medical students. Presently, there has been limited data and discussion exploring this finding. This study explored the discrepancies between self- and observer-ratings of empathy by comparing individual differences among medical students. Specifically, whether medical students who demonstrated discrepancies in self- and observer-ratings of empathy differ from those who did not demonstrate discrepancies, with regards to personality, attachment, and clinical competence. Method Sixty medical students participated in the study. Empathy was rated by an independent observer during simulated patient encounters. In addition, empathy was self-rated using the Jefferson Scale of Physician Empathy (student version). Personality was measured using the Big Five Inventory and attachment was assessed using the Experiences in Close Relationships Questionnaire. Clinical competence was evaluated by medical examiners during an Objective Structured Clinical Examination. Results: The majority of students performed in accordance with their self-ratings of empathy. Of those students who had discrepant scores, the majority had inflated selfratings as opposed to higher observer-ratings. A one-way ANOVA revealed significant differences between the groups on extraversion, openness, and total competence scores. Conclusions It appears that students differ with regards to extraversion, openness, and total competence. We propose that a deficit in metacognitive abilities, in addition to lower clinical competence, affects medical student's abilities to provide accurate self-assessments. Furthermore, in the minority of cases, it appears that medical students learn that it pays to adopt the view that "if you cannot feel it, fake it".

Objectives Although empathy is generally seen as a desirable attribute for medical professionals, it has usually been assessed through self report measures, which fail to capture the expression of empathy skills in the context of the clinical setting. As a trial for a larger scale study, this study explored the interrater reliability and feasibility of assessing empathy through observer-ratings using videotaped simulated patient encounters. Methods Forty-seven Year 4 students from an Australian Graduate School of Medicine participated in the study. Empathy was rated by two independent observers of the videotaped simulated patient encounters, in the context of Objective Structured Clinical Examination (OSCE) stations. Empathy was assessed using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM). Results Interrater reliability was assessed using generalisability theory. The magnitude of the g-coefficients indicated a strong degree of agreement between the two raters on medical student empathy across the five different OSCE stations. Conclusion: Assessing empathy using videotaped simulated patient encounters was found to have high interrater reliability and was a feasible method of assessment, providing a potential method for future research addressing empathy and clinical competence among medical students.

Introduction When training clinically competent doctors, most medical schools focus upon components of the interpersonal process between doctor and patient, such as empathy in the doctorpatient relationship. This study investigated the relationship between empathy and clinical competence among medical students. Method Sixty students from an Australian Graduate School of Medicine participated in the study. Clinical competence was assessed in an Objective Structured Clinical Examination (OSCE). Empathy was rated by an independent observer of the clinical interaction in OSCE stations using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM). In addition, empathy was self-rated using the Jefferson Scale of Physician Empathy (student version). Results Observed empathic behaviour, as rated objectively by an independent observer, was strongly associated with clinical competence and was evident across diverse types of consultations and a wide range of medical conditions. Observable empathy was also strongly associated with patients' ratings of the students' clinical performance. However, self rated empathy was not associated with clinical competence. Discussion & Conclusion The results suggest that a doctor-patient relationship fostered by empathy appears to complement the skills and knowledge required to effectively care for a patient. Strategies that enhance the behavioural expression of empathy may make medical students seem more clinically competent to both examiners and to patients. However, evidence that the medical students' internal emotions are discrepant with their behaviour raises difficult questions regarding the fundamental nature of genuine empathy, with potential implications for the sustainability of the positive relationship between empathy and clinical competence.

MEDU staff members attended a presentation by John Bushnell, who is Professor of Medical Education at the University of Wollongong and the Director of the Graduate Medical Programme

Traditionally case based learning (CBL) in a medical curriculum has taken the form of a paper case presented to a group of students in a tutorial room. In the first Phase of the new medical programme at the University of Wollongong we have chosen to have a patient volunteer and a clinician present the case history together in the form of a consultation. The aim of this study was to determine if this format was valuable to the students. Data was collected from a CBL based survey (n=53). Results indicate that 73% of students found it valuable to see a clinician take a history from a real patient and that the students identified the process of observation to help develop their skills in clinical decision making (71%) and history taking (51%). Having a patient present their history gave an “element of realism to the problem” and allowed students to “put a face to the case”. Students found it valuable to hear the different patients tell their story (70%). Only 20% of students found the process to be devalued even when the patient volunteer got confused in giving the history. Having a case presentation delivered by a patient volunteer and clinician together adds a level of complexity and reality to a CBL curriculum that is valued by the students. The gains are not just in the application of knowledge to the case but also in the demonstration of clinical practise and patient-clinician interactions that underpin the practise of medicine.

