The students' view of an innovative undergraduate medical course: the first year at the University of Newcastle,N.S.W.†

An innovative medical course commenced in 1978 in a new medical school at the University of Newcastle. An evaluation of the student response to the first year of this course was carried out. This evaluation aimed to assess how far the students had progressed towards the attainment of the long-term Faculty objectives on which the Newcastle curriculum is based. Students' perceptions of educational innovations were obtained and compared with the Faculty's stated aims. Students felt that they could approach a problem scientifically, in a manner consistent with the Faculty's specified methods. In the area of team work, students had accepted the need for training in team skills as preparation for work after graduation. Students have adapted to the use of objectives, to assessment for competence, and to the marking of one another's papers. These methods had been introduced to facilitate the development of skills necessary for independent and continuing self-education. Patient contact was designated as the greatest strength of the first year. Students expressed concern for patient well-being and the influence of student activities on patients. This indicated that students had progressed some way towards the attainment of the Faculty objective that they should develop an humanitarian approach to patients.     

When students learn numbers: evaluation of a course in clinical decision-making

This paper describes the evaluation of an innovative course in clinical decision-making (CDM). A traditional course in neurology taught concurrently to the same group of students by the same teacher was used for comparison. The aim of the course was to introduce students to the basic concepts of CDM as an aid to rational decision-making. The end-point of the evaluation was their perception of the immediate clinical relevance of CDM. It was postulated that by seeing this relevance they would be more likely to change their decision-making behaviour than by simply learning factual content or principles. The evaluation used an ongoing formative approach, including ethnographic analysis, questionnaires, small group discussion and supportive feedback for the teacher. The ongoing evaluation of the course resulted in revisions with increasing relevance within the students' level of experience, changes in sequence of presentations and encouragement of active student participation. A pre-test showed that students had difficulty in the correct assessment of the validity of data and in the correct revision of opinion. Results of the evaluation indicated that the CDM course did not achieve its objective of making students aware of the immediate clinical relevance of CDM. Possible reasons for this include the lack of reinforcement from clinicians suitable for modelling and the context specific nature of the learning of thinking processes. For a CDM course to be successful, it may need to be taught within the context of specific clinical topics. It is suggested that the evaluation approach used here is a cost-effective method when considering innovations in the curriculum and useful for generating further questions for study.     

Consumer views on the medical curriculum: a retrospective study of Aberdeen graduates

In a postal follow-up study of five annual cohorts of Aberdeen medical graduates. 371 respondents (out of 423 approached) gave their views on their undergraduate curriculum. Three out of four thought the curriculum had satisfactorily prepared them for their choice of career. But when asked about four areas of medical care these postgraduates thought that patient management outside hospital, social services relevant to medicine, and individual patient problems had been inadequately represented. Of the twenty-five curricular subjects on which respondents were asked to comment, anatomy and biochemistry were most often rated as excessively taught, while general practice was most often stated to be under-represented.
This study raises the question of more active participation by experienced consumers of medical education in shaping the content of the undergraduate curriculum.     

Ten questions to ask when planning a course or curriculum

Summary. This brief practical aid to course or curriculum development cannot replace educational qualifications or experience, but it does examine ten basic questions, any of which may be all too easily neglected. These are: (1) What arc the needs in relation to the product of the training programme? (2) What are the aims and objectives? (3) What content should be included? (4) How should the content be organized? (5) What educational strategies should be adopted? (6) What teaching methods should be used? (7) How should assessment be carried out’ (8) How should details of the curriculum be communicated? (9) What educational environment or climate should be fostered? (10) How should the process be managed? Each aspen is illustrated through the analogy of car manufacturing. The ten questions are relevant in all situations where a course or curriculum is being planned, including an undergraduate degree course, a short postgraduate course or a 1-hour lecture.     

A new course in basic therapeutic skills for medical and dental students at the College of Medicine, University of Lagos: student evaluation

A new course in basic therapeutic skills for first-year students at the College of Medicine, University of Lagos began in July 1980. The course is designed to teach basic medical procedures in nursing, first aid, medicine, surgery, paediatrics and dentistry. It also introduces the students, early in their medical or dental training, to the role in treatment and rehabilitation of dietetics, physiotherapy, prosthetics and orthotics, occupational therapy and medical social work.
The course is in its second year of implementation with 152 students participating in the inception year and 166 in the second year. The former group of students had a pre-test and post-test consisting of fifty multiple choice questions. The latter group were also examined in the performance of the skills taught them using check lists and rating scales of the Objective Structured Clinical Examination (OSCE) type.
At the end of the course the students completed an evaluation questionnaire. As a result, the organization of the course in its second year took account of many of the findings from student evaluation in the first year. The particular learning needs of dentistry students were included, hence the second class of dental students found the courses more relevant than the previous class. The teachers were encouraged to develop audiovisual presentations of their subjects and the increased use of simulators permitted greater opportunity for students to practise skills.
The study indicates that student evaluation of course organization and management can be of great value in providing the feedback required to progressively improve the learning environment.     

