Evaluation of feedback given to trainees in medical specialties.

The aim of this study was to evaluate the quality of feedback provided to specialty trainees (ST3 or higher) in medical specialties during their workplace-based assessments (WBAs). The feedback given in WBAs was examined in detail in a group of 50 ST3 or higher trainees randomly selected from those taking part in a pilot study of changes to the WBA system conducted by the Joint Royal Colleges of Physicians Training Board. They were based in Health Education Northeast (Northern Deanery) and Health Education East of England (Eastern Deanery). Thematic analysis was used to identify commonly occurring themes. Feedback was mainly positive but there were differences in quality between specialties. Problems with feedback included insufficient detail, such that it was not possible to map the progression of the trainee, insufficient action plans made and the timing of feedback not being contemporaneous (feedback not being given at the time of assessment). Recommendations included feedback should be more specific; there need to be more options in the feedback forms for the supervisor to compare the trainee's performance to what is expected and action plans need to be made.

Scoping systematic review on the extent, nature and quality of evidence underlying ophthalmic and paraophthalmic education.

BACKGROUND: Effective education of relevant professionals underpins provision of quality eye healthcare. OBJECTIVES: This scoping systematic review had 2 aims: first to investigate the extent and nature of scholarly output published on ophthalmic and paraophthalmic education, and second to focus on the quality of reporting of randomised controlled trials (RCTs) identified. STUDY SELECTION: A search strategy was created and applied to PubMed. Any scholarly publications on any aspect of education of those involved in the care of patients with visual problems as the main theme or context was selected. Predefined data were extracted. FINDINGS: Of 255 studies included, the most common type of scholarly publications were descriptions of an educational innovation, opinion pieces and descriptive studies. RCTs made up 5.5% of the sample. Most of the 14 RCTs failed to report most of the items recommended in the CONSORT guidelines. CONCLUSIONS: This review highlights the need for investigators, ethical committees and journals to insist on a better quality of RCT conduct than is presently apparent, but also that clinicians should not be blind to the strengths of non-RCT-based studies in the field of education.

Assistantship improves medical students' perception of their preparedness for starting work.

BACKGROUND: The GMC has recommended introducing student assistantships during which final year students, under supervision, undertake most of the responsibilities of a FY1 doctor. The Medical School at Queen's University Belfast in 2011/12 introduced an assistantship programme. We have evaluated the impact of the assistantship on students' perception of their preparedness for starting work. METHODS: Students were asked to complete a questionnaire at the beginning of the assistantship. It assessed the students' perception of their preparedness in five areas: clinical and practical skills, communications skills, teaching and learning, understanding the work environment and team working. After the assistantship they again completed the questionnaire. Comparison of the results allowed an assessment of the impact of the assistantship. RESULTS: There was a statistically significant improvement in the students' perception of their preparation for 49 of 56 tasks contained within the questionnaire. After the assistantship 81.2% of students felt well prepared for starting work compared with 38.9% before the assistantship. 93.9% agreed that the assistantship had improved their preparedness for starting work. CONCLUSIONS: The assistantship at Queen's University improves medical students' perception of their preparedness for starting work. The majority of medical students feel well prepared for starting work after completing the assistantship.

Does learning style influence academic performance in different forms of assessment?

Educational research on learning styles has been conducted for some time, initially within the field of psychology. Recent research has widened to include more diverse disciplines, with greater emphasis on application. Although there are numerous instruments available to measure several different dimensions of learning style, it is generally accepted that styles differ, although the qualities of more than one style may be inherent in any one learner. But do these learning styles have a direct effect on student performance in examinations, specifically in different forms of assessment? For this study, hypotheses were formulated suggesting that academic performance is influenced by learning style. Using the Honey and Mumford Learning Style Questionnaire, learning styles of a cohort of first year medical and dental students at Queen's University Belfast were assessed. Pearson correlation was performed between the score for each of the four learning styles and the student examination results in a variety of subject areas (including anatomy) and in different types of assessments - single best answer, short answer questions and Objective Structured Clinical Examinations. In most of the analyses, there was no correlation between learning style and result and in the few cases where the correlations were statistically significant, they generally appeared to be weak. It seems therefore from this study that although the learning styles of students vary, they have little effect on academic performance, including in specific forms of assessment.

Handwritten undergraduate case reports.