Introduction: An inter-professional educational initiative involving two cohorts of first year graduate-entry medical students was introduced at the University of Wollongong. This 3-week interdisciplinary clinical experience (ICE) where students worked with a range of health professionals, aimed to help students gain perspectives on professional roles, teamwork and inter-professional communication, and the impact of these on quality and safety in health care. Complexity theory provided the conceptual framework for the placement, with the National Patient Safety Education Framework guiding its implementation and evaluation. Methods: Quantitative and qualitative methods were used to evaluate the outcomes from student and preceptor perspectives, including a pre-and post-ICE administration of a 4 sub-scale version of the Readiness for Inter-professional Learning Scale (RIPLS)3 to students. Results: Most students and preceptors agreed that ICE met its learning outcomes, with reflective comments providing some insight in to the nature of the learning experience. Significant RIPLS findings included the tendency of medical students, post ICE, to agree less strongly with statements relating to ‘Teamwork and Collaboration’ and ‘Positive Professional Identity’, and disagree less strongly with those relating to ‘Negative Professional Identity’. Conclusions: Less positive student responses to questions about ‘teamwork and collaboration’ and ‘professional identity’ following the placement may be due to the experience itself or because it reinforced negative beliefs about the value of learning from other health professionals who are not doctors. Alternatively, students may have had an underdeveloped professional identity themselves. Further study is underway to provide some insight into the findings.

When training clinically competent doctors, most medical schools focus upon components of the interpersonal process between doctor and patient, such as empathy in the doctor-patient relationship. This study investigated the relationship between empathy and clinical competence among medical students.

Case based learning (CBL) is an important learning tool in many medical schools worldwide. Similarly Phase 1 (the first 18months) of our new medical programme makes use of a fortnightly CBL process to encourage the application of scientific understanding to a patient presentation. The Phase 1 CBL process is distinct from others in that a wrap-up of the case and science is presented. The aim of this study was to determine if the case wrap-up at the end of the fortnight was valuable to the students. Data was collected from a CBL-based survey (n=53). Quantitative results indicate that 98% of students found it useful to see the science applied to the patient case. Students found the wrap-up to be a useful summary of the case (92%), helping them to integrate the science and clinical medicine (90%). The majority of respondents (77%) found it useful to have a scientist and clinician deliver the wrap-up together and that the wrap-up helped them understand how the case developed and how the patient was managed (90%). Comments received from the surveys indicated that students found the wrap-up “helps to consolidate and reinforce knowledge” and “clarifies the depth of knowledge” that’s required at this stage of the course. In conclusion, a case wrap-up delivered by faculty is a valuable learning tool for medical students early in their studies. It allows staff to clearly demonstrate the process of CBL and the underpinning of clinical reasoning with scientific knowledge to improve the understanding of a clinical scenario.

Converging evidence from several health disciplines suggests that field supervisor ratings of student competencies may be affected by systematic leniency and halo biases. Characteristics of the rating scales, rather than unskilled assessors, may be primarily responsible for these unsatisfactory assessment outcomes. The vignette method has yielded positive preliminary results. In the vignette approach, the supervisor is provided with pre-designed vignettes and asked to choose a vignette that best matches the student‘s performance. The current study is a multi-site initiative involving six universities in Australia and funded by an Australian Learning and Teaching Council (ALTC) grant. A key aim is to design, standardise, and evaluate a catalogue of vignettes to assess clinical psychology competencies in the field, and to compare outcomes from the vignette and rating-scale approaches. Preliminary results from the study are reported. The vignettes were designed following a rigorous process: (i) A group of experts drafted vignettes (V1) for each of 4 performance levels across 9 broad competency domains (36 vignettes), (ii) V1-vignettes were scrutinised within small group discussions or assigned to an expert in the psychology domain before revised V2-vignettes were produced, (iii) V2-vignettes were evaluated either within a small group of experts or by two blinded experts who independently revised the vignettes. Expert comments were considered before revised V3-vignettes were prepared for pilot testing, (iv) a web-based survey program was used to present the V3-vignettes to a group of experts (n=12) for evaluation and calibration. The experts reviewed each vignette independently, rated the vignettes in terms of their adequacy and efficacy, and calibrated each vignette using a visual analogue scale that ranged from 1 (unskilled) to 10 (competent), (v) The V3-vignettes were field tested by having a group of field supervisors (n=25) use the vignettes and the conventional ra

Objectives: Provoke scrutiny and reflection about assessment of competencies in field placements Enhance awareness of biases that may affect supervisor ratings of students on placements Discuss issues and solutions Outline a multi-site, ALTC-funded initiative that seeks to address problems

