Teaching medical students gynaecological examination using professional patients-evaluation of students' skills and feelings

Gynaecological examinations are especially sensitive, both for the inexperienced student and for the woman being examined. To assist the students in this process, we have introduced a separate training session for medical students using so-called professional patients during the first week of the course in obstetrics and gynaecology. The aim of the study was to evaluate the outcome, attitudes and feelings towards this type of training and to gain knowledge on how to further develop the method. After the training session, students, teachers and professional patients were asked to fill in anonymously different questionnaires assessing their views on the education. In conclusion students, teachers and professional patients found this training programme with professional patients to be of great value. It was felt that the teaching session reduced stress and anxiety; the students were relieved, calmer and more secure after the training. It is strongly recommended that this type of programme with professional patients should be used for teaching gynaecological examination techniques to medical students.     

Long-term retention of teaching skills after attending the Teaching Improvement Project: a longitudinal,self-evaluation study

In order to test retention of teaching skills acquired on a two-day Teaching Improvement Project course 94 participants from 12 courses were pre-tested using a sef-evaluation questionnaire and then re-tested with the same questionnaire, between one and two years after course attendance. With a 77% post-course response rate significant differences were measured in participants' self-evaluation of their teaching skills, particularly in the use of learning objectives, structuring learning, questioning techniques and self-confidence. A control, 'demonstrating practical procedures', which was not part of the course, showed no significant difference. Many free comments indicated that teachers had used their new teaching skills with students, that they were more confident as teachers and that they felt their students had benefited from their teacher training. A smaller number of comments suggested some teachers had become more reflective.     

Unexpected pathological findings in skills training and assessing skills

This article draws attention to unexpected pathological findings encountered by students and teachers when examining one another and/or simulated patients in skills training and assessment sessions.Although no literature on the subject was found, it appears to be not uncommon for students and teachers to find abnormalities during skills training and assessment. It is important that both students and teachers should be aware of this possibility and students should be encouraged to disclose any unexpected findings. Teachers should be given guidelines on the appropriate course of action during teacher-training sessions and students should be informed of the possibility of finding abnormal pathology prior to their participation in skills training and assessment.     

AMEE Guide no. 34: Teaching in the clinical environment

Teaching in the clinical environment is a demanding, complex and often frustrating task, a task many clinicians assume without adequate preparation or orientation. Twelve roles have previously been described for medical teachers, grouped into six major tasks: (1) the information provider; (2) the role model; (3) the facilitator; (4) the assessor; (5) the curriculum and course planner; and (6) the resource material creator (Harden & Crosby 2000). It is clear that many of these roles require a teacher to be more than a medical expert. In a pure educational setting, teachers may have limited roles, but the clinical teacher often plays many roles simultaneously, switching from one role to another during the same encounter. The large majority of clinical teachers around the world have received rigorous training in medical knowledge and skills but little to none in teaching. As physicians become ever busier in their own clinical practice, being effective teachers becomes more challenging in the context of expanding clinical responsibilities and shrinking time for teaching (Prideaux et al. 2000). Clinicians on the frontline are often unaware of educational mandates from licensing and accreditation bodies as well as medical schools and postgraduate training programmes and this has major implications for staff training. Institutions need to provide necessary orientation and training for their clinical teachers. This Guide looks at the many challenges for teachers in the clinical environment, application of relevant educational theories to the clinical context and practical teaching tips for clinical teachers. This guide will concentrate on the hospital setting as teaching within the community is the subject of another AMEE guide.     

Advantages of using the multiple case method at the clinical stage of medical education

The multiple case method is an uncomplicated form of discussion learning. Its primary objective is to make students familiar with knowledge already presented to them in lectures and written material. For each session, a large number of situations within a theme are described in handouts. After individual preparatory work, a group of 20-40 (-60) students cooperates to reach understanding and acceptable handling. The main tasks of the teacher are to stimulate the discussion and detect misunderstandings. In a course on infectious diseases, we have successfully used this method of teaching on a large scale for more than a decade. During 24 consecutive runs of the course, with a total of approximately 500 students over a 6-year period, the method was consistently rated high by the students. The long-term persistence of this method can be attributed not only to its learning value but also to the fact that it is simple and easy to practise with relatively large groups of students, thereby decreasing the risk of teachers' burnout.     

