Conceptions of problem-based learning: the perspectives of students entering a problem-based medical program.

Effective learning in higher education is associated with students' perceptions of clear goals and standards of an educational program. In programs using problem-based learning (PBL), students' conceptions of what PBL is about could determine how well they perceive the clarity of goals and standards of their program. In this study the authors aim to investigate the relationship between the nature of first-year students' conceptions of PBL and their perceptions of the clarity of goals and standards of a graduate-entry, problem-based medical program. Results are that most students conceive of PBL as mainly working collaboratively to solve and understand a problem, and place less emphasis on PBL as learning independently. There is no relationship between students' conceptions and perceived clarity of course goals and standards. It is suggested that teachers not only need to help students develop their understanding of what PBL is about but also need to help students learn how to self-regulate their learning in PBL programs.

The neurosurgical training curriculum in Australia and New Zealand is changing. Why?

The Neurosurgical Advanced Training curriculum of the Royal Australasian College of Surgeons (RACS) is currently undergoing change. Given the high standard of neurosurgery in Australia and New Zealand, it may be questioned why such change is necessary. However, the curriculum has not kept pace with developments in professional practice, educational practice or educational theory, particularly in the assessment of medical competence and performance. The curriculum must also adapt to the changing training environment, particularly the effects of reduced working hours, reducing caseloads due to shorter inpatient hospital stays and restricted access to public hospital beds and operating theatres, and the effects of sub-specialisation. A formal review of the curriculum is timely.

Clinical skills in junior medical officers: a comparison of self-reported confidence and observed competence.

BACKGROUND: The intern year is a key time for the acquisition of clinical skills, both procedural and cognitive. We have previously described self-reported confidence and experience for a number of clinical skills, finding high levels of confidence among Australian junior doctors. This has never been correlated with an objective measure of competence. AIMS AND HYPOTHESIS: We aimed to determine the relationship between self-reported confidence and observed competence for a number of routine, procedural clinical skills. METHODS: A group of 30 junior medical officers in their first postgraduate year (PGY1) was studied. All subjects completed a questionnaire concerning their confidence and experience in the performance of clinical skills. A competency-based assessment instrument concerning 7 common, practical, clinical skills was developed, piloted and refined. All 30 PGY1s then completed an assessment using this instrument. Comparisons were then made between the PGY1s' self-reported levels of confidence and tutors' assessments of their competence. RESULTS: A broad range of competence levels was revealed by the clinical skills assessments. There was no correlation between the PGY1s' self-ratings of confidence and their measured competencies. CONCLUSIONS: Junior medical officers in PGY1 demonstrate a broad range of competence levels for several common, practical, clinical skills, with some performing at an inadequate level. There is no relationship between their self-reported level of confidence and their formally assessed performance. This observation raises important caveats about the use of self-assessment in this group.

Making the most of learning in the operating theatre: student strategies and curricular initiatives.

BACKGROUND: Students in medical programmes around the world are required to attend with their patient in the operating theatre, yet little is known about this area of medical education. Most of the published literature on the operating theatre is normative in character, written from the perspective of the surgeon as teacher. This paper, in contrast, reports the student's perspective as learner. It is an interpretive case study conducted in the department of surgery at an Australian university. METHODS: Research approaches were combined in a multi-method strategy which included in-depth interviews with students and surgeons, observations in operating theatres, group interviews and a student survey. The aim was to understand the student's experience of the theatre as a learning environment, with a view to improving teaching and learning in this setting. FINDINGS: The operating theatre is a challenging place in which to learn. The challenges are conceptualized in this paper around three key domains: the challenge posed by the physical environment and the emotional impact of surgery as work; the challenge of the educational task, and the challenge of managing the social relations of work in the operating theatre. CONCLUSION: Students who report finding the operating theatre a useful experience are those who adopt active strategies to successfully manage their learning across the three domains. The paper describes curricular initiatives that have been introduced in a department of surgery to help more students make the most of their learning in theatres, and goes on to discuss the wider implications of the findings for surgical education beyond this case study.

Preparedness for hospital practice among graduates of a problem-based, graduate-entry medical program.

OBJECTIVE: To compare preparedness for hospital practice between graduates from a problem-based, graduate-entry medical program and those from other programs (undergraduate problem-based and traditional). DESIGN: Survey of graduates (by mailed questionnaire) and organisers of clinical training (by semistructured interview); results were compared with published results of surveys of graduates from other programs. SETTING AND PARTICIPANTS: All graduates of the first intake of the University of Sydney graduate-entry medical program were surveyed at the end of their first intern year (2001), along with the director of clinical training or intern manager at each of the New South Wales hospitals that employed the graduates. MAIN OUTCOME MEASURES: Graduates' self-reported level of preparedness in the eight domains of the Preparation for Hospital Practice Questionnaire; and organisers' opinions of their strengths and weaknesses. RESULTS: 76 of 108 graduates from the graduate-entry program (70%) and organisers of clinical training at all 17 hospitals participated. Graduates from the program felt more prepared than did those from other programs in five of the eight domains assessed (interpersonal skills, confidence, collaboration, holistic care, and self-directed learning) and no less prepared in any domain. Organisers rated the graduates highly, especially in clinical competence, confidence, communication and professional skills. Opinions of interns' knowledge of basic sciences conflicted, with strengths and weaknesses mentioned with equal frequency. CONCLUSION: Graduates from the graduate-entry, problem-based program are at least as well prepared for their intern year as graduates from traditional and undergraduate problem-based programs.