I. Hermann

Can medical schools rely on clerkships to train students in basic clinical skills

 Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final‐year medical students in 1996 and 1997.

An evaluation study of the didactic quality of clerkships

Previous qualitative research at the University of Antwerp revealed dissatisfaction amongst medical students about clinical clerkships.

Effectiveness of basic clinical skills training programmes: a cross-sectional comparison of four medical schools

Training in physical diagnostic skills is an important part of undergraduate medical education. The objective of this study was to study the outcome of skills training at four medical schools.

Correlation of a written test of skills and a performance based test: a study in two traditional medical schools

Studies in innovative curricula have shown that a written test of skills is potentially able to predict OSCE scores. In this study we verified the potential of a written test of skills as an alternative to an OSCE in two traditional medical schools. A 12 station OSCE was scored using detailed checklists and global rating scales. The written test of skills consisted of 132 true-false questions. Students were assessed immediately before graduation in 1997. The size of the reported correlations confirms that the written test of skills can be used to predict performance-based test scores in traditional medical schools to some extent. For research purposes, particularly for outcome research to compare curricula of medical schools, a written test of skills is a viable alternative to performance-based testing. A written test of skills is unable to replace the OSCE for assessment of individual students.

Unsatisfactory basic skills performance by students in traditional medical curricula

Effectivity of basic clinical skills among students in their final year at two typically European medical schools was evaluated. The two schools rely heavily on clerkships to train basic clinical skills. Three groups of final-year students from two medical schools were studied in a 12-station, 13-minute OSCE. This OSCE was based on existing skill lists and was constructed in close consultation with faculty of both schools. Observers were senior faculty and experienced general practitioners. Students were rated unsatisfactory in any station when a mean score of 50% was given. Results show poor overall performance, indicating defective skills training, for skills of both the compulsory and the non-compulsory clerkships. Therefore curricula need revision and in the meantime basic clinical skills should receive ample attention in postgraduate education.

Contraceptive knowledge and expectations by adolescents: an explanation by focus groups.

To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to health care providers, a qualitative research was performed with four focus groups of 17-year-old girls of different education levels. All 26 girls except one were of Belgian origin. There was a fixed scenario for each group. The discussions were tape-recorded, transcribed and analysed via content analysis. Knowledge concerning the daily use and side-effects of contraceptives was insufficient. A school physician is not the person they want to talk to. The influence of the peer in the group is very important. The general practitioner is the most frequently consulted health care provider for the first pill prescription, but for a gynaecological examination they thought they had to visit a gynaecologist. The girls expected confidentiality from their general practitioner and wanted sufficient consultation time. Factors inhibiting the visits for obtaining contraceptives were the cost, waiting time and fear of the gynaecological examination. Adolescents intended to visit their general practitioner for contraceptives, but the family practice had to be easily accessible. It is a challenge for general practitioners to provide good contraceptives to adolescents and to promote compliance.

Factors determining the place of palliative care and death of cancer patients

Abstract Factors determining the place of palliative care and death were studied by interviewing 40 patients using a semi-structured questionnaire. The 86 interviews assessed showed that both emotional and somatic factors played a part in the determination of whether patients were transferred and of their place of death. Emotional factors were mentioned in 41% as being of importance, and physical factors in 32%. Material and financial factors are probably underestimated owing to the methodology.

Efficacy of influenza immunisation programmes: comparison of two European systems in one practice

In many European countries, influenza vaccination is recommended for the elderly (over 65 years) and high-risk groups, and administered by general practitioners. We have studied the variations in rates of uptake in a group practice located in Belgium which also deals with patients from the Netherlands. Comparing immunisation rates for the two parts of the population allowed us to compare the effects of the two different systems for the administration and reimbursement of vaccinations. 75.2% (n=407) of the eligible Dutch patients were immunised versus 64.3% (n=364) of the Belgian patients. For patients over 65 years the corresponding rates were 77.5% (n=244) versus 62% (n=245). Attendance at a special flu immunisation clinic was also higher among Dutch (71.2%) than Belgian (54.7%) patients. Programmatic differences between the Dutch and Belgian systems for flu vaccination are likely to account for these findings.

General practitioners caring for terminally ill patients resident in a hospice.

Abstract The goal of this study was to investigate why GPs have little or no involvement in the medical process relating to any of their patients when they are admitted to a palliative care unit (PCU) and what solutions they suggest. The study took the form of a descriptive pilot study based on a short questionnaire. It emerged that GPs felt their involvement was influenced by their job description, by practical factors (time investment, distance between practice and PCU, remuneration, referral) and personal issues (e.g. dealing with dying). It is concluded that GPs need education in palliative/supportive care and approved remuneration as well as knowledge about their task in the PCU.

Implementation and evaluation of oral care procedures in palliative care: the quality circle

Background: Terminally ill patients entering a hospice in Sint-Camillus, Antwerp often have oral problems as infections, halitosis, dry mouth, stomatitis, bleeding, etc. This has many consequences on the physical (pain while eating and drinking, taking medication), relational (pain while talking, bad breath impeding intimacy, etc.), psychological (shame, low self-esteem) and spiritual dimensions. This study has as its objectives: