Background:  Many clinicians are involved in medical education, with small group teaching (SGT) forming a significant part of their work. Most facilitate these sessions by experience and common sense: less than one-third of them have received formal training in SGT.

Context:  Evidence suggests small group productivity depends on good facilitation rather than on topic knowledge. Applying the fundamental concepts of SGT will lead to improvements in the quality of clinicians’ teaching and in student learning. Good SGT creates the perfect environment for learning and discussion, without the need for didactic teaching. SGT emphasises the role of students in sharing and discussing their ideas in a safe learning environment, without domination by the tutor.

Innovation:  This article provides clinicians with basic requirements for effective session design and planning, explains how to encourage student participation, how to manage students as a group, how to manage student learning, and how to recognise and deal with problems.

Implications:  Active facilitation and group management is the key to success in SGT, and consequently better learning outcomes. Improving the facilitation skills of clinical teachers makes teaching more effective, stimulating, and enjoyable for both tutors and students.

Background:  All newly qualified doctors will look after patients in the last stages of life.

Context:  This article is a review of the literature regarding medical students learning from hospice patients, focusing on practical concerns of relevance to those involved in organising or conducting medical student teaching.

Innovation:  Medical students have increasing opportunities to learn about palliative care from talking to patients in a hospice. This resource is not fully utilised, in part because of concerns about patient and student welfare. These concerns are not supported by current research findings, including a qualitative interview study of patients and staff.

Implications:  We would encourage course coordinators to use opportunities for medical students to talk to hospice patients in order to enhance the education of medical students.

Background:  Over the last few years the London Deanery has offered workshops in supervision skills for clinical teachers. In response to the concern that supervision conversations are time consuming, we devised an exercise to promote the ability to carry out a small piece of supervision that can nudge forwards an issue in a short time (10 minutes or less): speed supervision.

Context:  The workshops are part of the faculty development programme for clinical and educational supervisors in primary and secondary care at the London Deanery. The workshops teach a question-based approach to help the supervisee reflect and shift their perspective.

Innovation:  Offering advice is often not the most time-efficient way to help someone towards the solution for an issue. We chose to introduce an approach that could help a supervisee think differently about an issue in a brief period of time. Helping a supervisee to make a small piece of progress in their thinking can in turn lead to future changes. Supervisors are encouraged to explore values and context as well as technical and scientific aspects.

Implications:  Even during a brief period of supervision, asking questions rather than reaching for the familiar solution may be surprisingly satisfying for both supervisee and supervisor alike. The skills can be applied to professional and personal dilemmas and situations.

Background:  Using trained actors to simulate trainee doctors in difficulty is a cost-effective communication skills teaching tool that can be enhanced by techniques that are familiar to hi-fidelity electronic simulation. Simulation has two broad strands: the first exchanges the patient for an actor in the clinical encounter, and the second introduces some form of technology to the encounter. The strand concerning actors is well developed, and generally focuses on ‘the consultation’. Where simulation draws on technology, the spectrum is broad: it may be relatively low-tech, for example computer-based scenarios to test prescribing, through to more high-tech approaches to learning practical skills using sophisticated manikins that replicate patient signs and symptoms. Over the years simulation has radically changed medical training, and is set to continue to do so in the future.

Context:  Actors have been used for many years to contribute to the training and assessment of medical students, specialty trainees and established doctors. Their role to date has largely been limited to playing patients in scenarios.

Innovation:  This innovation in communication skills teaching seeks to draw on both strands of simulation. It sees actors playing general practice (GP) trainees to enhance the continuing professional development of established GP trainers, in contrast to the more usual use of actors playing patients. It also makes use of the control mechanisms afforded by technological simulation in fine-tuning role-play scenarios.

Implications:  By using actors, the scenarios can be played up or down in order to challenge participants and maximise their learning. More research is needed to develop this approach further in other medical education contexts.

Background:  Problem-based learning (PBL) is a teaching method where the use of clinical problems is the starting point for learning, and it is through the process of working through these problems that students acquire the knowledge and skills required to be a doctor.