BACKGROUND: This article describes a 'back to the future' approach to case 'write-ups', with medical students producing handwritten instead of word-processed case reports during their clinical placements. Word-processed reports had been found to have a number of drawbacks, including the inappropriate use of 'cutting and pasting', undue length and lack of focus. METHOD: We developed a template to be completed by hand, based on the hospital 'clerking-in process', and matched this to a new assessment pro forma. An electronic survey was conducted of both students and assessors after the first year of operation to evaluate impact and utility. RESULTS: The new template was well received by both students and assessors. Most students said they preferred handwriting the case reports (55.6%), although a significant proportion (44.4%) preferred the word processor. Many commented that the template enabled them to effectively learn the structure of a case history and to improve their history-taking skills. Most assessors who had previously marked case reports felt the new system represented an improvement. The average time spent marking each report fell from 23.56 to 16.38 minutes using the new pro forma. DISCUSSION: Free text comments from the survey have led to the development of a more flexible case report template better suited to certain specialties (e.g. dermatology). This is an evolving process and there will be opportunities for further adaptation as electronic medical records become more common in hospital.

Evaluation of a final year work-shadowing attachment.

The transition from medical student to junior doctor is well recognised to be a difficult and stressful period. To ease this transition, most UK universities have a work-shadowing period (WSP), during which students can learn practical skills needed for forthcoming employment. The aim of this study was to evaluate the WSP at Queen's University Belfast, and gain the views of both students and Foundation Programme Supervisors and Directors (FPSDs). The study utilised both qualitative (focus groups) and quantitative (questionnaires) approaches. The FPSDs completed a specific questionnaire designed for this study, while the students completed the university's internal quality assurance questionnaire. Twenty-eight of the 37 (76%) FPSDs and 106 / 196 (54%) students completed the questionnaires. Focus groups were conducted with up to 10 students in each group in both a regional centre and a district general hospital at the start and the end of the WSP as well as 8 weeks into working life. The transcripts of the focus groups were analysed and themes identified. A number of deficiencies with the current WSP were identified, including concerns about the use of log books, the timing of the attachment and relatively low levels of supervision provided by senior hospital staff members. As a result, students felt unprepared for commencing work, with particular mention given to medical emergencies, prescribing, and the emotional aspects of the job. A number of recommendations are made, including the need for more senior input to ensure better student attendance, participation and clinical interaction. Furthermore, students should be offered additional supervised responsibility for delivery of patient care and more experiential learning with respect to drug prescribing and administration. The study also suggests that more needs to be done to help ease the emotional and psychological stresses of the early FY1 period. These issues have been resolved to a large extent with the introduction of the new final year Student Assistantship module in the academic year 2010-2011.

Foundation programme impact on junior doctor personality and anxiety in Northern Ireland.

OBJECTIVES: The main objectives of this study were to assess personality traits and levels of anxiety in Foundation Year 2 (F2) doctors during the foundation doctor training programme in the Northern Ireland Deanery (NIMDTA). METHODS: A prospective survey-based study was conducted for all F2 doctors attending the mandatory generic skills programme at NIMDTA. Anxiety was measured using the State-Trait Anxiety Inventory (STAI) while personality was assessed using the IPIP-NEO questionnaire. These previously validated questionnaires were completed at the start and again at the end of the F2 year. RESULTS: 147 (M=65, F=82) and 106 (M=55, F=51) F2 doctors completed questionnaires at both time points. STAI scores suggested a moderate level of anxiety amongst both male and female doctors at baseline and at the end of the academic year. There was no difference between gender for either parameter (Baseline-State: 34.0 vs. 36.0, p=0.48 and Trait: 39.0 vs. 40.5, p=0.33) (End-State: 41.0 vs. 36.0, p=0.14 and Trait: 42.0 vs. 40.5, p=0.78). IPIP-NEO scores for F2 doctors were consistently higher in the Accommodation (93.9 & 92.3) and Consolidation (88.8 & 87.6) personality factors and lower in the Neuroticism factor (66.3 & 65.9) at both assessment time-points. Female F2 doctors scored significantly higher in the accommodation factor at the end of the academic year when compared to their male counterparts (88.0 vs. 94.0, p<0.001). There was no difference between the genders for the other personality factors at the end of the year (p>0.09). CONCLUSION: This first cohort of F2 doctors were exposed to many emerging changes in their training which did not appear to have any detrimental effect on their anxiety levels or personality profiles and suggests that junior doctors may not be affected by external influences or changing educational environments.

Junior doctors and undergraduate teaching: the influence of gender on the provision of medical education.

