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Background: A key clinical skill for undergraduate medical students is communication with children, yet it is becoming increasingly difficult for medical schools to provide sufficient experience within a secondary care setting. One potential solution to this is to develop innovative ways of involving local schools.Aim: To demonstrate what was learned from a pilot school visit and show how this was developed into a successful programme.Method: As part of their GP-based Foundations of Primary Care course, medical students were allocated to local primary schools in their tutorial groups led by their GP tutors. They developed and delivered health promotion activities that were appropriate for school pupils. Review of the visit identified areas of improvement which were used to redesign the programme. Surveys were conducted after the subsequent visit to assess the response of medical students, school pupils and teachers.Learning outcomes: Medical students gained experience in communicating and interacting with school-aged children, and developed teaching and team working skills. School pupils reported change in their health-related knowledge and behaviour and the visits introduced them to the medical profession at a young age. The visits were well received by the teachers who valued the medical students' input.Conclusions: Building on the learning from the pilot school visit, a successful programme was developed that was challenging but ultimately enhanced medical student learning and brought significant benefits for the school pupils. Future developments include the potential to expand the topics taught and developing training in teaching for medical students.

Understanding the holistic impact of long-term conditions (LTCs) on a patient, due to their high prevalence, morbidity, mortality and cost, is an important part of the primary care undergraduate medicine curriculum. Increasingly, we set learning outcomes for our students anticipating what the patient would want them to know. But are our expectations congruent with what patients would want them to know? In this leading article, we propose that patient involvement in curriculum design remains inadequate. We base our argument on (1) an existing strong theoretical premise that increasing patient incorporation enhances the delivery of medical education, (2) recommendations from major health organisations, our regulator and leading healthcare educationalists and (3) a growing body of evidence that what is important to physicians may not reflect what is important to patients. We advocate that patient involvement in curriculum design will result in a better understanding of how LTCs affect their physical, psychological and social health and of their journey through health care and community support services. This learning is essential, but unfortunately often overlooked, if we are to ensure that students in their future roles plan patient care using an empathic, holistic, patient-centred and socially accountable approach.

Medical students preparing to undertake general practice (GP) placements need to be equipped with the unique skills required to successfully utilise and adapt to current and emerging remote consultation modalities used in primary care and integrate this into their day-to-day clinical practice. Medical educators needed to flexibly and quickly cater learning to the evolving landscape. A three-hour teaching session was devised to be delivered to 50 students online via Microsoft Teams��� and facilitated by five general practice tutors in groups of 10, prior to students��� GP placements. In pre-assigned pairs, students undertook two role-play scenarios for the main remote modalities of telephone and video-consultations. E-consultations were explored via discussion of simulated encounters. The authentic technology pertinent to each modality was used; this included a training version of NHS Scotland���s Near Me IT platform for video-consultations, the students��� own mobile phones for telephone consultations and simulated PDFs generated using the e-consultation facility. Teaching was evaluated via a student focus group pre and post placement. Student feedback was positive. The session prepared them for their placement and increased their confidence. They suggested this teaching be incorporated earlier in the medical school curriculum. They appreciated learning with the same IT platforms used on placement. Some students had no prior experience of remote consultations and subsequently were expected to undertake independent remote consultations almost immediately upon arrival. Careful design of challenging scenarios mirroring common GP presentations via remote modalities can increase student preparedness and confidence prior to GP placements during the COVID-19 pandemic.

Background Action plans have been shown to be important in changing behaviour. In learners, action plans have been proposed as a mechanism by which feedback leads to an increase in expertise: feedback leads to action plans, which lead to changes in learning behaviours and finally to improvement. Little is known about the extent to which students are able to make specific actions plans that relate to the feedback they are given, however. We explored whether medical students created action plans after being given feedback, the quality of those plans and whether the action plans were related to the feedback given. Action plans have been shown to be important in changing behaviour METHODS: We collected data from a communication session for Year-1 medical students on the feedback they were given and the action plans they made for improvement. Results Most students (185/196, 94%) made one or more action plans, but only 31/196 (16%) made one or more action plans that were directly related to the feedback given to them. Conclusions Although educators may include action planning in education, students are not making specific enough action plans to effect change. Future work should include support for students in making better-quality action plans. …students are not making specific enough action plans to effect change.

Context\ud Globally, doctor–patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by ‘good communication’ and whether there is consensus internationally remain unclear.\ud \ud Objectives\ud Here, we characterise understandings of ‘good communication’ in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes ‘good communication’.\ud \ud Methods\ud A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: ‘What is good communication?’ Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory.\ud \ud Results\ud The overarching theme that emerged from medical students was that ‘good communication’ requires adherence to certain ‘rules of communication’. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors’ communication strikingly negatively, viewing these doctors as problematically cold and unresponsive.\ud \ud Conclusions\ud Contradictory perceptions of ‘good communication’ in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western ‘patient-centredness’ and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.