Health professional education invariably includes clinical field placements as an integral component of professional training in an effort to ensure that knowledge, skills, and behaviour learned about in an academic context are integrated and applied to clinical practice. Significant weight is usually attached to the assessment of competence by supervisors, which typically consists of a structured report rating performance on a number of areas. Such reports are subject to systematic rating biases, particularly leniency and halo errors. Strikingly similar results are observed across disciplines including psychology, social work, nursing, pharmacy and medicine. The leniency bias is typically evident in the reluctance of field supervisors to assign low and fail grades to students on placement. The halo bias is reflected in an overall positive impression of a student who has done well in one competency domain, reducing judgement of true differences between competency domains. Factors contributing this phenomenon may include the small numbers of students on placement at any given time, leaving the supervisor without an anchor', and leading to a greater propensity for uncertainty and bias. Secondly, the active face-to-face engagement and intensive supervisor-student interactions over an extended period of time in the field may lead to a relatively close supervisor-student interpersonal relationship that serves to systematically bias supervisor ratings. This study set out to determine the extent of the problems with reliability and validity of supervisor judgments of competency in postgraduate clinical psychology training.

The changing nature of health care provision and disease profiles has led to a reassessment of the clinical settings that are optimal for student learning. Modern integrated medical curricula usually do not include a separate course for disciplines such as psychiatry. Further, Hospital based psychiarty curricula do not expose students to psychiatry in primary care settings.

of a presentation at the Third International Clinical Skills Conference, 1-4 July 2009, Prato, Italy.

The medical schools at the University of Western Sydney, University of Wollongong and University of Sydney have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast. The new partnership agency - the North Coast Medical Education Collaboration - builds on the experience of regional doctors and their academic partners. A steering comm ittee has identified the availability and support requireme nts of local practitioners to provide training, and has undertaken a comparative mapping of learning objectives and assessments from the courses of the three universities. The goals of the program include preparing doctors who can perform effectively in rural settings and multi disciplinary health care teams, and to advance research in medical education.

Modern integrated medical curricula usually do not include a separate pathology course. Consequently, there is a risk that important pathological principles may be omitted. We aimed to ensure that pathology is properly represented by developing a core pathology curriculum created in consultation with local pathologists. Appropriate information technology to track the delivery of this material within the integrated curriculum structure was developed using a learning content management system in which a metadata schema was constructed. This allows a sophisticated view of where and how pathology appears in the course and can also increase the visibility of the subject by demonstrating the central place of pathology in medicine. In conclusion, a core curriculum in pathology that can be tracked by information technology with sufficient power and flexibility is a solution to the potential loss of pathology from integrated medical courses. We believe the result is superior to a stand-alone pathology course.

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower North Island of New Zealand. RESULTS: No relationship was found between GP personal and practice demographic characteristics and GP identification of psychological and physical symptoms. Patients were more likely not to present psychological symptoms (62%) than not present physical symptoms (5%) in consultation. Thirteen percent of GPs wanted more formal psychiatric training, 45% wanted more contact time in consultation, and 72% thought that cost was a barrier to patients attending. No significant relationship was found between these factors and GP detection of significant psychological symptoms in consultation. DISCUSSION: Personal and practice demographics of GPs may not predict their ability to detect physical and psychological symptoms. More research is needed to explore these findings which contradict previous work.

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower North

Background. GPs are an accessible health care provider for most patients with mental disorders and are gatekeepers to specialist care. The extent to which patients consider their primary care team as relevant to their mental health problems needs to be explored. Objectives. To explore reasons why patients choose not to disclose psychological problems to GPs, and to discuss the implications for the provision of primary mental health care. Methods. A cross-sectional survey of consecutive patients attending general practices in New Zealand (part of the MaGPIe study). Patients were screened using the GHQ-12 and a stratified sample participated in a structured in-depth interview to assess their psychological health. Non-disclosure of psychological problems was explored. GPs assessed patients' psychological health using a 5-point scale of severity. Results. Seventy GPs (90%) and 775 patients (70%) participated. Overall, 29.8% of all patients and 36.9% of patients with current symptoms reported non-disclosure of self-perceived psychological problems. Younger patients, those consulting more frequently and those with greater psychiatric disability were more likely to report non-disclosure. The most frequently given reasons were beliefs that a GP is not the 'right' person to talk to (33.8%) or that mental health problems should not be discussed at all (27.6%). Conclusions. Interventions such as screening and GP education may be ineffective in improving primary mental health care unless accompanied by educational programmes for the general public to increase mental health literacy, de-stigmatise mental illness and increase awareness of general practice as an appropriate and effective source of health care.