Anita Helen Laidlaw

Developing research skills in medical students: AMEE Guide No. 69

This Guide has been written to provide guidance for individuals involved in curriculum design who wish to develop research skills and foster the attributes in medical undergraduates that help develop research. The Guide will provoke debate on an important subject, and although written specifically with undergraduate medical education in mind, we hope that it will be of interest to all those involved with other health professionals’ education. Initially, the Guide describes why research skills and its related attributes are important to those pursuing a medical career. It also explores the reasons why research skills and an ethos of research should be instilled into professionals of the future. The Guide also tries to define what these skills and attributes should be for medical students and lays out the case for providing opportunities to develop research expertise in the undergraduate curriculum. Potential methods to encourage the development of research-related attributes are explored as are some suggestions as to how research skills could be taught and assessed within already busy curricula. This publication also discusses the real and potential barriers to developing research skills in undergraduate students, and suggests strategies to overcome or circumvent these. Whilst we anticipate that this Guide will appeal to all levels of expertise in terms of student research, we hope that, through the use of case studies, we will provide practical advice to those currently developing this area within their curriculum.

Behaviour and burnout in medical students

Background Burnout is prevalent in doctors and can impact on job dissatisfaction and patient care. In medical students, burnout is associated with poorer self-rated health; however, it is unclear what factors influence its development. This study investigated whether health behaviours predict burnout in medical students. Methods Medical students (n=356) at the Universities of St Andrews and Manchester completed an online questionnaire assessing: emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA), alcohol use, physical activity, diet, and smoking. Results Approximately 55% (54.8%) of students reported high levels of EE, 34% reported high levels of DP, and 46.6% reported low levels of PA. Linear regression analysis revealed that year of study, physical activity, and smoking status significantly predicted EE whilst gender, year of study, and institution significantly predicted DP. PA was significantly predicted by alcohol binge score, year of study, gender, and physical activity. Conclusions Burnout is present in undergraduate medical students in the United Kingdom, and health behaviours, particularly physical activity, predict components of burnout. Gender, year of study, and institution also appear to influence the prevalence of burnout. Encouraging medical students to make healthier lifestyle choices early in their medical training may reduce the likelihood of the development of burnout.Background Burnout is prevalent in doctors and can impact on job dissatisfaction and patient care. In medical students, burnout is associated with poorer self-rated health; however, it is unclear what factors influence its development. This study investigated whether health behaviours predict burnout in medical students. Methods Medical students (n=356) at the Universities of St Andrews and Manchester completed an online questionnaire assessing: emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA), alcohol use, physical activity, diet, and smoking. Results Approximately 55% (54.8%) of students reported high levels of EE, 34% reported high levels of DP, and 46.6% reported low levels of PA. Linear regression analysis revealed that year of study, physical activity, and smoking status significantly predicted EE whilst gender, year of study, and institution significantly predicted DP. PA was significantly predicted by alcohol binge score, year of study, gender, and physical activity. Conclusions Burnout is present in undergraduate medical students in the United Kingdom, and health behaviours, particularly physical activity, predict components of burnout. Gender, year of study, and institution also appear to influence the prevalence of burnout. Encouraging medical students to make healthier lifestyle choices early in their medical training may reduce the likelihood of the development of burnout.

Communication skills: An essential component of medical curricula. Part I: Assessment of clinical communication: AMEE Guide No. 51

This AMEE Guide in Medical Education is Part 1 of a two part Guide covering the issues of Communication. This Guide has been written to provide guidance for those involved in planning the assessment of clinical communication and provides guidance and information relating to the assessment of various aspects of clinical communication; its underlying theory; its practical ability to show that an individual is competent and its relationship to students’ daily performance. The advantages and disadvantages of assessing specific aspects of communication are also discussed. The Guide draws attention to the complexity of assessing the ability to communicate with patients and healthcare professionals, with issues of reliability and validity being highlighted for each aspect. Current debates within the area of clinical communication teaching are raised: when should the assessment of clinical communication occur in undergraduate medical education?; should clinical communication assessment be integrated with clinical skills assessment, or should the two be separate?; how important should the assessment of clinical communication be, and the question of possible failure of students if they are judged not competent in communication skills? It is the aim of the authors not only to provide a useful reference for those starting to develop their assessment processes, but also provide an opportunity for review and debate amongst those who already assess clinical communication within their curricula, and a resource for those who have a general interest in medical education who wish to learn more about communication skills assessment.

Production of acute and chronic itch with histamine and contact sensitizers in the mouse and guinea pig

Abstract: Itch is a major symptom of skin disease and is poorly understood, in part due to the lack of adequate small animal models. We show, using iontophoresis of histamine and capsaicin, that it is possible to induce scratching behaviour in both guinea pig and mouse. Use of iontophoresis may obviate the problems of induction of pain as well as itch when injection is used. The behavioural response to capsaicin, however, differs from that seen with histamine, raising the possibility that the use of scratch counts as a method of measuring itch severity needs to be set in the context of other responses. Naloxone partly inhibits scratching in mouse and guinea pig due to histamine. We also show that contact sensitization with 2‐4 dinitrochlorobenzene (DNCB) can be used as a simple assay for chronic itch allowing study of scratching over at least a 15‐h period. The characteristics of scratching (but not the time course) induced with DNCB are similar to those seen with histamine.