OBJECTIVES: Within medical education, there is a discrepancy between the achievement level of White students and that of their ethnic minority peers. The processes underlying this disparity have not been adequately investigated or explained. This study utilises social network analysis to investigate the impact of relationships on medical student achievement by ethnicity, specifically by examining homophily (the tendency to interact with others in the same group) by ethnicity, age and role. METHODS: Data from a cross-sectional social network study conducted in one UK medical school are presented and are analysed alongside examination records obtained from the medical school. Participants were sampled across the four hospital placement sites; a total of 158 medical students in their clinical phase (Years 3 and 4) completed the survey. The research was designed and analysed using social capital theory. RESULTS: Although significant patterns of ethnic and religious homophily emerged, no link was found between these factors and achievement. Interacting with problem-based learning (PBL) group peers in study-related activities, and having seniors in a wider academic support network were directly linked to better achievement. Students in higher academic quartiles were more likely to be named by members of their PBL group in study activities and to name at least one tutor or clinician in their network. Students from lower-achieving groups were least likely to have the social capital enabling, and resulting from, interactions with members of more expert social groups. CONCLUSIONS: Lower levels of the social capital that mediates interaction with peers, tutors and clinicians may be the cause of underperformance by ethnic minority students. Because of ethnic homophily, minority students may be cut off from potential and actual resources that facilitate learning and achievement.

Students often receive little feedback after summative objective structured clinical examinations (OSCEs) to enable them to improve their performance. Electronic audio feedback has shown promise in other educational areas.We investigated the feasibility of electronic audio feedback in OSCEs.An electronic OSCE system was designed, comprising (1) an application for iPads allowing examiners to mark in the key consultation skill domains, provide "tick-box" feedback identifying strengths and difficulties, and record voice feedback; (2) a feedback website giving students the opportunity to view/listen in multiple ways to the feedback. Acceptability of the audio feedback was investigated, using focus groups with students and questionnaires with both examiners and students.87 (95%) students accessed the examiners' audio comments; 83 (90%) found the comments useful and 63 (68%) reported changing the way they perform a skill as a result of the audio feedback. They valued its highly personalised, relevant nature and found it much more useful than written feedback. Eighty-nine per cent of examiners gave audio feedback to all students on their stations. Although many found the method easy, lack of time was a factor.Electronic audio feedback provides timely, personalised feedback to students after a summative OSCE provided enough time is allocated to the process.

Summary Background The deleterious effects of climate change mean that environmental sustainability is increasingly becoming a moral and economic necessity. Consequently, clinicians will increasingly be called upon to manage the effects of health care on climate change, and they must therefore do as much as is practically possible to limit the negative effects of their practice on the environment. As medical educators we have the opportunity not only to reduce the environmental impact of our own clinical practice, but also that of those who we teach, through innovation. Such novelty can be explored during student-selected components (SSCs). Clinicians will increasingly be called upon to manage effects of health care on climate change Context The project, entitled ‘Can we introduce sustainability to clinical skills teaching?’ was led by two third-year medical students during their SSC periods. New ways to make existing skills more sustainable were explored by surveying existing practice in the workplace, analysing selected skills in a lab-based setting and through discussions with sustainability champions. Innovation Cannulation and intravenous (IV) antibiotic preparation were chosen by the students as prototype skills. These skills were observed by the students in the workplace and adapted by them to appease the ‘triple bottom line’ of sustainability: environmental, social and economic factors were addressed. The revised skills were taught by the students to their peers in a sustainably conscious fashion. Implications Provided that such innovations in sustainable skills teaching are deemed appropriate by clinical skills directors, such methods could be adopted across medical schools and expanded to cover a wider range of skills.

The one real object of education is to have a man in the condition of continually asking questions. [1]The Lancet report on Health Professionals for a New Century [2] highlights the importance of e...

Given the changes in society we are experiencing, the increasing focus on patient centred care and acknowledgment that medical education needs to continue not only in the residency programmes but throughout the doctors career, is not surprising. This article describes the attention currently paid to professionalism in the residency programmes, differences in perception of professionalism between patients, faculty, students and residents, differences in professionalism issues in the different educational phases, as well as their consequences for training and assessment regarding professionalism. Continuous medical education in professionalism is thereafter briefly discussed.