Medical interviewing: initial student problems

Although every lecturer in a department of medical education would endorse the importance of sound medical interviewing the position of courses on this subject is generally unstressed. In the past few years a course has been developed in the Department of Internal Medicine at the University hospital of Utrecht in which special attention is paid to the sort of problems students experience in the initial phase of medical interviewing. Use is made of simulated patients. At the same time attention is given to both the medical and communicative aspects. This approach is specially appreciated by the students. Self assessment shows that they report a considerably enhanced proficiency. Observations and questionnaires show that the students have problems mostly on the emotional level, both in coping with their own emotions and in discussing personal and emotional topics with a patient.     

A medical curriculum: evaluation by final-year students

Seventy-five students, at the end of their final year, responded to a postal questionnaire designed to assess their views on their medical curriculum. The responses of those intending to enter general practice were compared with those of intending hospital doctors and comparisons were also made between respondents who had enrolled for a 6-year course and those who had enrolled for the newer 5-year course.     

Curriculum evaluation: status and options

A questionnaire was used to ascertain: the status of the curriculum; curriculum characteristics; factors which have been useful in facilitating and improving the curriculum; opinions of the teaching staff on various ways of improving the educational process; and frequency of utilization of various teaching methods and audio-visual aids. The questionnaire was sent to 100 randomly selected faculty members (about 60% of total faculty members). The responses were statistically analysed to explain and elucidate the nature of the curriculum, factors or agents which have influenced the curriculum, the pattern of utilization of teaching methods and audio-visual aids, and the problems which have inhibited the rate of change. The implications of these findings for facilitating and improving the educational process are discussed.     

Medical chemistry: evaluation of active and problem-oriented teaching methods

In the preclinical phase of basic medical education at the Karolinska Institute in Stockholm, Sweden, chemistry extends over 16 weeks and changes were made to the teaching methods during 7 of those weeks--one in organic chemistry and 6 in intermediary metabolism. The number of lectures was reduced and problem-oriented group tasks wee introduced instead which required a higher level of student responsibility for individual learning. Teaching and group tasks were designed to give the students a better understanding of the biochemical processes in their entirety as well as the way these are controlled in the human body. From this base the students will be enabled to discuss and understand physiological, pathological and medical phenomena. Experience and results show that student performance in examinations improved significantly, that students acquired a better understanding and a more comprehensive grasp of the subject, and a noticeably more positive interest in medical chemistry. They remember approximately 60% more a few years after completing the course than do students who have been instructed in a more traditional manner, and although the load of the teachers has increased by some 20% in respect of scheduled time, the instructors have gained in improved student contact and a wider knowledge of their subjects. The results have remained the same for each course since the change was introduced in 1977. Due to new admission criteria, more students now have less knowledge of mathematics and chemistry, and more students have social circumstances that make independent studies more attractive (family obligations and financial obligations).(ABSTRACT TRUNCATED AT 250 WORDS)     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

Analysis of examinations in curriculum review

This paper describes the analysis of the written professional examinations administered at the Medical School, Universiti Kebangsaan Malaysia (UKM), during the academic year 1979–80. It is a product of a collaborative activity involving medical teachers and two short-term consultants of the World Health Organization.
The examination papers were analysed in order to identify content areas disproportionately emphasized in the examinations; to determine the quality and appropriateness of the examination items used; and to review the extent of continuity and integration across departments and courses.
This paper is intended to introduce an approach to curriculum review which is based on analysis of the examination system. The procedures and sample outcomes are described and the implications for curriculum development and evaluation are discussed.     

Videotape demonstration of physical examination: evaluation of its use in medical undergraduate teaching

A videotape demonstration of the physical examination of the alimentary system was used, in place of a traditional lecture, in the first week of a teaching programme for half of a group of commencing, clinical students. At the end of the week, these students obtained higher scores than the matched controls in a clinical assessment which utilized an objective scoring-chart devised especially for this study.     

The Rural Area Project (RAP) in Thailand: curriculum development

The Rural Area Project is a collaborative developmental project of Chulalongkorn University and the Ministry of Public Health in Thailand. The main objective of the project is to increase the number of doctors in the country in such a way that they would be posted in rural districts and have appropriate knowledge, skill and attitude for rural practice. Curriculum development for the project has been carried out to serve the project objective as well as to ensure that the project graduates are accepted as qualified doctors. Several principles and assumptions have been used as strategies in the developmental process. They include co-operative participation in curricular planning, systematic formulation of educational objectives, organization of common courses, utilization of existing health services, planning innovative courses in community medicine and general practice, extensive use of self-instructional modules, efficient use of teachers' time and planned gradual delegation of responsibility to students.     

