Background: Clinical bedside teaching is arguably the most favoured form of teaching by medical students, but has been on the decline in recent years. Junior doctors are often underused as teachers and, with adequate training, may help to solve this problem. Bedside Teachers is a junior doctor-led teaching programme that is delivered throughout South-East Scotland, and is now in its third year. This study aimed to investigate the perceptions of final-year medical students participating in the Bedside Teachers programme, and how they compared this with teaching from senior staff.
Methods: Anonymised questionnaires were issued to all participants. Students were asked to rate statements relating to: (i) the quality of bedside teaching tutorials; and (ii) the teaching delivered by junior doctors compared with that delivered by senior staff.
Results: All students indicated that the tutorials improved their confidence in clinical examination. Eighty-seven per cent indicated that it provided a useful clinical experience that they would otherwise not have received. All respondents indicated that junior doctors were more approachable than senior staff. The majority of students indicated that they thought junior doctors covered more relevant material to being a good junior doctor, and that junior doctor-led teaching was at least as good or better than teaching by senior staff on a number of other criteria.
Conclusions: With adequate training, junior doctors can be a useful resource for increasing the bedside teaching opportunities available to students, with potential advantages over using senior staff.
Background: The UK General Medical Council has recommended that medical students be taught how to teach; however, the current state of teaching skills training in England has not yet been investigated.
Aims: To explore the current state of undergraduate teaching skills training at medical schools in England.
Methods: A questionnaire survey was sent to all 24 medical schools in England, enquiring about the basic structure, content areas, staffing, delivery and assessment methods of compulsory courses.
Results: A response rate of 22/24 (92%) was achieved, and 18/22 (82%) of the responding institutions offered some form of teaching skills training. The most frequently covered content areas were small group facilitation skills, large group teaching skills and use of effective feedback. Teaching was delivered by a combination of hospital doctors, non-physician educators or general practitioner educators in the majority of courses. Six of the nine (67%) compulsory courses featured student assessments. The main barriers to implementing these courses were staffing limitations, insufficient time and lack of student engagement.
Conclusions: Our study demonstrates both the similarities and variation between undergraduate teaching skills courses across England. However, further research will be necessary to determine whether the long-term impact of such training will result in better educators, and ultimately in improved patient care.
Background: Novel studies have previously highlighted the educational benefits of peer-led learning and peer marking of examinations. Limited data exist about the educational value of students writing their own exam questions and sharing these with other students.
Aim: To evaluate the potential for medical students to learn about palliative care through the process of writing examination questions.
Methods: Fourth-year medical students on a palliative medicine rotation were invited to write a short-answer exam question in a similar format to the official examination run by the medical school. The questions were checked for accuracy and applicability by the coordinator, and were then distributed to students. The answers to the student-generated questions were discussed in a feedback forum at the end of the rotation.
Results: Twenty students took part in the exercise. All agreed the exercise was beneficial to their learning. Eighteen (90%) students did not feel the task was too much additional work. Eight (40%) students felt more confident in passing the official medical school exams. Students enjoyed the exercise, with 19 (95%) indicating that they were keen to repeat this in the future.
Conclusion: Peer-led examination question writing could complement the delivery of palliative care teaching for medical students.
Background: Vertical integration (VI) has been recommended as an undergraduate medical curriculum structure that fosters the transition to postgraduate training. Our definition of VI includes: (1) the provision of early clinical experience; (2) the integration of biomedical sciences with clinical cases; (3) long clerkships during the final year; and (4) increasing levels of clinical responsibility for students. The aim of the current study is to support the hypothesis that medical graduates from VI programmes meet the expectations of postgraduate supervisors better than those from non-VI curricula.
Methods: A questionnaire study was carried out among supervisors of postgraduate training programmes run at Utrecht (the Netherlands, VI; n = 128) and Hamburg (Germany, non-VI; n = 114). The supervisors were asked about their medical graduates’ preparedness for work, knowledge and capabilities to manage some specific parts of the work as a doctor. They evaluated their performances on a five-point Likert scale.
