A novel approach to improve undergraduate surgical teaching.

BACKGROUND: Undergraduate surgery is at an important crossroads. Many departments report significant difficulties delivering effective teaching. Our student feedback indicated a dated surgical curriculum lacking structure, quality and uniformity. We report on a new "blended" approach employing a combination of professional DVDs, case based discussions, online material and traditional bedside teaching designed to provide structure, standardization, and equality of learning . METHODS: Year 4 students who had undertaken the new course and year 5 students who had participated in the traditional teaching programme were compared. Students completed a 20 item questionnaire about their experiences of the surgical teaching programme. RESULTS: One hundred and seventy-one year 4 (70%) and 148 year 5 students (66%) responded. Domains relating to "Overall Satisfaction with the course", "Approval of innovative teaching methods and interactivity" and "Satisfaction with the clarity of course information" showed improvements when comparing the new and old programmes. However bedside teaching was not rated as highly in the new programme (p<0.05). CONCLUSION: This blended approach has resulted in improved student understanding and engagement. The apparent compromise of bedside teaching may be a reflection of higher expectations. We believe that a similar blended approach has the potential to re-invigorate surgical teaching elsewhere.

Non-graduate and graduate entry medical students attitudes to psychiatry.

OBJECTIVE: Graduate entry medical students' views of psychiatry may differ from those of school leavers. This study hypothesised that (i) exposure to a psychiatry attachment is associated with a positive change in attitudes towards psychiatry in both graduate entry and non-graduate entry students, (ii) graduate entry students exhibit a more positive attitude to psychiatry compared to non-graduate entry students and (iii) graduate entry students are more interested in a career in psychiatry than non-graduate entry students. METHODS: In this study 247 medical students (118 females and 129 males) completing their psychiatry rotation were invited to complete questionnaires examining career choice, attitudes to psychiatry and career attractiveness for a range of specialties including surgery, medicine, general practice and psychiatry before and after their psychiatry attachment. Questionnaires were distributed prior to commencement of their attachment and redistributed on the final day of the attachment. RESULTS: Of the 165 participants in the study, 75 students entered medicine via the traditional route (without a primary degree), 49 entered via the graduate entry programme and 41 had a primary degree. Overall, medical students displayed positive attitudes towards psychiatry. However, while there was an improvement in attitudes towards psychiatry and the career attractiveness of psychiatry on completion of the rotation, no differences were found between graduate and non-graduate entry students. Psychiatry and general practice had lower ratings for career attractiveness than other specialities. No significant changes were found in the first and second choice of specialty. CONCLUSION: Our results show that improvements in attitude and career attractiveness do not necessarily correlate with increased choice of psychiatry as a specialty. Graduate entry has been considered a possible opportunity for increasing recruitment in psychiatry but our results suggest that this may not be the case. Follow-up studies are required to determine whether career attractiveness correlates with future career choice.

The effect of modernising medical careers on foundation doctor career orientation in the Northern Ireland Foundation School.

OBJECTIVES: Modernising Medical Careers (MMC) emerged in response to acknowledged problems in training in the Senior House Officer grade. The objective of this study was to assess the effect of the Foundation Year 2 (F2) training programme on career orientation in the Northern Ireland Deanery. METHODS: A prospective survey-based study was conducted for all F2 doctors participating in the Northern Ireland Foundation Programme. Career orientation was investigated using the Specialty Choice Inventory 45 (SCI45) at the start (Q1) and end (Q2) of the F2 year. Specialty choice was collated after the outcome of specialty recruitment in 2008. RESULTS: There were 231 F2 doctors in programme during the first F2 year in 2006-2007. 147 (M=65, F=82) and 106 (M=55, F=51) completed questionnaires at Q1 and Q2. Male F2 doctors scored significantly higher in the action orientation (54.0 vs. 50.0, p<0.001) and need for assertiveness (53.0 vs. 48.0, p=0.005) subscales at both time points as well as Q1 detail is crucial (57.0 vs. 51.0, p=0.014) and Q2 independent specialty (53.0 vs. 46.0, p=0.016). Female F2 doctors scored significantly higher in the educating patients subscale at both time-points (44.0 vs. 46.0, p=0.009 and 46.0 vs. 47.0, p=0.03). Analysis of SCI45 subscale scores suggested that males tended to favour the surgical specialties while females favoured the care of the elderly and paediatric specialties. Overall only 29% of doctors were successfully appointed to a specialty in which they had expressed an interest at Q1 whilst 47.8% were selected to specialist training for their declared specialty interest at Q2. CONCLUSIONS: Despite introducing MMC with a coordinated UK wide specialty application process (MTAS), a detrimental effect on their career orientation was not evident. Pragmatic career choices based on lifestyle may be the reason why female doctors expressed a preference for care of the elderly and paediatrics while their male colleagues favoured acute, more surgically biased specialties.