BACKGROUND: International experience has demonstrated that the medical profession is becoming less dominated by men. This "feminization of medicine" has been a topic of much debate in the medical literature. As the gender ratio in the profession changes, it is likely that a greater proportion of undergraduate education will be provided by women. Whether this shift away from the male-dominated provision of medical education will have an effect on undergraduate education is unknown. PURPOSE: The aim of this research was to clarify whether there are differences between the attitudes and practices of male and female junior doctors regarding the practice of undergraduate teaching. METHOD: A survey methodology among a cohort of nonconsultant hospital doctors in a major Irish teaching hospital was utilized. The overall response rate was 93%. The cohort held a positive attitude toward teaching undergraduates, and the majority were actively engaged in this activity. Doctors of both genders expressed a willingness to undertake teacher training. RESULTS: There were no significant differences between the genders regarding the self-reported quantity of teaching provided to undergraduates. Male doctors perceived themselves as more confident educators when compared to female doctors, but this is likely to reflect cohort demographics in which a greater proportion of male doctors were more senior. CONCLUSIONS: This study demonstrates that male and female doctors have similar attitudes toward, and practices in, voluntary undergraduate teaching. As a result, any gender shift in medicine is unlikely to result in a significant change in junior doctors' attitudes toward undergraduate medical education.

Current trends in Communication Skills Training in UK schools of medicine.

BACKGROUND: Communication Skills Training (CST) is now mandatory for all students in UK Schools of Medicine. However, the extent to which all schools follow a similar curriculum is unclear. AIMS: This paper reports the findings of a survey of CST teaching in all UK Schools and compares the findings with an earlier survey. METHODS: A specially designed questionnaire survey was sent to all Schools, and this was supplemented by follow-up telephone interviews. RESULTS: There is a high level of consensus across Schools about the aims and objectives of CST, its location within the overall curriculum, and how it is assessed. There is also a dedicated staff member specifically responsible for CST delivery in all Schools. A wide number of different specialisms also contribute to training. However, wide variations remain in CST pedagogy. In addition, several problems were identified in relation to the integration and operation of CST. CONCLUSIONS: While the paper identifies and delineates a typical or 'modal' model of CST in UK Schools of Medicine, it also emphasizes the importance of flexibility in this part of the curriculum.

Is there a place for e-learning in clinical skills? A survey of undergraduate medical students' experiences and attitudes.

BACKGROUND: e-learning is established in many medical schools. However the effectiveness of e-learning has been difficult to quantify and there have been concerns that such educational activities may be driven more by novelty, than pedagogical evidence. Where some domains may lend themselves well to e-learning, clinical skills has been considered a challenging area for online learning. AIMS: The aims of this study are to assess undergraduate medical students? perceived level of IT ability and accessibility, and attitudes towards e-learning in basic clinical skills education, compared to other teaching methods. METHODS: A self-administered questionnaire was developed to capture undergraduate medical students: (i) demographic details (ii) perceived level of IT ability and accessibility (iii) experiences and attitudes towards e-learning and clinical skills training. Responses were linked to student?s performance in a clinical skills OSCE. RESULTS: The majority of students reported good access to computers and the internet, both on and off campus and appear confident using IT. Overall students felt that e-learning had a positive impact on their learning of clinical skills and was comparable to other traditional forms of clinical skills teaching. Students who displayed deep learning traits when using e-learning, performed better in clinical skills OSCEs. CONCLUSION: Undergraduate medical students value the use of e-learning in clinical skills education, however they vary in their utilization of such learning environments. Students rate e-learning just as highly as other traditional methods of clinical skills teaching and acknowledge its integration in a blended approach. Developers of clinical skills curricula need to ensure e-learning environments utilize media that encourage deeper approaches to learning.

Developing pre-qualification inter-professional education for nursing and medical students: sampling student attitudes to guide development.

Teamwork and collaboration are regarded as important goals for health and social care education and inter-professional education (IPE) the vehicle to achieve this. However, there is debate concerning the best strategies for implementation, location and delivery of IPE. This exploratory study was undertaken to anticipate some of the problems of implementing a pre-qualification IPE programme for Children's Branch nursing students and medical students undertaking a Paediatrics module and to identify strategies to maximise success. A modified version of the readiness for inter-professional learning scale (RIPLS), including additional open-ended questions, was used with a convenient, purposeful sample of 20 medical and 10 nursing students. Both groups regarded learning team-working skills as important. Medical students regarded IPE as a means to learn about team-work and professional roles otherwise they indicated a preference for a discipline-based approach. Both groups were found to have acquired a strong sense of their own professional role. Both perceived IPE as disadvantageous if it impeded their own professional learning. Results also highlighted the importance of class size, stage of learning, appropriate skills and subject in IPE planning. We conclude that a small exploratory study can provide a useful guide for programme planning and additional qualitative data can enable a more comprehensive explanation of results.