Results: The two groups of supervisors did not differ in their judgment of their graduates’ preparedness for work and level of knowledge. However, supervisors in Utrecht evaluated their graduates higher with respect to capability to work independently, solving medical problems, managing unfamiliar medical situations, prioritising tasks, collaborating with other people, estimating when they need to consult their supervisors and reflecting on their activities.
Discussion: Graduates from VI medical curricula appeared to be more capable in several facets of a doctor’s job. Research into the actual performance of graduates from VI and non-VI curricula is needed to further support a firm recommendation for VI curricula.
Background: In light of the global trends of increasing obesity, the education of doctors and other health professionals warrants greater attention to promoting effective weight management through health behaviours related to eating and exercise.
Context: Gaps in training in these areas have been identified related to weight management and wellness. Diverse benefits of healthy lifestyle interventions have been noted.
Innovation: Recommendation for developing immersion programmes for medical students and other health professionals involving practical experience in weight management through lifestyle modification, addressing nutritional and caloric intake and energy expenditure through exercise.
Implications: Integrating healthy lifestyle programmes into medical and health professional education could yield several benefits. Enhancing curriculum and educational processes by promoting medical and health professional students’ awareness of, participation and immersion in, healthy lifestyle interventions may ultimately lead to better health outcomes for health professionals and their patients.
Background: Professionalism is widely acknowledged as being central to medical practice, and is taught at most UK medical schools. The impact of this teaching in the context of competing influences on a student’s developing view of themselves as professional is, however, unclear. We explored the understanding of professionalism in third-year medical students who have recently completed this element of their formal teaching, and related this understanding to previously unexplored wider influences placed upon them during their development.
Methods: A questionnaire consisting of two closed questions and two open questions was distributed via e-mail to third-year students at Imperial College School of Medicine, London. The closed questions explored both beliefs about what constitutes medical professionalism and preferences for the teaching of professionalism. The open questions explored the contexts within which students believed their understanding of professionalism was derived. Content analysis of text-based questions was performed.
Results and discussion: The most commonly cited aspects of professionalism by students in this study were confidentiality, good medical knowledge and practical skill. Students also cited promptness, hygiene and appearance as being important, although these factors are rarely cited in the literature. Students cited role models, the media and parents as the three most important influences on their view of professionalism. These merit further consideration in future research and course design. Most students agreed that professionalism should be taught at medical school, but that this would be best achieved within a clinical setting. The favoured model for acquisition of views on professionalism was observation of doctors rather than formal teaching.
Background: Patient safety is an increasingly recognised issue in health care. Systems-based and organisational methods of quality improvement, as well as education focusing on key clinical areas, are common, but there are few reports of educational interventions that focus on non-technical skills to address human factor sources of error. A flexible model for non-technical skills training for health care professionals has been designed based on the best available evidence, and with sound theoretical foundations.
Context: Educational sessions to improve non-technical skills in health care have been described before. The descriptions lack the details to allow educators to replicate and innovate further.
Innovation: A non-technical skills training course that can be delivered as either a half- or full-day intervention has been designed and delivered to a number of mixed groups of undergraduate medical students and doctors in postgraduate training. Participant satisfaction has been high and patient safety attitudes have improved post-intervention.
Implications: This non-technical skills educational intervention has been built on a sound evidence base, and is described so as to facilitate replication and dissemination. With the key themes laid out, clinical educators will be able to build interventions focused on numerous clinical issues that pay attention to human factor contributors to safety.
Background: Although the value of echocardiography in acutely unwell patients is well established, it is often difficult to deliver conventional studies immediately. This has led to the development of training programmes in screening echocardiography.
Context: Echocardiography is a difficult skill to master and requires an integration of knowledge-based learning and mentored practical training.