Collaboration across the pond: the multi-school progress testing project.

This collaborative project between the National Board of Medical Examiners and four schools in the UK is investigating the feasibility and utility of a cross-school progress testing program drawing on test material recently retired from the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) examination. This article describes the design of the progress test; the process used to build, translate (localize), review, and finalize test forms; the approach taken to (web-based) test administration; and the procedure used to calculate and report scores. Results to date have demonstrated that it is feasible to use test items written for the US licensing examination as a base for developing progress test forms for use in the UK. Some content areas can be localized more readily than others, and care is clearly needed in review and revision of test materials to ensure that it is clinically appropriate and suitably phrased for use in the UK. Involvement of content experts in review and vetting of the test material is essential, and it is clearly desirable to supplement expert review with the use of quality control procedures based on the item statistics as a final check on the appropriateness of individual test items.

Feedback of audit results can improve clinical teaching (but may also impair it).

The objective of this study was to determine whether formal, written feedback to teachers would improve the quality of teaching. Twenty-seven units that were teaching clinical skills in teaching hospitals (TH), district general hospitals (DGH) and GP surgeries were used as the setting. One hundred and eighty-eight students in Audit Phase 1 (1997) and 175 students in Audit Phase 2 (1998) completed a questionnaire regarding time utilization during teaching sessions, tutor characteristics and course attributes. Feedback of results from the Audit Phase 1 questionnaire to each individual unit was combined with anonymized results of the other units. TH units (which had scored poorly in the first questionnaire) significantly improved the quality of their teaching. This was seen in increases in (1) the degree of prior preparation, (2) the number of sessions that adhered to the guidelines provided in the study guide, (3) time spent with patients and (4) the interest shown in the students. By contrast, the DGH units and GP units (which had scored well in the first questionnaire), scored poorly in the second questionnaire for prior preparation (GP units) and educational value (DGH units). It is concluded that feedback can improve the quality of student teaching. However, when presented as a contrast with other poorly performing units, feedback may induce complacency.

Basic clinical skills: don't leave teaching to the teaching hospitals.

OBJECTIVE: To compare student perception of teaching in general practice (GP), district general hospitals (DGHs) and teaching hospitals (THs) and their examination results. SETTING: The medical school at Queen's University, Belfast. SUBJECTS AND METHODS: A total of 161 medical and 34 dental students completed an objective structured clinical examination and questionnaire at the end of their second semester of basic skills teaching. They scored the course for teaching style, educational value and enjoyment. Teaching attributes of the tutors were similarly recorded. Students were also asked to quantify how time was used and to comment on the course. INTERVENTIONS: A new programme for teaching first- and second-year students basic clinical skills in the community. RESULTS: Teaching in GP and DGHs was reported to be more educational and enjoyable than in the TH. In GP most time was spent being lectured, in DGHs most time was spent with the patient, and in THs, waiting for the tutor. General practitioners and doctors in DGHs were more likely to model positive teaching attitudes such as showing interest in students and providing feedback. The most common complaints related to insufficient time spent with patients in GP and poor tutor preparation in THs. All teaching sites achieved similar examination results. CONCLUSION: Clinical skills can be taught to medical students early in their curriculum using GP tutors. Student preference was strongly for being taught by GPs rather than in THs. Simple steps such as prior preparation and the locating of a suitable patient could markedly improve student experience both in GP and in hospitals.

A survey of communication skills training in UK schools of medicine: present practices and prospective proposals.

It is now widely accepted that effective interpersonal communication is at the heart of quality health care delivery but that current standards in medicine must be improved (Numann 1988; Cowan et al. 1992). One approach acknowledged by the General Medical Council (1991) devotes more attention during training to the theme of communication, and quite significant modifications of the undergraduate medical curriculum are presently taking place. This article documents the results of a postal survey of the 26 UK Schools of Medicine, designed to illuminate current practices and future plans in respect of communication skills training (CST). As such, it takes advantage of the present period of ongoing curricular innovation and change to extend and update earlier reviews (Whitehouse 1991; Frederikson & Bull 1992). A total of 19 responses was received. Following preliminary analysis, the four schools who had already implemented their new curriculum were selected for further in-depth investigation by means of telephone interviews. In addition to reporting frequencies and percentages for responses to questions, cross-tabulations were carried out to explore relationships between certain of the findings. Apart from some consistency in CST teaching methods adopted, the overall picture to emerge is one of considerable variability in such areas as course content, timing, duration and assessment. Foremost among the difficulties encountered in implementing CST appeared to be lack of adequate physical resources and suitably trained staff. Future plans were often sketchy and inchoate. Results are discussed and tentative recommendations for the further development of CST in the medical curriculum proffered.

Teenage mothers and their peers: a research challenge.

Recent reports have highlighted the adverse health experience of teenage mothers. The question of how these mothers' perceptions of their own health status and social networks differ from those of their nulliparous peers is explored in this pilot study, which highlights some practical problems associated with research in this important field.

PIP: This pilot study was undertaken to identify practical problems in studying the effects of teenage motherhood, and compare the assessments of perceived health status and social networks of teenage mothers with those of their nulliparous peers. A total of 55 teenage mothers with one child were matched with the control group of nulliparous teenagers with no history of pregnancy concerning the date of birth, type of house, and postcode. Different results between the groups were manifested despite the comparable characteristics. Upon initial analysis, Vitality and Mental Health sub-scales of the short form 36 mean scores on mothers were significantly lower than the control. Mean scores on the B subscales were significantly higher in the General Health Questionnaire, showing high levels of insomnia/anxiety. With regard to self-assessed health status, the number of people providing support or the degree of satisfaction felt with the support in both groups did not have any significant differences. Although findings in this study highlights some practical problems related to teenage motherhood, detailed screening interviews of a large number of respondents is required to obtain a closely match in the control group.

The implications of teenage pregnancy and motherhood for primary health care: unresolved issues.

Teenage pregnancy and motherhood have implications for several different aspects of primary health care. First, the provision of health education and contraceptive services is obviously relevant to the prevention of unplanned teenage pregnancy. Secondly, appropriate obstetric care should be provided for teenagers, who are at high risk of developing complications in pregnancy and childbirth. Thirdly, and perhaps even more significantly, there is the implication of care required to deal with longer-term adverse health consequences associated with teenage pregnancy. In each of these areas, certain issues remain unresolved. This paper identifies key questions that remain unanswered, including the possibility of long-term adverse physical and psychological health consequences for teenage mothers and their children. The conclusion is that further research addressing these unresolved issues is necessary in order to inform health professionals and allow the implications for primary care to be assessed.

PIP: The issues of teenage pregnancy and motherhood impact upon several different aspects of primary health care. The provision of health education and contraceptive services is relevant to the prevention of unplanned teenage pregnancy. For teenagers who do become pregnant, appropriate obstetric care must be provided. Teenagers are at high risk of developing complications during pregnant and childbirth. Finally, care must also be delivered to manage the longer-term adverse health consequences associated with teenage pregnancy. Issues remain unresolved in each of these areas of health care delivery. The authors identify the questions which remain unanswered, including the possibility of long-term adverse physical and psychological health consequences for teen mothers and their children. Further research addressing the unresolved issues is needed to inform health professionals and allow the implications for primary care to be assessed.