Context  Many advantages of PBL over traditional curricula have been proposed. On reviewing the evidence on the results of PBL curricula for producing better doctors, students tend to perform either a little better or a little worse in examinations. In this article the educational and psychological theories supporting PBL are described.

Implications:  There is a wealth of theory underpinning the use of PBL to teach clinical medicine, despite disappointing results. Future research should concentrate on the reasons behind this uncoupling of theory and outcomes.

Background:  Undergraduate interprofessional education (IPE) is perceived by many in health and social care education to reduce barriers between the professions. In Aberdeen there has been an IPE programme with Robert Gordon University and University of Aberdeen, and 10 health and social care courses since 2003. The steering groups reported to the Scottish Government in 2008. It was recommended that IPE should be extended from classroom-based learning experiences to practice-based learning experiences.

Methods:  Replicating the same methodology, this study aimed to ascertain attitudinal change experienced by students undertaking IPE in clinical practice. Small groups in theatre and primary care were the pilot placement areas. The study design was a joint venture between the IPE research team and members of the clinical team. IPE activities were created for the specialities using adult learning and patient-centred approaches.

Results:  Thirty-eight students from medicine, nursing and pharmacy were involved in the studies, and completed readiness for interprofessional learning scale (RIPLS) questionnaires before and after the course activity. There were 29 valid responses, showing a strong level of agreement for 14 out of 19 questions. The studies suggest that the IPE activities implemented had positive effects on the students’ perceptions of interprofessional working.

Discussion:  The implications are that IPE does not require large classroom-based activities to be successful. The study was successful in achieving its aims and learning outcomes for students in the two locations. It demonstrated that students can leave university better prepared for practice. There is a need for a rigorous longitudinal study to ensure tomorrow’s health and social care workforce demonstrate graduate attributes in interprofessional working.

Objectives:  Virtual patients are used across a variety of clinical disciplines for both teaching and assessment, but are they an appropriate environment in which to develop professional skills? This study aimed to evaluate students’ perceived effectiveness of an online interactive virtual patient developed to augment a personal professional development curriculum, and to identify factors that would maximise the associated educational benefits.

Methods:  Student focus group discussions were conducted to explore students’ views on the usefulness and acceptability of the virtual patient as an educational tool to teach professionalism, and to identify factors for improvement. A thematic content analysis was used to capture content and synthesise the range of opinions expressed.

Results:  Overall there was a positive response to the virtual patient. The students recognised the need to teach and assess professionalism throughout their curriculum, and viewed the virtual patient as a potentially engaging and valuable addition to their curriculum. We identified factors for improvement to guide the development of future virtual patients.

Conclusion:  It is possible to improve approaches to teaching and learning professionalism by exploring students’ views on innovative teaching developments designed to augment personal professional development curricula.

Background:  Medical error continues to significantly harm patients, notwithstanding the continued efforts to improve the situation over the past decade. We report a pilot project using high-fidelity simulation to integrate the World Health Organisation (WHO) patient safety curriculum into undergraduate medical education.

Methods:  From the literature on avoidable medical error we developed a series of authentic clinical scenarios using a Clinical Skills Lab (CSL) and simulated patients to produce a high-fidelity simulated ward environment. The clinical challenges embody common day-to-day encounters experienced by newly graduated doctors. After participating, final-year medical students were given time to reflect on the experience, given feedback and completed a quantitative evaluation.

Results:  Twenty final-year medical students completed the scenarios, and gave written feedback using a Likert scale (ranging from 1, strongly disagree, to 7, strongly agree). The responses showed 18 students agreed or strongly agreed that the session was valuable, all 20 would recommend the session to peers and 18 would be interested in attending further sessions. The students gave more mixed views of faculty feedback: 13 agreed or strongly agreed that this was useful, five were undecided and two were undecided or disagreed.