This article is the second in a series on professionalism in the European Journal of Internal Medicine. The current article will first focus on these different views and definitions that are currently adopted by the various researchers, and subsequently discuss the consequences for the training and assessment of professionalism and professional behaviour in medical education.

Item does not contain fulltext Despite calls for feedback to be incorporated in all assessments, a dichotomy exists between formative and summative assessments. When feedback is provided in a summative context, it is not always used effectively by learners. In this study we explored the reasons for this. We conducted individual interviews with 17 students who had recently received web based feedback following a summative assessment. Constant comparative analysis was conducted for recurring themes. The summative assessment culture, with a focus on avoiding failure, was a dominant and negative influence on the use of feedback. Strong emotions were prevalent throughout the period of assessment and feedback, which reinforced the focus on the need to pass, rather than excel. These affective factors were heightened by interactions with others. The influence of prior learning experiences affected expectations about achievement and the need to use feedback. The summative assessment and subsequent feedback appeared disconnected from future clinical workplace learning. Socio-cultural influences and barriers to feedback need to be understood before attempting to provide feedback after all assessments. A move away from the summative assessment culture may be needed in order to maximise the learning potential of assessments.

Background In undergraduate clinical examinations, the use of real patients as long cases is being replaced by objective structured clinical examinations (OSCEs) which use simulated scenarios, although we lack published psychometric data on long cases to support the move from real to simulated patients. Aim To assess candidate performance across two history-taking long cases to estimate the number of cases required for a reliable assessment. Results are compared with psychometric data from an OSCE. Setting A final-year qualifying undergraduate clinical examination. Method Two observed history-taking long cases were included, alongside an OSCE. Candidates interviewed two unstandardized real patients. The history-taking part (14 minutes) was observed, uninterrupted, by examiner(s) who assessed data gathering, interviewing, and diagnostic and management skills. The presentation (7 minutes) was unstructured; the examiner(s) intervened as appropriate. Marks were expressed as a percentage of the total possible score and analysed using generalizability theory to estimate intercase reliability. Results Two examiner pairs independently rated both long cases for 79 (36·7%) of the 214 candidates. Projections based on generalizability theory showed that 10 20-minute cases would give reliabilities of 0·84 for single-marked and 0·88 for double-marked candidates, compared with a projected reliability of 0·73 for the same 214 candidates taking the OSCE. Conclusion If history-taking long cases are observed, three-and-a-half hours of testing time using 10 unstandardized patients would produce a reliable test. Long cases therefore are, in terms of reliability, no worse and no better than OSCEs in assessing clinical competence.

Item does not contain fulltext CONTEXT: There is little research into how to deliver summative assessment student feedback effectively. The main aims of this study were to clarify how students engage with feedback in this context and to explore the roles of learning-related characteristics and previous and current performance. METHODS: A website was developed to deliver feedback about the objective structural clinical examination (OSCE) in various formats: station by station or on skills across stations. In total, 138 students (in the third year out of five) completed a questionnaire about goal orientation, motivation, self-efficacy, control of learning beliefs and attitudes to feedback. Individual website usage was analysed over an 8-week period. Latent class analyses were used to identify profiles of students, based on their use of different aspects of the feedback website. Differences in learning-related student characteristics between profiles were assessed using analyses of variance (anovas). Individual website usage was related to OSCE performance. RESULTS: In total, 132 students (95.7%) viewed the website. The number of pages viewed ranged from two to 377 (median 102). Fifty per cent of students engaged comprehensively with the feedback, 27% used it in a minimal manner, whereas a further 23% used it in a more selective way. Students who were comprehensive users of the website scored higher on the value of feedback scale, whereas students who were minimal users scored higher on extrinsic motivation. Higher performing students viewed significantly more web pages showing comparisons with peers than weaker students did. Students who just passed the assessment made least use of the feedback. CONCLUSIONS: Higher performing students appeared to use the feedback more for positive affirmation than for diagnostic information. Those arguably most in need engaged least. We need to construct feedback after summative assessment in a way that will more effectively engage those students who need the most help.

Given the changes in society we are experiencing, the increasing focus on patient-centred care and acknowledgement that medical education including professionalism issues needs to continue not only in the residency programmes but also throughout the doctors career, is not surprising. Although most of the literature on professionalism pertains to learning and teaching professionalism issues, addressing unprofessional behaviour and related patient safety issues forms an alternative or perhaps complementary approach. This article describes the possibility of selecting applicants for a medical school based on personality characteristics, the attention to professional lapses in contemporary undergraduate training, as well as the magnitude, aetiology, surveillance and methods of dealing with reports of unprofessional behaviour in postgraduate education and CME.