Understanding undergraduate student perceptions of mental health, mental well-being and help-seeking behaviour

Despite relatively high levels of psychological distress, many students in higher education do not seek help for difficulties. This study explored undergraduate student understanding of the concepts of mental health and mental well-being and where undergraduate students would seek help for mental well-being difficulties. Semi-structured interviews were carried out with 20 undergraduate students from 5 different subject areas. Interviews were transcribed and thematically analysed. Results highlighted that the majority of participants viewed mental health and mental well-being as two distinct concepts but their views did not affect where they would seek help for mental well-being difficulties. Medical students reported public stigma relating to help seeking for mental well-being difficulties. Undergraduate students are most likely to seek help for mental well-being difficulties from peers, but whether this experience is useful is less clear. How such an approach impacts upon the individual from whom assistance is sought is also not well understood.

Social anxiety in medical students: Implications for communication skills teaching.

Background: Social anxiety manifests as a fear of social situations, including being observed by others (Bruce & Saeed 1999). Communication skills workshops frequently involve student performance being observed by others, therefore social anxiety may impact upon attitudes to this style of teaching. Aims: To determine the levels of social anxiety amongst medical undergraduates and investigate whether this influenced attitudes towards communication skills teaching. Methods: 247 medical students (three year groups, 60% female) from the University of St Andrews completed a questionnaire survey measuring levels of social anxiety and attitudes to communication skills teaching (Mattick & Clarke 1998; Rees et al. ). Results: Average social anxiety scores in the students were lower (t-tests, P < 0.001) than other groups measured by Mattick & Clarke (1998). A minority (8%) of medical undergraduates however experienced high levels of social anxiety. High social anxiety scores correlated with negative attitudes to communication skills teaching, especially among female students (r = 0.359, P < 0.0001). Conclusions: Social anxiety contributes to a negative attitude towards communication skills teaching and may impact on participation in group workshops. This information could influence the methods tutors use for the provision of feedback in such workshops.

National survey of clinical communication assessment in medical education in the United Kingdom (UK)

BackgroundAll medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools.MethodsThe survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication.ResultsResults were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills.ConclusionsIt is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.

Talk weight: an observational study of communication about patient weight in primary care consultations.

BACKGROUND Obesity is a major public health issue and primary care practitioners are well placed to opportunistically raise the issue of overweight or obesity with their patients. AIM AND METHODS This study investigated the prevalence of weight discussion in primary care consultations with overweight and obese patients, in a practice in Fife, Scotland, and described weight-related communication using video analysis. FINDINGS Weight was raised in 25% of consultations with overweight and obese patients. GPs initiated weight discussion more often than patients; however, these attempts were often blocked by patients. Weight-related outcomes were more common when patients initiated the weight discussion. This study confirms the potential of video analysis for understanding primary care weight discussion. It also suggests that GPs may benefit from a communication-based intervention to tackle patient blocking behaviours and contributes to the evidence suggesting that interventions targeted to increase the prevalence of weight-related discussions with their patients are needed.

How Do Medical Students Respond to Emotional Cues and Concerns Expressed by Simulated Patients during OSCE Consultations? – A Multilevel Study

Objectives How medical students handle negative emotions expressed by simulated patients during Objective Structured Clinical Examinations (OSCE) has not been fully investigated. We aim to explore (i) whether medical students respond differently to different types of patients’ emotional cues; and (2) possible effects of patients’ progressive disclosure of emotional cues on students’ responses. Methods Forty OSCE consultations were video recorded and coded for patients’ expressions of emotional distress and students’ responses using a validated behavioural coding scheme (the Verona Coding Definitions of Emotional Sequence). Logistic multilevel regression was adopted to model the probability of the occurrence of student reduce space response behaviour as a function of the number of patients’ expressions of emotional cues. Results We found that medical students offered responses that differed to emotional cue types expressed by simulated patients. Students appeared to provide space to emotional cues when expressed in vague and unspecific words and reduce space to cues emphasizing physiological or cognitive correlates. We also found that medical students were less likely to explore patients’ emotional distress nearer the end of the consultation and when the duration of a patient speech turn got larger. Cumulative frequency of patients’ emotional cues also predicted students’ reduce space behaviour. Practical Implications Understanding how medical students manage negative emotions has significant implications for training programme development focusing on emotion recognition skills and patient-centred communication approach. In addition, the statistical approaches adopted by this study will encourage researchers in healthcare communication to search for appropriate analytical techniques to test theoretical propositions.

Anxiety and self‐awareness in video feedback

Doctor–patient communication is an integral part of good medical practice and medical education throughout the UK. Innovative methods of clinical communication training make use of technology, including video feedback, within undergraduate learning; however, medical students may encounter barriers such as social anxiety and self‐awareness that could prevent them from fully benefiting from training sessions. This study investigated the extent to which medical student anxiety and self‐awareness impacted on their learning experience in video feedback workshops.