Conclusion:  With the caveats of a small sample size, first experience of high-fidelity simulation, the ‘halo’ effect in the evaluation, and with possible omissions from our evaluation, the students reported predominantly positively on the experience. We believe that the use of high-fidelity simulation in patient safety is a promising, safe and low-cost curricular development in undergraduate medical education. It is transferable worldwide and has the potential to improve patient safety outcomes by reducing medical error.

Background:  How to improve patient safety remains an intractable problem, despite large investment and some successes.

Context:  Academics have argued that the root of the problem is a lack of a comprehensive ‘safety culture’ in hospitals. Other safety-critical industries such as commercial aviation invest heavily in staff training to develop such a culture, but comparable programmes are almost entirely absent from the health care sector.

Innovation:  In rock climbing and many other dangerous activities, the ‘buddy system’ is used to ensure that safety systems are adhered to despite adverse circumstances. This system involves two or more people using simple checks and clear communication to prevent problems causing harm. Using this system as an example could provide a simple, original and entertaining way of introducing medical students to the idea that human factors are central to ensuring patient safety.

Implications:  Teaching the buddy system may improve understanding and acceptance of other patient safety initiatives, and could also be used by junior doctors as a tool to improve the safety of their practice.

Background:  The General Medical Council mandates that UK medical graduates must be able to ‘prescribe drugs safely, effectively and economically’. However, data from three UK medical schools show that graduates are poorly prepared for prescribing, and a recent study detected a prescribing error rate of 8.4 per cent amongst foundation year 1 doctors.

Context:  This study took place in the National Health Service (NHS) Fife where, in common with all health boards in the UK, medical students are not permitted to prescribe. University of Edinburgh final-year medical student volunteers took part in the study.

Innovation:  Medical, pharmacy and nursing staff collaborated to design and implement a controlled process (pre-prescribing) that allows medical students to write instructions on in-patient drug charts, and requires a doctor’s countersignature before drugs are dispensed. Key features of the pre-prescribing protocol include fluorescent stickers for drug charts, bookmark aide-memoires to guide countersigning and ward-based information sheets. Twelve final-year medical students wrote 586 pre-prescriptions, and no adverse events were reported.

Implications:  This study demonstrates the successful small-scale implementation of pre-prescribing. Initial data regarding the safety of the process is positive, but further evaluation is required to reassure all that the risk of adverse events is minimal. The project is to be expanded throughout South East Scotland with a view to all units providing the opportunity for pre-prescribing during the first student assistantships in March 2012. The longer-term goal is to set-up safe processes that will support medical students undertaking pre-prescribing throughout most of their final year.

Background:  Advancement in technology is an important driver for the evolution of the medical curriculum. With continued criticism of medical students’ knowledge of anatomy, further investigation into adjuncts for anatomy teaching seems appropriate. This project sought to create an interactive 3D stereoscopic tutorial to bridge the teaching of anatomy and pathology.

Methods:  Anonymised computed tomography (CT) scans were collected of a normal aorta and a ruptured abdominal aortic aneurysm. These scans were rendered into 3D stereoscopic images using open-source software. These images were then annotated with interactive labels and buttons to access information on normal aortic anatomy and the clinical details of abdominal aortic aneurysms. A total of 183 first-year medical students viewed the tutorial, and 160 gave feedback (87%).

Results:  The students found the 3D system aided their understanding of anatomy and pathology (93 versus 3%), and provided an advantage when compared with current anatomy classes (93 versus 1%). The students highlighted the musculoskeletal system and cerebral vasculature as areas for future 3D visualisation. Of the responders, 96 per cent felt that the curriculum would benefit from further 3D stereoscopic anatomy/pathology tutorials.

Discussion:  This technology has the exciting potential to use the radiographic libraries in hospitals for medical education. The computer software, however, has some limitations at present. It is not able to effectively distinguish between tissues of similar densities. Furthermore, not all tissues are amenable to CT scanning of a high enough resolution for presentation. Despite these limitations, the software continues to advance and is capable of producing very high quality anatomy images.