Recommendations in the literature concerning measures to address the challenges to professionalism have converged on the establishment of an education community, on a structured curriculum dealing with professionalism, on developing programs for role modelling and mentoring, and on attention to the assessment of professional conduct. The interventions in the field of medical education appear central among these efforts, since it is during medical school that the template for professional conduct in medicine is primarily learned. This article attempts to provide a more in-depth discussion of the goals, purposes and current factors influencing teaching and learning professional behaviour in the medical school curriculum and the residency programs.

Core medical knowledge has been assessed for over fifty years and technical and communication skills for at least twenty. The assessment of professionalism however has failed to achieve recognition within this time frame. The interest in the assessment of professionalism and professional behaviour thus is a fairly recent development. This article will firstly clarify how professional behaviour assessment relates to other assessment methods using the framework proposed by Miller6. Thereafter a brief overview will be provided of the current “tool box” of methods available to assess professionalism. Data on the validity, reliability, feasibility, acceptability and educational utility of these “tools” as derived from published evidence will be reviewed. Subsequently a general overview of the way forward in the assessment of professionalism and professional behaviour will be given.

This paper is the fourth article in a series on Professionalism and provides an overview of current methods used for teaching and learning about professionalism. The questions "whether" and "how" professionalism can be placed in the formal medical school curricula are addressed, and the informal learning related to professionalism reviewed.

There is general agreement that professionalism and professional behaviour should be (formatively and summatively) assessed, but consensus on how this should be done is still lacking. After discussing some of the remaining issues and questions regarding professionalism assessment, this article discusses the importance of qualitative comments to the assessment of professional behaviour, focuses on the currently most frequently used tools, as well as stresses the need for triangulation (combining) of these tools.

The concept of professionalism has undergone major changes over the millennia in general and the last century specifically. This article, the first in a series of articles in this Journal on professionalism, attempts to provide the reader with a historical overview of the evolution of the concept of professionalism over time. As a result of these changes, medical school curricula, and contemporary specialist training programs are increasingly becoming competence based, with professionalism becoming an integral part of a resident's training and assessment program.

Background A London medical school final MBBS examination for 155 candidates. Objective To investigate whether observing the student–patient interaction in a history taking (HT) long case adds incremental information to the traditional presentation component. Design A prospective study of a HT long case which included both examiner observation of the student-patient interview (Part 1) and traditional presentation to different examiners (Part 2). Checklist and global ratings of both parts were compared. Examiners were paired to estimate inter-rater reliability. The students also took a 20 station Objective Structured Clinical Examination (OSCE). Outcome measures Correlation of (I) examiner ratings for observation and presentation of the HT long case (II) examiner pair ratings and (III) stepwise regression analysis of scores for the HT long case with OSCE scores. Results Seventy-five (48·4%) candidates had two examiner pairs marking their case history. Observation and presentation scores correlated poorly (checklist 0·38 and global 0·33). Checklist and global scores for each part correlated at higher levels (observation 0·64 and presentation 0·61). Inter-rater reliability correlations were higher for observation (checklist 0·72 and global 0·71) than for presentation (checklist 0·38 and global 0·60). When HT long case scores were correlated with OSCE scores, using stepwise regression, global presentation scores showed the highest correlation with the OSCE score (0·36) and the global observation score contributed a further 12% to the correlation (0·50). Conclusion Observation of history taking in a long case appears to measure a useful and distinct component of clinical competence over and above the contribution made by the presentation.

Valerie Wass argues that the OSCE is the fairest assessment method The objective structured clinical examination (OSCE) is becoming the favoured method of clinical competence testing in undergraduate and postgraduate examinations. The examination, however, requires a high level of funding - more examiners, patients or role players, and equipment are necessary. The traditional long and short case examinations were more fun for the examiner, who could interact freely with the candidate, and they were, perhaps, more true to life. The new examinations may feel artificial and rather reductionist. ### Key issues #### Study the curriculum Look carefully at the curriculum and course books. Well planned OSCEs aim to cover the course content as widely as possible. Make sure you know what is being assessed #### Understand the skills Make sure you understand the criteria for the skill. Work these out yourself rather than learn a checklist. Get a good demonstration of the skill to model on #### Practise the skills with as many patients as possible Observe each other. Revise together. Observe and give feedback. It can be fun #### Remain confident You need the right mentality. You will undoubtedfly flunk some stations. Forget it immediately and move confidently on to the next So why the change? The answer hinges on reliability. The stakes are high …

Introduction It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors. Objective This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors. Methods Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors. Results Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6–9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80–2.52) or 2 years in training (OR 2.23; 95 % CI 1.89–2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61–1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders. Conclusion The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0320-x) contains supplementary material, which is available to authorized users.