Computerization of undergraduate medical curriculum content

A method is reported for the computerized storage and retrieval of informative summaries of the didactic portion of the first 3 years of the medical undergraduate curriculum utilizing the MICOM word processor and SORT 200 program with disc storage. Each lecture, small group session, laboratory or clinical experience summary is assigned a page of computer memory and is coded in the header line for various indices describing the session format, location, audiovisual usage, teacher and other demographics. The second line contains the lecture title and its situation within the teaching block. A summary of the teaching session follows. This was compiled and distilled from summaries prepared by the individual teachers, lecture handouts and the personal notes of the two medical students who divided the lectures equally between themselves and prepared individual summaries which were then exchanged. The resulting composite summary was returned to the teacher for comment and/or modification before entry onto the MICOM word processor. The SORT 2000 program permits search, selection and retrieval of the content of each teaching session from the data contained in the header line or any word, word segment or phase occurring in the summary. Reproduction of the data discs facilitates multiple access and allows each department or teaching block to review the complete curriculum quickly, identify redundancies and more fully integrate new or existing material.     

Medical teaching—help or hindrance?

The paper describes an ongoing research study into the learning practices of medical students. Responses from structured interviews of forty-four (20%) first-year students at the University of New South Wales indicate that they work long hours, use few resources, consult little with teaching staff, co-operate a lot with each other and see themselves as responsible for their own learning. It is suggested that teacher training activities should take more notice of the actual learning practices of students if teachers and students are not to become confused and disillusioned.     

Project work in the medical curriculum

This paper outlines one component, the project, which in 4 years became an integral part of the Human Ecology course at the Department of Community Medicine at the University of Glasgow. Although it is to be retained in some form, it would seem that the full potential of the device for medical undergraduates has not been realized; instead of retaining it in a token or contracted form, it could have served as the basis for cementing the learning and experience gained in the two halves of the division between the pre-clinical and the clinical years.     

Medical students' attitude towards psychiatry: a ten-year comparison†

Medical students' interest in and attitudes toward psychiatry, both as a field of education and as a medical specialty, have been explored by a number of investigators. The present study compares two series of investigations completed at the McGill University teaching hospitals over a ten year span and involving third year medical students in 1968–69 (n=59) and in 1978–79 (n=168). The findings of these two studies are evaluated in two parts: (1) comparison of attitudes toward psychiatry before and after clinical training in 1978–79. (2) comparison of the results obtained in 1969 with those in 1979. The results of the comparison showed that students currently put more emphasis on the clinical aspects of psychiatric training and less on the theoretical and research aspects of psychiatry. Thirty-two percent of students in 1979 found psychotherapy to be the most useful treatment modality as compared with only 10 percent in 1969. Findings reflecting the usefulness of organic therapies in psychiatry remained fairly consistent, but behaviour therapy was found to be less useful by students in 1979 than in 1969. In the 1969 survey, 2 per cent of the third year students indicated an interest in psychiatry as a future career as compared with 3.3 per cent in 1979. The implications of these findings are discussed in relation to the psychiatric training programmes in medical schools.     

An evaluation of a workshop on educational methods for health science teachers in Lagos, Nigeria

A workshop on educational methods held at the College of Medicine, University of Lagos in 1980 was evaluated by means of questionnaires. The workshop was favourably received and enhanced the teaching practices of participants. As a result of the workshop, most participants wrote instructional objectives, used more audiovisual aids and adopted new methods of teaching and assessment of clinical skills. Although the session on the production of self-instructional packages (SIPs) was rated highly at the workshop, relatively few participants had completed a programmed text at time of follow-up. Similarly, most participants had set MCQs but few had calculated either the facility or discrimination index.
The participants themselves suggested that future workshops should be tailored to the particular educational needs of different disciplines. The authors suggest that intensive short-term workshops may be useful for content areas which require more time than an extensive workshop permits.     

The approaches to learning of students in a traditional and in an innovative problem-based medical school

The way in which students approach their learning is dependent on a variety of factors including the characteristics of the departments and teaching to which they are exposed. These factors appear to influence whether the students adopt a surface, deep or strategic approach. In order to explore further the relationship between educational context and approach to learning, a comparison was made between students attending a traditional medical school and those attending a problem-based medical school. The results showed marked differences, with the problem-based school being higher on deep approach and lower on surface approach than the traditional school. This study provides one of the first pieces of evidence of a difference between students in the two types of medical school which can be directly attributed to the educational environment. Students in the problem-based school appear to have an approach to learning which more closely approximates the aims of most medical schools. The results provide support for the philosophies and strategies of the problem-based schools.     

Intensive bedside teaching of physical examination to medical undergraduates: evaluation including the effect of group size

The effectiveness of intensive bedside teaching of techniques of physical examination of the alimentary system to students commencing their clinical training was assessed. All students viewed a videotape demonstrating these techniques and then participated in a morning practice examination session but only half of the class received afternoon bedside teaching of physical examination in addition. Teaching in history taking was used as a 'placebo' for the control group, and half the students in each of the study and control groups were taught in units of four, the other half in units of eight. Thus the effect of group size could also be estimated. After 1 week, the Students' performance of a physical examination was assessed using a standardized scoring chart which demonstrated good reliability. The study group performed significantly better than the control and within the study group there was a trend for the students taught in smaller units to perform better.