How residents perceive their teaching role in the clinical setting: a qualitative study

Residents play an important role in teaching and they consider teaching medical students as one of their primary responsibilities. Teaching is, however, limited due to lack of teaching skills and the time constraints involved in preparing and conducting teaching. Eighteen residents involved in teaching medical students and who took part in an initial study on teaching were interviewed on the perceived benefits of teaching and the role of residents in the teaching process. They also provided recommendations on how a training programme for residents could be created. The findings showed that enthusiasm and enjoying teaching were qualities of good teachers. Lack of time and support from attending staff were factors that contributed considerably to poor quality of teaching. There was a need for basic teaching skills and the recommendations provided included literature on teaching, training workshops, constructive evaluation and feedback and interactive sessions with experts.     

Evolution of medical education in the Department of Medicine of the Complutense University of Madrid in the last decade

Abstract

Objectives: This paper aims to show changes in Medical Education in the Department of Medicine at the Complutense University of Madrid in the last 10–15 years.

Results: Medical education in the Department of Medicine at the Complutense University of Madrid has undergone significant changes in the last 10–15 years. An attempt to summarize these shows that radical change in the teaching of medicine for both teachers and students has taken place in three areas: 1. Progressive development of Patient-centered medical education. 2. Development of a competency-based training concerned with the mastering of knowledge and skills and their evaluation through objective and structured clinical assessment tests. 3. Introducing simulation techniques and virtual reality in the teaching of clinical practice aimed at improving our students' training and enhancing patient safety.

Conclusions: We believe that the changes applied have pleased students as well as teachers and even patients and are helping to improve the training of our students.     

Improved student preparation from implementing active learning sessions and a standardized curriculum in the surgical examination course

Students' knowledge before and preparation for courses with practical skills training or bedside teaching may be insufficient and reduce efficiency of teaching time at the bedside and in skills training. To study the effect of a new curriculum on students' preparation for courses, a quasi-randomized study was conducted. All medical students were included who participated in the surgical examination course during a period of four semesters. In the intervention group, specified topics for every session, a course book describing only those procedures relevant for the course and a foregoing case-based active learning session were introduced as compared to the traditional way of teaching the surgical examination course. For evaluation a questionnaire for the students was used. A total of 614 questionnaires (return rate 79.6%) were included in the analysis. Student as well as teacher preparation significantly improved in the intervention group from 34.8 to 73.6% and 46.1 to 73.0%, respectively. The case-based learning session and the course book were considered helpful by 77.7 and 96.4% of the students, respectively. The introduction of a timetable with specified topics for every session, a course book and a foregoing case-based learning session significantly improved student preparation for the surgical clinical examination course.     

Preparing medical students for the e-patient*

The emergence of the e-patient has resulted in many medical practitioners' being ill-equipped to deal with the 21st-century medical practice. This Guide is a teaching guide for medical educators so that they can prepare their students for the new environment that has resulted from the emergence of the e-patient. Within the context of theoretical perspectives, the Guide begins by defining the concept, and examining the history of the e-patient, detailing typical e-patient activities and some complexities raised by these activities. Finally, the Guide details the topic areas that should be covered in a course aimed at preparing medical students for e-patients. The result is a theoretical and practical teaching Guide that equips medical teachers and their students with the necessary background information, and also assists teachers in the teaching of that information so that their students may become health practitioners fully equipped to deal with the problems and potential of the e-patient.     

AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers

This guide provides an overview of research on lecturing, a model of the processes of lecturing and suggestions for improving lecturing, learning from lectures and ways of evaluating lectures. Whilst primarily directed at teachers in the healthcare professions, it is equally applicable to all teachers in higher education. Lectures are the most ubiquitous method of teaching so they are an important part of a teacher's repertoire. Lectures are at least as effective as other methods of teaching at imparting information and explaining. Intention, transmission and output are the basis of a model of lecturing. The key skills of preparing lectures, explaining and varying student activities may be derived from the model. Preparation is based on purposes, content, various structures of lectures and the preparation of audiovisual aids. The essential ingredients of explaining are clarity, interest and persuasion. By varying activities, one can renew attention and develop student learning. Learning from lectures can be improved by teaching students the structure of lectures and methods of listening and note-taking. Student ratings of lectures are useful but over-used and limited ways of evaluating lectures. Equally important is peer review and more important than either student ratings or peer feedback is reflection on the practice of lecturing by individuals and course teams.     

Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators

There has been recent increasing interest in reflective practice within physiotherapy education as a method for reducing the 'theory-practice gap' and as a means of articulating, exposing and developing knowledge embedded in practice. Several contrasting theories have been developed to explain the role, place, purpose and definition of reflection in learning and teaching; however, much of the research to date has relied on theoretical debate rather than high quality empirical evidence. The aim of this paper was therefore, to report how a group of United Kingdom (UK) based physiotherapy Professional Practice Coordinators (n = 33) with their unique insight into the concept from both the academic and clinical perspective viewed and interpreted the use of reflective practice within their physiotherapy curriculum. Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire. Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies. The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.     

The problem-based learning tutorial laboratory - a method for training medical teachers

An extensive staff development program was started in 1998 in the Faculty of Medicine at the University of Helsinki. A problem-based learning method was introduced as a new style of teaching in the curriculum reform. This paper describes a teaching method 'Problem-based learning - tutorial laboratory' for training medical teachers to act as tutors and to understand their roles as facilitators of learning and the dynamics of a small group. The method was based on learning cycles: teachers had a possibility to experience tutoring, to get feedback about it from an educational expert and from a peer teacher and also they were able to reflect on their views in the group. The teachers were content with the training. Sessions improved teacher cooperation across the departments and brought new teaching ideas for shared use. It also helped to cope with the resistance related to the curriculum change process.     

Why community physicians teach students (or not): barriers and opportunities for preceptor recruitment

The recent trend towards ambulatory teaching can pose challenges in terms of recruitment of ambulatory teachers. In order to improve recruitment efforts, we examined the reasons that community preceptors who teach and those who do not teach give for teaching or not teaching students in their offices. Physicians who teach students in their offices report they do so for the enjoyment and for the opportunity to provide teaching to these students. Physicians who do not teach in their offices report constraints of their practice situation, having other non-teaching challenges and being unaware of the teaching possibilities as barriers to teaching. Community preceptors were more likely to be alumni (medical school or postgraduate training) than those who were not preceptors. This study provides insight into the motivators and barriers for ambulatory teachers and has implications for recruiting and rewarding community preceptors.     

Team up! Linking teamwork effectiveness of clinical teaching teams to residents’ experienced learning climate

Abstract

Background: Supportive learning climates are key to ensure high-quality residency training. Clinical teachers, collaborating as teaching team, have an important role in maintaining such climates since they are responsible for residency training. Successful residency training is dependent on effective teamwork within teaching teams. Still, it remains unclear whether this team effort benefits residents’ perceptions of the learning climate. We, therefore, investigated to what extent teamwork effectiveness within teaching teams is associated with (1) the overall learning climate, and (2) its affective, cognitive and instrumental facets?

Methods: This study used a web-based platform to collect data in clinical departments in the Netherlands from January 2014 to May 2017. Teamwork effectiveness was measured with the TeamQ questionnaire, administered amongst clinical teachers. The learning climate was measured with the D-RECT, applied amongst residents. Associations were analyzed using multilevel models and multivariate general linear models.

Results: Teamwork effectiveness was positively associated with the overall learning climate as well as with the affective and the instrumental facets of the learning climate. No significant associations were found with the cognitive facet.

Conclusion: Effective teamwork within teaching teams benefits learning climates in postgraduate medical education. Therefore, departments aiming to improve their learning climate should target teamwork within teaching teams.     

Tuning medical education for rural-ready practice: designing and resourcing optimally

In an effort to bring doctors back to the bush the Australian government has resourced a number of rural clinical schools (RCS). At the RCS in the University of Western Australia students were allocated in small groups to rural sites for the entire fifth year of a six-year course, sitting the same final examinations as city students. Key factors guiding the successful outcome were the resourcing and implementation of the infrastructure and teaching and learning pedagogy. In designing support, the disconnection of students from their city colleagues was anticipated as an issue, as was the pedagogical indoctrination of the teachers. The curriculum implementation was adapted in this light. The role of the Web in teaching and learning, and their status as 'student colleagues' and independent learners were pivotal aspects. As students settled at their site, their confidence grew and their anxiety over urban disconnection dissipated. By benchmarking themselves using Web-based formative assessments and in formative 'objective structured clinical examinations' staged for them by the RCS, the students received ongoing feedback on their progress. This model of embedding students in rural centres for an extended period with rural practitioners as teachers was successfully implemented at multiple sites geographically vastly separate.     

AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide

This practical guide for health professions teachers provides a perspective of one of the most important educational developments in the past 30 years.Problem-based learning (PBL) is a continuum of approaches rather than one immutable process. It is a teaching method that can be included in the teacher's tool-kit along with other teaching methods rather than used as the sole educational strategy.PBL reverses the traditional approach to teaching and learning. It starts with individual examples or problem scenarios which stimulate student learning. In so doing, students arrive at general principles and concepts which they then generalize to other situations. PBL has many advantages. It facilitates the acquisition of generic competences, encourages a deep approach to learning and prepares students for the adult learning approach they need for a lifetime of learning in the health care professions. It is also fun. PBL helps in curriculum planning by defining core, ensuring relevance of content, integrating student learning and providing prototype cases. There are also drawbacks associated with PBL. Students may fail to develop an organized framework for their knowledge. The PBL process may inhibit good teachers sharing their enthusiasm for their topic with students and student identification with good teachers.Teachers may not have the skills to facilitate PBL.The problem scenario is of crucial significance. It should engage the students' interest and be skilfully written. While the medium selected for presentation of the scenario is usually print, other media may be used.The clinical tasks carried out by the student may replace the problem scenario as the focus for learning.Students are supported during the PBL process by tutors and/or study guides.The amount of support required is inversely related to the students' prior learning and understanding of the PBL process. A range of additional learning resources and opportunities may be made available to the students, including textbooks, videotapes, computer-based material, lectures and clinical sessions. Tutors require group facilitation skills, an understanding of the PBL process and knowledge of the course and of the curriculum in general.They need special personal qualities and it is preferable if they have expertise in the content area.While special assessment processes have been developed to assess students learning by the PBL method, the general principles of assessment apply to PBL courses and a mixed menu of assessment methods needs to be employed. Curriculum design involves a skilful blend of educational strategies designed to help students achieve the curriculum outcomes. PBL may make a valuable contribution to this blend but attention needs to be paid to how it is implemented.     

An assessment of medical students' experiences of learning about the psychosocial enquiry in their introductory clinical course

Medical students' ability to take a meaningful psychosocial history has been shown to decline during clinical training. We postulated that psychosocial histories are given a low priority in busy clinical attachments. The aim of this study was to identify factors that affect how medical students gain skills in psychosocial assessment. A random sample of 37 students filled in a questionnaire before and after their introductory course, and they were asked to keep a logbook of their experiences of teaching about psychosocial history taking. There were 504 teaching experiences recorded of which less than half were positive. Negative experiences often related to poor communication by clinicians. At the end of the course less than half the students felt confident in taking a psychosocial history. To improve doctors' skills in this important area we suggest that teaching in psychosocial history taking should be made explicit, as an integrated part of the overall assessment of a patient.     

Scientific method for medical practitioners: the case method of teaching pathology in early twentieth-century Edinburgh

The appointment of James Lorrain Smith as first full-time professor of pathology at the University of Edinburgh in 1912 led to a series of reforms in pathology teaching there. Most significant was the inception of what Lorrain Smith called the "case method of teaching pathology," which used the investigation of clinical cases as the basis for a series of exercises in clinico-pathological correlation. This paper examines the social and cognitive organization of the case method of teaching, and shows how such exercises were expected to inform the students' future medical training and practice. In so doing, it also throws light on the relationship between medical science and clinical practice that obtained in Edinburgh at that time.     

Teaching and assessing communication skills in Maastricht: the first twenty years

In order to share the issues involved in setting up a communication skills training programme in a medical school, the development of such a programme at the Skillslab of Maastricht Medical School, the Netherlands, is described and the problems encountered are addressed. A multidisciplinary working group developed teaching goals for communication skills, focused on observable behaviour to be displayed by students. These teaching goals were incorporated in a generic model for doctor-patient communication. A longitudinal training programme was created, throughout the four years of the preclinical curriculum. Students meet in small groups of 10, once every 2 weeks. In between group sessions they practise consultation skills in simulated patient contacts. Communication skills are assessed in the annual multiple station examination. In the development of this programme the following consecutive actions were taken: teaching material was produced, and an assessment tool was developed, as were instruments for programme evaluation. The programme evaluation allowed student feedback to teachers, the teachers' departments, and the administration of the medical school. Finally, teacher training was professionalized.