Innovation: We developed a three-stage programme: (1) a 1-day course containing didactic lectures on normal and abnormal pathology, a 2-hour practical element with rotation through different tutors then seminars and self-assessment, with an interactive quiz; (2) a period of consolidation via apprenticeship with a recognised trainer; and (3) formal assessment.
Implications: We propose a specific training programme to teach the difficult practical skill of screening echocardiography. The use of theoretical and practical elements with structured teaching and an apprenticeship may serve as a model for teaching other practical skills in clinical medicine.
Background: To compare medical student experiences in an innovative out-patient clinic, in which women are cared for directly by medical students, versus the traditional resident continuity clinics (RCCs).
Methods: A prospective study with medical students randomly assigned to either the Medical Student Out-patient Clinic (MSOC) or the RCC. Students rated their preceptors on a five-point Likert scale and completed an experience log. The primary outcome was student perception of overall teaching quality. Secondary outcomes included the numbers of patients they saw, as well as the number of speculum examinations, bimanual examinations and breast examinations they personally performed, and the number of sessions in which a preceptor did not submit an evaluation of the student.
Results: A total of 62 out of 63 students (98%) completed surveys during the study period. MSOC students performed more bimanual exams (1.7 versus 1.2, p = 0.015) and breast exams (1.0 versus 0.3, p < 0.001), saw fewer patients (1.8 versus 4.2, p < 0.001), and rated both the overall teaching quality (4.8 versus 4.0, p < 0.001) and the preceptor (5.0 versus 4.2, p < 0.001) higher. MSOC students received more feedback from their preceptors.
Conclusions: The MSOC programme provided our students with an improved learning experience. The high ratings were likely to have resulted from the one-on-one teaching from the attending physician and the absence of competing resident learners.
Background: Actionable feedback targeted to the learner’s needs is one of the strongest predictors of improved performance in learning. Unfortunately, when a trainee makes an error, although instructors may understand what a trainee has done wrong, they can erroneously assume they know why.
Context: There is a growing recognition that cognitive biases impede clinical diagnosis, however, the same biases can also undermine accurate and effective feedback.
Innovation: Instead of focusing primarily on correcting actions, it is often crucial to diagnose trainees’‘frames’– the thought processes that drive their actions. We offer an efficient three-step algorithm for providing this ‘frame-based’ feedback: (1) describe how the trainee is doing according to the instructor; (2) diagnose the trainee’s immediate learning needs using inquiry to elicit their frame; and (3) direct instruction to those needs.
Implications: ‘Misdiagnosis’ of the trainee’s actual needs wastes time when instructors teaching unneeded material, diminishes the trainee’s faith in the value of instruction and undermines patient safety when incorrect frames about important clinical processes persist.
Background: The reduction in the length of hospital stay for surgical patients at a time of expanding medical student numbers has created challenges in the provision of adequate exposure to surgical patients. This has required the use of surgical learning opportunities in the ambulatory setting, including the preoperative assessment clinic. At Keele University, fourth-year medical students follow patient journeys through the preoperative assessment process, gaining experience of history taking, examination, prescribing and practical skills. This is followed by group discussion with a clinical teaching fellow, focusing on management and clinical reasoning. We audited the experience our students gained in the preoperative assessment clinic against the relevant Tomorrow’s Doctors outcomes.
Methods: An audit tool was created by reviewing the patient journey to identify potential learning opportunities. These were then mapped to the relevant Tomorrow’s Doctors outcomes. Audit pro formas were completed for each student at the end of the clinic by the clinical educator, with a total of 42 sessions audited.
Results: Our findings show that it is possible for students to gain experience in all nine of the identified Tomorrow’s Doctors outcomes in the preoperative assessment clinic. Practical procedure experience was gained by 92 per cent of students, and 70 per cent demonstrated clinical judgment and decision skills.
Discussion: This study shows that students can gain experience in multiple Tomorrow’s Doctors outcomes in the preoperative assessment clinic. In particular, it is a useful environment to learn and teach practical procedures, clinical reasoning and decision-making skills.